Results of total knee arthroplasty with NexGen LPS-Flex for osteoarthritis in the valgus knee: a study of 26 patients followed for a minimum of 2 years

  • Naoki Nakano
  • Tomoyuki Matsumoto
  • Hirotsugu Muratsu
  • Takehiko Matsushita
  • Koji Takayama
  • Tokio Matsuzaki
  • Ryosuke Kuroda
  • Masahiro Kurosaka
Original Article
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Accepted:

Abstract

The present study aimed to examine the results of total knee arthroplasty (TKA) with the NexGen Legacy posterior-stabilized (LPS)-Flex system for osteoarthritis in the valgus knee. Between 2003 and 2011, 27 valgus knees in 26 patients who underwent TKA with the NexGen LPS-Flex implant were clinically and radiologically evaluated after a minimum follow-up of 2 years. The original diagnosis was osteoarthritis. Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), maximum flexion angle, maximum extension angle, and radiological femorotibial angle (FTA) were evaluated pre- and postoperatively. The mean KSKS improved from 42.6 before surgery to 82.2 by the final follow-up (p < 0.01), and the mean KSFS improved from 41.1 to 80.9 (p < 0.01). The mean maximum flexion angle changed from 109.1° to 117.3° (no statistical significance) and the maximum extension angle improved from −9.7° to −3.6° (p < 0.05) postoperatively. The postoperative radiological FTA was 172.4°, which was closer to a neutral angle (174°) than the preoperative FTA (166.4°) (p < 0.01). None of the patients had undergone revision surgery by the final follow-up. As a conclusion, TKA with the NexGen LPS-Flex implant for osteoarthritis in the valgus knee resulted in satisfactory improvement regarding objective outcomes, although a longer term follow-up with a greater number of cases is necessary to verify these results.

Keywords

Total knee arthroplasty Valgus deformity NexGen LPS-Flex Clinical outcome Radiological results 
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Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Anouchi YS, McShane M, Kelly F Jr, Elting J, Stiehl J (1996) Range of motion in total knee replacement. Clin Orthop Relat Res 331:87–92PubMedCrossRefGoogle Scholar
  2. 2.
    Kurosaka M, Yoshiya S, Mizuno K, Yamamoto T (2002) Maximizing flexion after total knee arthroplasty: the need and the pitfalls. J Arthroplasty 17:59–62PubMedCrossRefGoogle Scholar
  3. 3.
    Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME (2003) Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis. J Bone Joint Surg Am 85A(7):1278–1285Google Scholar
  4. 4.
    D’Lima DD, Patil S, Steklov N, Colwell CW Jr (2007) An ABJS best paper: dynamic intraoperative ligament balancing for total knee arthroplasty. Clin Orthop Relat Res 463:208–212PubMedGoogle Scholar
  5. 5.
    Parratte S, Pagnano MW (2008) Instability after total knee arthroplasty. J Bone Joint Surg Am 90(1):184–194PubMedGoogle Scholar
  6. 6.
    Ranawat AS, Ranawat CS, Elkus M, Rasquinha VJ, Rossi R, Babhulkar S (2005) Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg Am 87:271–284PubMedGoogle Scholar
  7. 7.
    Aglietti P, Buzzi R, Giron F, Zaccherotti G (1996) The Insall-Burstein posterior stabilized total knee replacement in the valgus knee. Am J Knee Surg 9(1):8–12PubMedGoogle Scholar
  8. 8.
    Hood RW, Vanni M, Insall JN (1981) The correction of knee alignment in 225 consecutive total condylar knee replacements. Clin Orthop Relat Res 160:94–105PubMedGoogle Scholar
  9. 9.
    Miyasaka KC, Ranawat CS, Mullaji A (1997) 10- to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res 345:29–37PubMedCrossRefGoogle Scholar
  10. 10.
    Stern SH, Moeckel BH, Insall JN (1991) Total knee arthroplasty in valgus knees. Clin Orthop Relat Res 273:5–8PubMedGoogle Scholar
  11. 11.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14PubMedGoogle Scholar
  12. 12.
    Li G, Most E, Sultan PG et al (2004) Knee kinematics with a high-flexion posterior stabilized total knee prosthesis: an in vitro robotic experimental investigation. J Bone Joint Surg Am 86A(8):1721–1729Google Scholar
  13. 13.
    D’Lima DD, Steklov N, Fregly BJ, Banks SA, Colwell CW Jr (2008) In vivo contact stresses during activities of daily living after knee arthroplasty. J Orthop Res 26(12):1549–1555PubMedCrossRefGoogle Scholar
  14. 14.
    Sharma A, Komistek RD, Scuderi GR, Cates HE Jr (2007) High-flexion TKA designs: what are their in vivo contact mechanics? Clin Orthop Relat Res 464:117–126PubMedGoogle Scholar
  15. 15.
    Tarabichi S, Tarabichi Y, Hawari M (2010) Achieving deep flexion after primary total knee arthroplasty. J Arthroplasty 25(2):219–224PubMedCrossRefGoogle Scholar
  16. 16.
    Ranawat CS (2003) Design may be counterproductive for optimizing flexion after TKR. Clin Orthop Relat Res 416:174–176PubMedCrossRefGoogle Scholar
  17. 17.
    Ritter MA (2006) High-flexion knee designs: more hype than hope? In the affirmative. J Arthroplasty 21:40–41PubMedCrossRefGoogle Scholar
  18. 18.
    Sancheti KH, Sancheti PK, Shyam AK, Joshi R, Patil K, Jain A (2013) Factors affecting range of motion in total knee arthroplasty using high flexion prosthesis: a prospective study. Indian J Orthop 47(1):50–56PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Bin SI, Nam TS (2007) Early results of high-flex total knee arthroplasty: comparison study at 1 year after surgery. Knee Surg Sports Traumatol Arthrosc 15(4):350–355PubMedCrossRefGoogle Scholar
  20. 20.
    Gupta SK, Ranawat AS, Shah V, Zikria BA, Zikria JF, Ranawat CS (2006) The P.F.C. sigma RP-F TKA designed for improved performance: a matched-pair study. Orthopedics 29:S49–S52PubMedGoogle Scholar
  21. 21.
    Huang HT, Su JY, Wang GJ (2005) The early results of high-flex total knee arthroplasty: a minimum of 2 years of follow-up. J Arthroplasty 20(5):674–679PubMedCrossRefGoogle Scholar
  22. 22.
    Choi WC, Lee S, Seong SC, Jung JH, Lee MC (2010) Comparison between standard and high-flexion posterior-stabilized rotating-platform mobile-bearing total knee arthroplasties: a randomized controlled study. J Bone Joint Surg Am 92(16):2634–2642PubMedCrossRefGoogle Scholar
  23. 23.
    Kim YH, Sohn KS, Kim JS (2005) Range of motion of standard and high-flexion posterior stabilized total knee prostheses. A prospective, randomized study. J Bone Joint Surg Am 87(7):1470–1475PubMedCrossRefGoogle Scholar
  24. 24.
    Nutton RW, van der Linden ML, Rowe PJ, Gaston P, Wade FA (2008) A prospective randomised double-blind study of functional outcome and range of flexion following total knee replacement with the NexGen standard and high flexion components. J Bone Joint Surg Br 90(1):37–42PubMedCrossRefGoogle Scholar
  25. 25.
    Murphy M, Journeaux S, Russell T (2009) High-flexion total knee arthroplasty: a systematic review. Int Orthop 33(4):887–893PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Krackow KA, Jones MM, Teeny SM, Hungerford DS (1991) Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res 273:9–18PubMedGoogle Scholar
  27. 27.
    Elkus M, Ranawat CS, Rasquinha VJ, Babhulkar S, Rossi R, Ranawat AS (2004) Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Joint Surg Am 86A(12):2671–2676Google Scholar
  28. 28.
    Nagura T, Dyrby CO, Alexander EJ, Andriacchi TP (2002) Mechanical loads at the knee joint during deep flexion. J Orthop Res 20(4):881–886PubMedCrossRefGoogle Scholar
  29. 29.
    Suggs JF, Hanson GR, Park SE, Moynihan AL, Li G (2008) Patient function after a posterior stabilizing total knee arthroplasty: cam-post engagement and knee kinematics. Knee Surg Sports Traumatol Arthrosc 16(3):290–296PubMedCrossRefGoogle Scholar
  30. 30.
    Koskinen E, Remes V, Paavolainen P, Harilainen A, Sandelin J, Tallroth K et al (2011) Results of total knee replacement with a cruciate-retaining model for severe valgus deformity-a study of 48 patients followed for an average of 9 years. Knee 18(3):145–150PubMedCrossRefGoogle Scholar
  31. 31.
    Idusuyi OB, Morrey BF (1996) Peroneal nerve palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors. J Bone Joint Surg Am 78(2):177–184PubMedGoogle Scholar
  32. 32.
    Piedade SR, Pinaroli A, Servien E, Neyret P (2009) Revision after early aseptic failures in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17(3):248–253PubMedCrossRefGoogle Scholar
  33. 33.
    Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN (2012) The new knee society knee scoring system. Clin Orthop Relat Res 470(1):3–19PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • Naoki Nakano
    • 1
  • Tomoyuki Matsumoto
    • 1
  • Hirotsugu Muratsu
    • 2
  • Takehiko Matsushita
    • 1
  • Koji Takayama
    • 1
  • Tokio Matsuzaki
    • 1
  • Ryosuke Kuroda
    • 1
  • Masahiro Kurosaka
    • 1
  1. 1.Department of Orthopaedic SurgeryKobe University Graduate School of MedicineKobeJapan
  2. 2.Department of Orthopaedic SurgerySteel Memorial Hirohata HospitalHimejiJapan

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