Is Achieving High Flexion Necessary for Satisfaction after Total Knee Arthroplasty in Indian Patients?

Total knee arthroplasty (TKA) is a very successful operation for the treatment of end-stage arthritis of the knee joint. In spite of improvement in surgical technique, implant design, postoperative pain management, and rehabilitation, some patients are not satisfied with the outcome of the surgery. It is believed that high-flexion (H-F) activities such as cross-legged sitting and squatting are necessary for satisfaction after TKA in Indian patients due to cultural and social reasons. This has led to the development and marketing of implant designs allowing H-F after TKA without strong evidence in the literature.

We carried out a retrospective study to determine the level of satisfaction in 74 patients operated for 120 TKA over a 5 year period. This was determined on the basis of a satisfaction questionnaire which included questions to assess satisfaction regarding pain relief and ability to perform routine daily activities and high knee flexion activities such as squatting and cross-legged sitting.

Out of a total of 74 patients, 69 patients were overall satisfied with their TKA. Out of these, only 5 patients could squat or sit in a cross-legged position. Majority of the patients were satisfied with the pain relief and improvement in their capacity to work provided by TKA.

Ability to perform H-F activities after TKA is not a necessary prerequisite for satisfaction in Indian patients. Implant designs allowing H-F should be used in a selected group of patients with good preoperative knee flexion and specific requirements.