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High-flexion total knee replacement: functional outcome at one year.

Matthew S Hepinstall, Amar S Ranawat, Chitranjan S Ranawat

HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery

|September 3, 2011

Summary

High-flexion total knee replacement (TKR) prostheses improve function, but 20% of patients still struggle with deep flexion activities like kneeling or squatting one year post-surgery. Pain significantly impacts deep flexion ability, more than the achieved knee range of motion.

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Knee Joint

Knee Joint

The knee joint is the most complicated joint in the body. It consists of three articulations– two tibiofemoral and one patellofemoral. As is characteristic of synovial joints, the knee joint has a thin articular capsule that partially surrounds this joint cavity. Additionally, several ligaments, muscles, and cartilaginous structures support the movement of the knee.
A total of seven ligaments support the knee joint. The patellar ligament, which is also attached to the quadriceps femoris group...

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Area of Science:

Orthopedic surgery
Biomedical engineering
Rehabilitation science

Background:

Total knee replacement (TKR) aims to restore function, with enhanced flexion implants offering improved outcomes.
Most studies focus on range of motion, but the quality of function in deep knee flexion is critical for daily activities.

Purpose of the Study:

To evaluate the functional outcomes in deep knee flexion after TKR using a specific high-flexion prosthesis.
To investigate the impact of residual pain and maximum flexion angle on deep flexion function.

Main Methods:

Prospective follow-up of 100 knees in 83 patients after TKR with a rotating-platform posterior-stabilized high-flexion prosthesis.
Assessment of range of motion, Knee Society scores, and a questionnaire evaluating residual pain and high-flexion activities (kneeling, squatting, heel sitting).

Keywords:

functional outcome high flexion mobile bearing patient satisfaction rotating platform total knee arthroplasty

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Main Results:

Mean knee flexion was 125° with a high Knee Society score (95), yet 20% of patients reported inability to kneel, squat, or sit on heels.
57% could kneel, 69% could squat, and 46% could sit on heels without significant difficulty.
Deep flexion function correlated with pain scores but not with knee flexion angles or overall Knee Society scores.

Conclusions:

While high-flexion TKR prostheses show encouraging results, a significant minority of patients experience limitations in deep flexion activities one year post-surgery.
Residual pain is a key factor affecting functional outcomes in deep knee flexion, highlighting the need for pain management alongside range of motion improvements.