A gradually reducing radius (GRADIUS) design implant can facilitate a smooth transition from stability through full range of motion in total knee arthroplasty (TKA). Nonetheless, patient-specific factors associated with good knee flexion remain unclear.
OBJECTIVE:
This study aimed to determine the factors associated with good knee flexion after cruciate-retaining TKA with a GRADIUS prosthesis in an Asian population.
METHODS:
This retrospective study included 135 patients that were stratified according to postoperative knee flexion angle (KFA) into Group F ( 120∘; 85 patients [63.2%]) and Group NF ( 120∘; 50 patients [36.8%]).
RESULTS:
Patients in Group F were taller and had a lower body mass index (BMI) smaller preoperative hipkneeankle angle and better preoperative extension and flexion angle than Group NF patients. The multivariable analysis revealed that patients’ height (odds ratio [OR]: 1.07, 0.0150), BMI (OR: 0.85, 0.0049), and preoperative flexion angle (OR: 1.06, 0.0008) predicted good KFA. The ROC curve analysis showed that the cutoff values of a good KFA were height 155.1 cm, BMI 22.1 kg/m2, and preoperative KFA 120∘.
CONCLUSIONS:
Patient height, BMI, and preoperative KFA were independent factors affecting good postoperative KFA in patients of Asian descent who underwent cruciate-retaining TKA with a GRADIUS design.
ScuderiGRBourneRBNoblePCBenjaminJBLonnerJHScottWN. The new knee society knee scoring system. Clin Orthop Relat Res.2012; 470(1): 3-19. doi: 10.1007/s11999-011-2135-0.
2.
KuboMMaedaTKumagaiKAmanoYKawasakiTImaiS. Good postoperative flexion angle improves knee function and improvement of flexion angle increases patient satisfaction after total knee arthroplasty. J Arthroplasty.2021; 36(9): 3137-40. doi: 10.1016/j.arth.2021.04.040.
3.
LizaurAMarcoLCebrianR. Preoperative factors influencing the range of movement after total knee arthroplasty for severe osteoarthritis. J Bone Joint Surg Br.1997; 79(4): 626-9. doi: 10.1302/0301-620x.79b4.7242.
4.
LongoUGCiuffredaMManneringND’AndreaVLocherJSalvatoreG, et al. Outcomes of posterior-stabilized compared with cruciate-retaining total knee arthroplasty. J Knee Surg.2018; 31(4): 321-40. doi: 10.1055/s-0037-1603902.
5.
SongSJParkCHBaeDK. What to know for selecting cruciate-retaining or posterior-stabilized total knee arthroplasty. Clin Orthop Surg.2019; 11(2): 142-50. doi: 10.4055/cios.2019.11.2.142.
6.
LiCDongMYangDZhangZShiJZhaoR, et al. Comparison of posterior cruciate retention and substitution in total knee arthroplasty during gait: a systematic review and meta-analysis. J Orthop Surg Res.2022; 17(1): 152. doi: 10.1186/s13018-022-03047-y.
7.
BenbarkaSBenbarkaS. Posterior cruciate-retaining versus posterior stabilising prostheses for primary total knee arthroplasty in treating osteoarthritis: a systematic review and meta-analysis of randomised controlled trials. Surgeon.2024: S1479-666X(23)00152-X. doi: 10.1016/j.surge.2023.12.002.
8.
MatsuzakiTMatsumotoTMuratsuHKuboSMatsushitaTKawakamiY, et al. Kinematic factors affecting postoperative knee flexion after cruciate-retaining total knee arthroplasty. Int Orthop.2013; 37(5): 803-8. doi: 10.1007/s00264-013-1803-y.
9.
WatanabeMKuriyamaSNishitaniKNakamuraSMatsudaS. What is the optimal posterior cruciate ligament tension to achieve patient satisfaction in cruciate-retaining total knee arthroplasty? J Arthroplasty.2023; 38(6): S183-9. doi: 10.1016/j.arth.2023.01.050.
10.
OkazakiK. Adopting the joint line theory for bone resection in cruciate-retaining total knee arthroplasty to prevent flexion gap tightness. Orthop Surg.2022; 14(5): 984-9. doi: 10.1111/os.13256.
11.
HowardJLMorcosMWLantingBASomervilleLEMcAuleyJP. Reproducing the native posterior tibial slope in cruciate-retaining total knee arthroplasty: technique and clinical implications. Orthopedics.2020; 43(1): e21-6. doi: 10.3928/01477447-20191122-06.
12.
JinQHLeeWGSongEKKimWJJinCSeonJK. No difference in the anteroposterior stability between the GRADIUS and multi-radius designs in total knee arthroplasty. Knee.2020; 27(4): 1197-204. doi: 10.1016/j.knee.2020.05.019.
13.
WillburgerREOberbergS. Early and mid-term results with the ATTUNE total knee replacement system compared to PFC Sigma: a prospective comparative study. J Orthop Surg Res.2022; 17(1): 509. doi: 10.1186/s13018-022-03397-7.
14.
KohnMDSassoonAAFernandoND. Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clin Orthop Relat Res.2016; 474(8): 1886-93. doi: 10.1007/s11999-016-4732-4.
15.
VaninNPanzicaMDikosGKrettekCHankemeierS. Rotational alignment in total knee arthroplasty: intraoperative inter- and intraobserver reliability of Whiteside’s line. Arch Orthop Trauma Surg.2011; 131(11): 1477-80. doi: 10.1007/s00402-011-1329-y.
16.
KandaY. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant.2013; 48(3): 452-8. doi: 10.1038/bmt.2012.244.
17.
FaulFErdfelderELangAGBuchnerA. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods.2007; 39(2): 175-91. doi: 10.3758/bf03193146.
18.
BaşdelioğluK. Effects of body mass index on outcomes of total knee arthroplasty. Eur J Orthop Surg Traumatol.2021; 31(3): 595-600. doi: 10.1007/s00590-020-02829-6.
19.
IshibashiTYamazakiTKondaSTamakiMSugamotoKTomitaT. Kinematics of bicruciate stabilized and cruciate retaining total knee arthroplasty. J Orthop Res.2022; 40(7): 1547-54. doi: 10.1002/jor.25186.
20.
VictorJBanksSBellemansJ. Kinematics of posterior cruciate ligament-retaining and -substituting total knee arthroplasty: a prospective randomised outcome study. J Bone Joint Surg Br.2005; 87(5): 646-55. doi: 10.1302/0301-620X.87B5.15602.
21.
YueBVaradarajanKMAiSTangTRubashHELiG. Differences of knee anthropometry between Chinese and white men and women. J Arthroplasty.2011; 26(1): 124-30. doi: 10.1016/j.arth.2009.11.020.
22.
UrabeKMahoneyOMMabuchiKItomanM. Morphologic differences of the distal femur between Caucasian and Japanese women. J Orthop Surg (Hong Kong).2008; 16(3): 312-5. doi: 10.1177/230949900801600309.
23.
RanjanMRangaswamyNGarikaSSYadavC. Does one size really fit all? Morphometric analysis of distal femur and proximal tibia in an ethnic Indian population and correlation to the sizing of existing total knee arthroplasty implants. Cureus. 2022; 14(10): e30824. doi: 10.7759/cureus.30824.
24.
PasquierGTillieBParratteSCatonnéYChouteauJDeschampsG, et al. Influence of preoperative factors on the gain in flexion after total knee arthroplasty. Orthop Traumatol Surg Res.2015; 101(6): 681-5. doi: 10.1016/j.otsr.2015.06.008.
25.
SugitaniKAraiYTakamiyaHTerauchiRNakagawaSUeshimaK, et al. Factors affecting range of motion after total knee arthroplasty in patients with more than 120 degrees of preoperative flexion angle. Int Orthop.2015; 39(8): 1535-40. doi: 10.1007/s00264-015-2710-1.
26.
HayashiSNakasaTMatsuokaYAkiyamaYIshikawaMNakamaeA, et al. Evaluation of the degenerative pattern of PCL in osteoarthritis patients using UTE-T2 mapping. Asia Pac J Sports Med Arthrosc Rehabil Technol.2021; 24: 35-40. doi: 10.1016/j.asmart.2021.01.004.
27.
SumidaYNakasaTIshikawaMNakamaeAAdachiN. The evaluation of degeneration of posterior cruciate ligament using CT Hounsfield unit in knee osteoarthritis. BMC Musculoskelet Disord.2021; 22(1): 309. doi: 10.1186/s12891-021-04177-w.
