Risk factors for a post-operative neutrally aligned total knee arthroplasty in the sagittal plane developing fixed flexion deformity at 2 years follow up study
Keywords:Knee arthroplasty, Fixed flexion deformity, Risk factor
Background: The incidence of fixed flexion deformity (FFD) following total knee arthroplasty (TKA) has been reported to be as high as 17%, increasing demand on the quadriceps and hindering mobility. The aim of this study is then to identify these predictors for the development of FFD.
Methods: In this retrospective study, all patients who underwent primary TKA from January 2008 to June 2009 at a single institution were identified. All patients with neutral alignment in the sagittal place of the knee intra-operatively were identified and followed up. The knee motion was measured in both operated and contralateral knees and followed-up for a minimum of 24 months post-operatively.
Results: Multivariate analysis demonstrated pre-operative FFD of the non-operated knee (p-value 0.03), pre-operative range of motion of the operated knee (p-value 0.01) and non-operated (p-value 0.01) knee and pre-operative maximum flexion of the operated knee (p-value 0.001) to be independent risk factors for development of FFD at 24 months.
Conclusions: Independent risk factors for the development of post-operative FFD in TKA are pre-operative FFD of the operated knee, FFD of the non-operated knee and the maximum flexion of the operated knee. The relative risk of a male developing FFD is also as high as 1.34.
Tew M, Forster IW. Effect of knee replacement on flexion deformity. J Bone Joint Surg Br. 1987;69(3):395-9.
Quah C, Swamy G, Lewis J, Kendrew J, Badhe N. Fixed flexion deformity following total knee arthroplasty. A prospective study of the natural history. The Knee. 2012;19(5):519-21.
Ritter MA, Campbell ED. Effect of range of motion on the success of a total knee arthroplasty. J arthroplasty. 1987;2(2):95-7.
Aderinto J, Brenkel IJ, Chan P. Natural history of fixed flexion deformity following total knee replacement: a prospective five-year study. J Bone Joint Surg Br. 2005;87(7):934-6.
Su EP. Fixed flexion deformity and total knee arthroplasty. J Bone Joint Surg Br. 2012;94(11A):112-5.
Perry JA, Antonelli DA, Ford WI. Analysis of knee-joint forces during flexed-knee stance. J Bone Joint Surg. 1975; 57(7A):961-7.
Berend, Keith R, Lombardi AV Jr, Adams JB. Total knee arthroplasty in patients with greater than 20 degrees flexion contracture. Clinl Orthopaedics Related Res. 2006;452:83-7.
Harato K, Nagura T, Matsumoto H, Otani T, Toyama Y, Suda Y. A gait analysis of simulated knee flexion contracture to elucidate knee-spine syndrome. Gait & posture. 2008;28(4):687-92.
Harato K, Nagura T, Matsumoto H, Otani T, Toyama Y, Suda Y. Knee flexion contracture will lead to mechanical overload in both limbs: a simulation study using gait analysis. The Knee. 2008;15(6):467-72.
Harato K, Nagura T, Matsumoto H, Otani T, Toyama Y, Suda Y. Extension limitation in standing affects weight-bearing asymmetry after unilateral total knee arthroplasty. J arthroplasty. 2010;25(2):225-9.
Cheng K, Ridley D, Bird J, McLeod G. Patients with fixed flexion deformity after total knee arthroplasty do just as well as those without: ten-year prospective data. International orthopaedics. 2010;34(5):663-7.
Lam LO, Swift S, Shakespeare D. Fixed flexion deformity and flexion after knee arthroplasty: What happens in the first 12 months after surgery and can a poor outcome be predicted? The Knee. 2003;10(2):181-5.
Singh G, Tan JH, Sng BY, Awiszus F, Lohmann CH, Nathan SS. Restoring the anatomical tibial slope and limb axis may maximise post-operative flexion in posterior-stabilised total knee replacements. Bone & joint j. 2013;95(10):1354-8.
Anouchi YS, McShane M, Kelly Jr F, Elting J, Stiehl J. Range of motion in total knee replacement. Clin Orthopaedics Related Res. 1996;331:87-92.
Firestone TP, Krackow KA, Teeny SM, Hungerford DS. The management of fixed flexion contractures during total knee arthroplasty. Clin orthopaedics related res. 1992;284:221-7.
Tanzer M, Miller J. The natural history of flexion contracture in total knee arthroplasty. A prospective study. Clin orthopaedics related res. 1989;248:129-34.
McPherson EJ, Cushner FD, Schiff CF, Friedman RJ. Natural history of uncorrected flexion contractures following total knee arthroplasty. J arthroplasty. 1994;9(5):499-502.
Lizaur A, Marco L, Cebrian R. Preoperative factors influencing the range of movement after total knee arthroplasty for severe osteoarthritis. J bone joint sur. 1997; 79(4B):626-9.
Ritter MA, Lutgring JD, Davis KE, Berend ME, Pierson JL, Meneghini RM. The role of flexion contracture on outcomes in primary total knee arthroplasty. J arthroplasty. 2007;22(8):1092-6.
Meftah M, Blum YC, Raja D, Ranawat AS, Ranawat CS. Correcting Fixed Varus Deformity with Flexion Contracture During Total Knee Arthroplasty: The “Inside-Out” Technique, AAOS Exhibit Selection. JBJS. 2012;94(10):e66.