Kneeling and standing up from a chair as performance-based tests to evaluate knee function in the high-flexion range: a randomized controlled trial comparing a conventional and a high-flexion TKA design

Paul J P van der Ven, Sebastiaan van de Groes, Jorrit Zelle, Sander Koëter, Gerjon Hannink, Nico Verdonschot, Paul J P van der Ven, Sebastiaan van de Groes, Jorrit Zelle, Sander Koëter, Gerjon Hannink, Nico Verdonschot

Abstract

Background: We compared the functional outcome between conventional and high-flexion total knee arthroplasty (TKA) using kneeling and sit-to-stand tests at 1 year post-operative. In addition, the patient's daily functioning, pain and satisfaction were quantified using questionnaires.

Methods: We randomly assigned 56 patients to receive either a conventional or a high-flexion TKA. Primary outcomes were maximum flexion angle and maximum thigh-calf contact measured during kneeling at 1 year post operatively. Secondary outcomes were the angular knee velocity and ground reaction force ratio measured during sit-to-stand performance tests, and questionnaires.

Results: At one year post-operative, maximum knee flexion during kneeling was higher for the high-flexion TKA group (median 128.02° (range 108-146)) compared to the conventional TKA group (119.13° (range 72-135)) (p = 0.03). Maximum thigh-calf contact force was higher for the high flexion TKA group (median 17.82 N (range 2.98-114.64)) compared to the conventional TKA group (median 9.37 N (range 0.33-46.58))(p = 0.04). The sit-to-stand tests showed a significantly higher angular knee velocity in the conventional TKA group (12.12 rad/s (95%CI 0.34-23.91); p = 0.04). There were no significant differences between groups in ground reaction force ratios and patient-reported outcome scores.

Conclusion: Although no differences were found in patient-reported outcome scores, differences in performance-based tests were clearly apparent. Standing up from a chair at 90° of knee flexion appeared to be easier for the conventional group. The kneeling test revealed significantly higher weight-bearing knee flexion for the high-flex group. Hence, if kneeling is an important activity for a patient a high-flex design may be recommendable.

Trial registration: The study was retrospectively registered in ClinicalTrials.gov under identifier NCT00899041 (date of registration: May 11, 2009).

Keywords: Functional outcome; High-flexion; Kneeling; Performance-based tests; Sit-to-stand; Total knee arthroplasty.

Conflict of interest statement

Ethics approval and consent to participate

The trial was approved by the Ethical Review Board Arnhem-Nijmegen, Netherlands (CMO 2008/021; ABR NL21274.091.08). Written informed consent was obtained from all study participants.

Consent for publication

Consent for publication was obtained from all study participants.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

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Fig. 1
CONSORT 2010 flow diagram

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