Download PDF
J Knee Surg 2024; 37(09): 687-692
DOI: 10.1055/a-2280-9851
Original Article

Prediction of Postoperative Range of Motion after Mobile-Bearing Medial Unicompartmental Knee Arthroplasty from the Preoperative Range of Motion and Other Preoperative Factors

Kensuke Anjiki
1   Department of Orthopaedic Surgery, Takatsuki General Hospital, Takatsuki Osaka, Japan
2   Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
,
Takafumi Hiranaka
1   Department of Orthopaedic Surgery, Takatsuki General Hospital, Takatsuki Osaka, Japan
,
Toshikazu Tanaka
1   Department of Orthopaedic Surgery, Takatsuki General Hospital, Takatsuki Osaka, Japan
,
Takaaki Fujishiro
1   Department of Orthopaedic Surgery, Takatsuki General Hospital, Takatsuki Osaka, Japan
,
Koji Okamoto
1   Department of Orthopaedic Surgery, Takatsuki General Hospital, Takatsuki Osaka, Japan
,
Shinya Hayashi
2   Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
,
Ryosuke Kuroda
2   Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
,
Tomoyuki Matsumoto 
2   Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
› Author Affiliations
Funding None.
› Further Information
   Permissions and Reprints

Abstract

Postoperative flexion after unicompartmental knee arthroplasty might be predicted from the preoperative range of motion and other preoperative factors, but this has not been sufficiently investigated. Between 2013 and 2017, 198 patients (198 knees) underwent unilateral knee arthroplasty with medial mobile-bearing unicompartmental knee arthroplasty. Range of motion was measured preoperatively and at the time of final follow-up. To investigate the accuracy of the prediction of preoperative to postoperative gain or loss of the flexion angle, we performed receiver operating characteristic analysis. Logistic regression analysis was used to evaluate other predictive factors. Change in flexion angle was significantly strongly and negatively correlated with the preoperative flexion angle (R = − 0.688; 95% confidence interval: −0.755 to −0.607; p < 0.001). Preoperative flexion angle was suggested to be a significant predictor of gain or loss of the flexion angle with the area under the curve of 0.781; the cutoff value calculated using the Youden index was 140 degrees. Logistic regression analysis showed that in addition to the preoperative flexion angle of the operated side, the postoperative flexion range was significantly affected by the patient's height and by the preoperative flexion angle of the contralateral knee. If the preoperative flexion angle in Oxford mobile-bearing medial unicompartmental knee arthroplasty is <140 degrees, the postoperative flexion angle may be improved; if it exceeds 140 degrees, the postoperative flexion angle may worsen. This predictive ability is further improved by consideration of the patient's height and the range of motion on the contralateral side.

Keywords

knee joint - UKA - flexion angle - ROC analysis - logistic regression analysis

Ethical Approval

The protocol of this retrospective study was approved by the ethics committee of our hospital.


Informed Consent

The patients provided written informed consent to participate.




Publication History

Received: 15 February 2022

Accepted: 01 March 2024

Accepted Manuscript online:
04 March 2024

Article published online:
29 April 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Lum ZC, Crawford DA, Lombardi Jr AV. et al. Early comparative outcomes of unicompartmental and total knee arthroplasty in severely obese patients. Knee 2018; 25 (01) 161-166
    CrossrefPubMedSearch in Google Scholar
  • 2 Kim KT, Lee S, Lee JS, Kang MS, Koo KH. Long-term clinical results of unicompartmental knee arthroplasty in patients younger than 60 years of age: Minimum 10-year follow-up. Knee Surg Relat Res 2018; 30 (01) 28-33
    CrossrefPubMedSearch in Google Scholar
  • 3 Kim MS, Koh IJ, Choi YJ, Lee JY, In Y. Differences in patient-reported outcomes between unicompartmental and total knee arthroplasties: A propensity score-matched analysis. J Arthroplasty 2017; 32 (05) 1453-1459
    CrossrefPubMedSearch in Google Scholar
  • 4 Brown NM, Sheth NP, Davis K. et al. Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: a multicenter analysis. J Arthroplasty 2012; 27 (08) 86-90
    CrossrefPubMedSearch in Google Scholar
  • 5 Horikawa A, Miyakoshi N, Shimada Y, Kodama H. Comparison of clinical outcomes between total knee arthroplasty and unicompartmental knee arthroplasty for osteoarthritis of the knee: a retrospective analysis of preoperative and postoperative results. J Orthop Surg Res 2015; 10: 168
    CrossrefPubMedSearch in Google Scholar
  • 6 Dalury DF, Fisher DA, Adams MJ, Gonzales RA. Unicompartmental knee arthroplasty compares favorably to total knee arthroplasty in the same patient. Orthopedics 2009; 32 (04) 1213-1226
    CrossrefPubMedSearch in Google Scholar
  • 7 Laurencin CT, Zelicof SB, Scott RD, Ewald FC. Unicompartmental versus total knee arthroplasty in the same patient. A comparative study. Clin Orthop Relat Res 1991; (273) 151-156
    PubMedSearch in Google Scholar
  • 8 Kleeblad LJ, van der List JP, Zuiderbaan HA, Pearle AD. Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65: a systematic review. Knee Surg Sports Traumatol Arthrosc 2018; 26 (06) 1811-1822
    CrossrefPubMedSearch in Google Scholar
  • 9 Hiranaka T, Tanaka T, Fujishiro T. et al. Is postoperative flexion angle genuinely better in unicompartmental knee arthroplasty than in total knee arthroplasty? A comparison between the knees in the same patients. Knee 2020; 27 (06) 1907-1913
    CrossrefPubMedSearch in Google Scholar
  • 10 Matsuda S, Kawahara S, Okazaki K, Tashiro Y, Iwamoto Y. Postoperative alignment and ROM affect patient satisfaction after TKA. Clin Orthop Relat Res 2013; 471 (01) 127-133
    CrossrefPubMedSearch in Google Scholar
  • 11 Han HS, Kang SB. Brief followup report: Does high-flexion total knee arthroplasty allow deep flexion safely in Asian patients?. Clin Orthop Relat Res 2013; 471 (05) 1492-1497
    CrossrefPubMedSearch in Google Scholar
  • 12 Kurosaka M, Yoshiya S, Mizuno K, Yamamoto T. Maximizing flexion after total knee arthroplasty: the need and the pitfalls. J Arthroplasty 2002; 17 (4, Suppl 1) 59-62
    CrossrefPubMedSearch in Google Scholar
  • 13 Tew M, Forster IW. Effect of knee replacement on flexion deformity. J Bone Joint Surg Br 1987; 69 (03) 395-399
    CrossrefPubMedSearch in Google Scholar
  • 14 Hsu CH, Lin PC, Chen WS, Wang JW. Total knee arthroplasty in patients with stiff knees. J Arthroplasty 2012; 27 (02) 286-292
    CrossrefPubMedSearch in Google Scholar
  • 15 Niki Y, Takeda Y, Harato K, Suda Y. Factors affecting the achievement of Japanese-style deep knee flexion after total knee arthroplasty using posterior-stabilized prosthesis with high-flex knee design. J Orthop Sci 2015; 20 (06) 1012-1018
    CrossrefPubMedSearch in Google Scholar
  • 16 Murray DW, Goodfellow JW, O'Connor JJ. The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg Br 1998; 80 (06) 983-989
    CrossrefPubMedSearch in Google Scholar
  • 17 Rosenberg TD, Paulos LE, Parker RD, Coward DB, Scott SM. The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am 1988; 70 (10) 1479-1483
    CrossrefPubMedSearch in Google Scholar
  • 18 Gibson PH, Goodfellow JW. Stress radiography in degenerative arthritis of the knee. J Bone Joint Surg Br 1986; 68 (04) 608-609
    CrossrefPubMedSearch in Google Scholar
  • 19 Hamilton TW, Choudhary R, Jenkins C. et al. Lateral osteophytes do not represent a contraindication to medial unicompartmental knee arthroplasty: a 15-year follow-up. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 652-659
    CrossrefPubMedSearch in Google Scholar
  • 20 Pandit H, Jenkins C, Gill HS. et al. Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. J Bone Joint Surg Br 2011; 93 (05) 622-628
    CrossrefPubMedSearch in Google Scholar
  • 21 Fischer JE, Bachmann LM, Jaeschke R. A readers' guide to the interpretation of diagnostic test properties: clinical example of sepsis. Intensive Care Med 2003; 29 (07) 1043-1051
    CrossrefPubMedSearch in Google Scholar
  • 22 Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant 2013; 48 (03) 452-458
    CrossrefPubMedSearch in Google Scholar
  • 23 Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg Br 2009; 91 (01) 52-57
    CrossrefPubMedSearch in Google Scholar
  • 24 Goh GS, Bin Abd Razak HR, Tay DK, Chia SL, Lo NN, Yeo SJ. Unicompartmental knee arthroplasty achieves greater flexion with no difference in functional outcome, quality of life, and satisfaction vs total knee arthroplasty in patients younger than 55 years. A propensity score–matched cohort analysis. J Arthroplasty 2018; 33 (02) 355-361
    CrossrefPubMedSearch in Google Scholar
  • 25 Erdem Y, Neyisci C, Yıldız C. Mid-term clinical and radiological results of oxford Phase 3 medial unicompartmental knee arthroplasty. Cureus 2019; 11 (09) e5674
    PubMedSearch in Google Scholar
  • 26 Karaca S, Erdem MN, Oztermeli A, Bal E, Gogus A, Hamzaoglu A. Clinical and radiological results of oxford Phase-3 medial unicompartmental knee arthroplasty. Cureus 2019; 11 (11) e6070
    PubMedSearch in Google Scholar
  • 27 Chokkhanchitchai S, Tangarunsanti T, Jaovisidha S, Nantiruj K, Janwityanujit S. The effect of religious practice on the prevalence of knee osteoarthritis. Clin Rheumatol 2010; 29 (01) 39-44
    CrossrefPubMedSearch in Google Scholar
  • 28 Hyodo K, Masuda T, Aizawa J, Jinno T, Morita S. Hip, knee, and ankle kinematics during activities of daily living: a cross-sectional study. Braz J Phys Ther 2017; 21 (03) 159-166
    CrossrefPubMedSearch in Google Scholar
  • 29 Anouchi YS, McShane M, Kelly Jr F, Elting J, Stiehl J. Range of motion in total knee replacement. Clin Orthop Relat Res 1996; 331: 87-92
    CrossrefPubMedSearch in Google Scholar
  • 30 Kamenaga T, Hiranaka T, Okimura K, Fujishiro T, Okamoto K. Contralateral knee flexion predicts postoperative knee flexion in unilateral total knee arthroplasty: a retrospective study. Orthop Traumatol Surg Res 2022; 108 (05) 103218
    CrossrefPubMedSearch in Google Scholar
  • 31 Koenen P, Ates DM, Pfeiffer TR, Bouillon B, Bäthis H. Femoral flexion position is a highly variable factor in total knee arthroplasty: an analysis of 593 conventionally aligned total knee replacements. Knee Surg Sports Traumatol Arthrosc 2020; 28 (04) 1014-1022
    CrossrefPubMedSearch in Google Scholar
  • 32 Hancock GE, Hepworth T, Wembridge K. Accuracy and reliability of knee goniometry methods. J Exp Orthop 2018; 5 (01) 46
    CrossrefPubMedSearch in Google Scholar