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Hyperextension following two different designs of fixed-bearing posterior-stabilized total knee arthroplasty

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Abstract

Purpose

Hyperextension after total knee arthroplasty (TKA) is related to worse functional outcomes. Among the reported predictive factors, it is unclear whether prosthesis design affects postoperative hyperextension. Hence, our objectives were to (1) compare time-dependent changes of the extension angle following multi-radius (MR) and single-radius (SR) TKA and (2) assess predictive factors for the hyperextension.

Methods

In this study, consecutive 136 MR TKAs and consecutive 71 SR TKAs performed by a single surgeon were reviewed. The extension angle was evaluated by digitized full-extension lateral radiographs at preoperative, 3 months and at 1 and 2 years after TKA. A positive value was defined as hyperextension. A multiple regression analysis was used to determine predictive factors for the extension angle and the risk of hyperextension > 5°.

Results

The postoperative extension angle of both groups gradually increased during the first 2 years and the SR group finally progressed with 4.04° greater extension than the MR group (p < 0.01). The incidence of hyperextension > 5° in the SR group was 18.3% and for the MR group, 7.4% (p = 0.02). However, the Oxford knee scores was nonsignificant different between the groups (p = 0.15). Preoperative extension angle, sagittal femoral component angle (SFA) and SR prosthesis were predictive factors for the extension angle at 2 years after TKA and were also associated with hyperextension > 5°.

Conclusions

The extension angle of the SR group became significantly more extended than that of the MR group during the first two years after TKA. Hence, ideal extension position immediately after SR TKA may be different from that of the MR TKA prosthesis. The preoperative extension angle, SFA and SR prosthesis were factors that were associated with postoperative hyperextension.

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Acknowledgements

We thank Mr. Roy I. Morien of the Naresuan University Graduate School for his assistance in editing the English expression and grammar in this document. We also thank Pariphat Chompoonutprapa, MD, Watcharapong Eiamjumras, MD, Thanawat Tantimethanon, MD, Parin Samapath, MD, for their technical assistance.

Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Orthopaedics, Faculty of Medicine, Naresuan University, 99 Moo 9 Thapho, Phitsanulok, 65000, Thailand

    Artit Laoruengthana, Piti Rattanaprichavej, Purinon Suangyanon, Monton Galassi & Passakorn Teekaweerakit

  2. Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Krit Pongpirul

  3. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Krit Pongpirul

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  1. Artit Laoruengthana
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Contributions

AL contributed to the conception and design of the study, as well as surgeons who performed the operation. PR and AL wrote and completed the manuscript. PR, PS, MG and PT collected the required data. AL, PR and KP was responsible for data interpretation and performed the statistical analysis. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Piti Rattanaprichavej.

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Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical approval

This study was approved by the appropriate Naresuan University Institutional Review Board. This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Laoruengthana, A., Rattanaprichavej, P., Suangyanon, P. et al. Hyperextension following two different designs of fixed-bearing posterior-stabilized total knee arthroplasty. Eur J Orthop Surg Traumatol 32, 1641–1650 (2022). https://doi.org/10.1007/s00590-021-03150-6

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  • DOI: https://doi.org/10.1007/s00590-021-03150-6

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