Risk factors of hyperextension and its relationship with the clinical outcomes following mobile-bearing total knee arthroplasty

  • Han-Jun Lee
  • Yong-Beom Park
  • Dong-Hoon Lee
  • Kyu-Hwang Kim
  • Dae Woong Ham
  • Seong Hwan KimEmail author
Knee Arthroplasty



To evaluate the incidence and risk factors of postoperative hyperextension after mobile-bearing total knee arthroplasty (TKA) and its clinical outcomes.

Materials and methods

This retrospective case–control study included 387 knees of primary TKA patients after a 5-year follow-up. The clinical outcomes and radiographs including posterior condylar offset (PCO), femur and tibial slope angle and its discrepancy were evaluated. The patients were divided into two groups (group 1: non-hyperextension, group 2: hyperextension). An extension greater than 5° measured using a goniometer at the final follow-up was defined as hyperextension. Logistic and linear regression analyses were performed.


Overall, 43 knees (11.1%) with hyperextension were observed at the last follow-up. There was no significant difference between groups in terms of the clinical outcomes although the functional scores were worse in group 2. There was no significant difference in the postoperative radiologic evaluation except for a change in PCO (group 1 vs. group 2; − 0.2 mm ± 3.8 vs. − 2.4 mm ± 3.0, p = 0.003), distal femoral resection slope angle (− 9.1° ± 2.1 vs. − 12.1° ± 1.7, p < 0.000) and discrepancy of the slope angle (0.3° ± 4.5 vs. − 3.6° ± 3.9, p < 0.000). The change in PCO [odds ratio (OR) 0.86, p = 0.012], discrepancy of the slope angle (OR 0.8136, p = 0.000) and the preoperative mechanical femorotibial angle (OR 1.09, p = 0.003) were associated with hyperextension.


Mobile-bearing TKA with hyperextension over 5° showed worse functional outcomes at the mid-term follow-up, even though no serious complications were observed. Care should be taken to maintain the posterior condylar offset and to match the resection angles in femur and tibia due to the risk of hyperextension and worse functional outcomes.

Level of evidence



Total knee arthroplasty Mobile bearing Hyperextension Posterior condylar offset Slope discrepancy 



There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The study was approved by the Institutional Review Boards of Chung-Ang University Hospital (no.: 1702-006-16037) and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopedic Surgery, Chung-Ang University College of MedicineChung-Ang University HospitalSeoulSouth Korea
  2. 2.Orthopedic DepartmentCentre Hospitalier de VersaillesLe ChesnayFrance

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