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Maximal flexion and patient outcomes after TKA, using a bicruciate-stabilizing design

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Physiological motion after total knee arthroplasty (TKA) should result in a large range of motion, which would lead to good clinical outcomes. An adjusted design of a bicruciate-stabilizing TKA was developed to reproduce physiological motion. The aim of this study was to (1) investigate the maximal knee flexion of this knee system, 1 year post-operatively; (2) determine the clinical and functional improvement and compare the outcomes between patients with and without high maximal flexion; and (3) evaluate the adverse events.

Materials and methods

In this prospective study, 62 patients with osteoarthritis received a bicruciate-stabilizing TKA. Maximum flexion was measured on a lateral X-ray pre- and post-operatively. Clinical and functional scores and the adverse events were reported up until 2 years after surgery.

Results

Pre-operatively, the median (range) maximal flexion was 131.5 (90–153)° and 1 year post-operatively, it was 130 (82–150)°. The results for the clinical scores showed an improvement between pre-operative values and post-operative values. The Kujala score and Knee Osteoarthritis Outcome Score (KOOS) symptoms, sport and quality of life score were better in patients with high maximal flexion (≥ 125°). Ten (serious) adverse device events were reported.

Conclusions

In conclusion, the bicruciate-stabilizing TKA obtained a maximal flexion comparable to the flexion pre-operatively and resulted in good clinical and functional outcomes. Patients with high flexion ability seem to perform better on clinical and functional outcomes. Furthermore, the adjusted design of the bicruciate-stabilizing TKA reduced the number of adverse events.

Level of evidence

Prospective cohort study, Level II.

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Acknowledgements

The authors wish to thank Janneke Rigters-Schimmel for her help with writing the research proposal and starting the study, Saskia Susan for her effort in patient recruitment and Jolanda Rubrech-van As for managing the data.

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Authors and Affiliations

  1. Sint Maartenskliniek Research, Sint Maartenskliniek, P.O. box 9011, 6500 GM, Nijmegen, The Netherlands

    Nienke M. Kosse & Petra J. C. Heesterbeek

  2. Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands

    Koen C. Defoort, Ate B. Wymenga & Gijs G. van Hellemondt

Authors
  1. Nienke M. Kosse
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  2. Petra J. C. Heesterbeek
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  3. Koen C. Defoort
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  4. Ate B. Wymenga
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  5. Gijs G. van Hellemondt
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Corresponding authors

Correspondence to Nienke M. Kosse or Petra J. C. Heesterbeek.

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Conflict of interests

The institution received funding from Smith & Nephew to pay for staff and materials. Smith & Nephew had no role in the design or conduct of the study, the collection, management, analyses, and interpretation of the data, or the preparation and review of the manuscript. NK and PH declare that they have no conflict of interest. GH received personal fees from Smith & Nephew and Zimmer Biomet outside the submitted work. AW received personal fees from Smith & Nephew outside the submitted work. KD received personal fees from Smith & Nephew, Corin medical and Atro Medical, outside the submitted work.

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Kosse, N.M., Heesterbeek, P.J.C., Defoort, K.C. et al. Maximal flexion and patient outcomes after TKA, using a bicruciate-stabilizing design. Arch Orthop Trauma Surg 140, 1495–1501 (2020). https://doi.org/10.1007/s00402-020-03491-7

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  • DOI: https://doi.org/10.1007/s00402-020-03491-7

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