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High-Flexion Total Knee Replacement: Functional Outcome at One Year

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HSS Journal

Abstract

Implants designed for enhanced flexion offer the prospect of improved function after total knee replacement (TKR). Whereas most studies evaluating these implants have focused on the range of knee flexion achieved, this study investigated the quality of function in deep knee flexion. The influences of residual pain and maximum flexion angle on function in deep knee flexion were also examined. Eighty-three patients (100 knees) were prospectively followed for 1 year after TKR with a rotating-platform posterior-stabilized high-flexion prosthesis. Range of motion was measured and Knee Society scores were calculated. A questionnaire evaluated residual knee pain and function in high-flexion activities. Mean Knee Society score was 95, and mean knee flexion was 125°, yet 20% of patients could neither kneel, nor squat, nor sit on their heels. Fifty-seven percent were able to kneel without significant difficulty; 69% were able to squat without significant difficulty; and 46% were able to sit on their heels without significant difficulty. Function in deep flexion correlated with pain scores but did not correlate with knee flexion angles or Knee Society scores. Results 1 year after TKR with a rotating-platform posterior-stabilized high-flexion prosthesis are encouraging, but one in five patients remain significantly limited in high-flexion activities.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Lenox Hill Hospital, 100 East 77th Street, New York, NY, 10021, USA

    Matthew S. Hepinstall MD & Amar S. Ranawat MD

  2. Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Amar S. Ranawat MD & Chitranjan S. Ranawat MD

  3. Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, NY, 10075, USA

    Matthew S. Hepinstall MD

Authors
  1. Matthew S. Hepinstall MD
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  2. Amar S. Ranawat MD
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  3. Chitranjan S. Ranawat MD
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Corresponding author

Correspondence to Matthew S. Hepinstall MD.

Additional information

One or more of the authors (ASR, CSR) have received funding from DePuy, a Johnson & Johnson Company (Warsaw, IN, USA).

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained.

Level of Evidence: Level IV: Prospective Case Series.

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Hepinstall, M.S., Ranawat, A.S. & Ranawat, C.S. High-Flexion Total Knee Replacement: Functional Outcome at One Year. HSS Jrnl 6, 138–144 (2010). https://doi.org/10.1007/s11420-009-9150-7

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  • DOI: https://doi.org/10.1007/s11420-009-9150-7

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