Comparison of risk for postoperative hyperextension between cruciate retaining and posterior stabilized total knee arthroplasties

Abstract

Introduction

The incidence of postoperative hyperextension and factors affecting hyperextension needs to be investigated separately for cruciate retaining (CR) and posterior stabilized (PS) total knee arthroplasties (TKAs), because the mechanism for preventing hyperextension is different according to the bearing design. The purpose of the study was to compare the incidence of postoperative hyperextension between CR and PS TKAs and analyze the factors affecting the postoperative hyperextension.

Methods

Matched 213 CR and PS TKAs with Persona® prosthesis were retrospectively reviewed. The preoperative demographics, clinical and radiographic knee condition, and pelvic incidence were similar between groups. Appropriate knee extension (0°–5°), confirmed with a goniometer, was achieved intraoperatively. The knee sagittal angle was radiographically measured preoperatively and at 2 years postoperative. The incidence of hyperextension (sagittal angle < − 5°) was investigated. The factors affecting the postoperative hyperextension were analyzed in terms of age, sex, preoperative mechanical axis, knee sagittal angle, postoperative posterior tibial slope (PTS), change of posterior femoral offset, and pelvic incidence.

Results

The knee sagittal angle was not significantly different preoperatively between CR and PS TKAs. The postoperative knee sagittal angle was 2.9° in CR TKAs and 4.4° in PS TKAs (p = 0.004). The incidence of postoperative hyperextension was 11.7% (25/213) in CR TKAs and 4.2% (9/213) in PS TKAs (p = 0.007). The preoperative sagittal angle, postoperative PTS, and pelvic incidence were the significant factors affecting the postoperative hyperextension in CR TKAs (odds ratio 0.869, 2.205, and 1.045, respectively); the preoperative sagittal angle was only the significant factor in PS TKAs (odds ratio 0.857)

Conclusions

Postoperative knee hyperextension occurred more frequently and was affected by more factors in CR TKAs than PS TKAs. Efforts to avoid hyperextension and closed observation are required in TKAs performed in patients with the risk factors.

Level of evidence

III.

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Contributions

The following authors have made substantial contributions to the following: (1) the conception and design of the study (SJS, CHP), provision of study materials or patients (SJS), acquisition of data (CHP), analysis and interpretation of data (CHP). (2) Drafting the article (SJS, KIK, and CHP), (3) final approval of the version to be submitted (SJS and KIK, and CHP).

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Correspondence to Cheol Hee Park.

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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the institutional review board.

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Song, S.J., Kim, K.I. & Park, C.H. Comparison of risk for postoperative hyperextension between cruciate retaining and posterior stabilized total knee arthroplasties. Arch Orthop Trauma Surg (2021). https://doi.org/10.1007/s00402-021-03822-2

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Keywords

  • Knee
  • Arthroplasty
  • Cruciate retaining
  • Posterior stabilized
  • Hyperextension