Rango de movilidad y resultados funcionales en tres diseños diferentes de artroplastia de rodilla primaria. Estudio Comparativo. [Range of motion and functional results in three different designs of total knee arthroplasty].
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Publicado:
nov 8, 2016
Palabras clave:
Prótesis total de rodilla, prótesis de alta flexión, prótesis convencionales, rango de movilidad. Total knee arthroplasty, high flexion arthroplasty, conventional arthroplasty, range of motion
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Resumen
Introducción: El objetivo de este trabajo fue analizar los resultados funcionales y el rango de movimiento entre tres grupos de pacientes con artroplastia total de rodilla: dos utilizando prótesis de alta flexión y el otro con un diseño convencional. Materiales y Métodos: 64 pacientes fueron operados con prótesis total de rodilla Zimmer NexGen®, y 34 pacientes operados con Optetrack ® de alta flexión. Luego de la exclusión de pacientes; 22 pacientes (grupo A) fueron tratados con diseño de alta flexión de Zimmer, 21 pacientes (grupo B) tratados con prótesis Zimmer convencional, y 25 pacientes (Grupo C) con artroplastia Optetrack® PS. La evaluación funcional se realizó con el Knee Society Score, el Western Ontario and McMaster Universities osteoathritis index y la escala analógica visual. Resultados: En el posoperatorio, el promedio de flexión máxima del grupo A subió de 99° a 113º, con un aumento promedio de 14º, en el grupo B de 106° a 118º con una ganancia promedio de 12º y en el grupo C de 110° a 111° siendo la ganancia de 1°. Los resultados funcionales evaluados con KSS y el WOMAC presentaron mejorías en los tres grupos. Conclusión: Las evaluaciones clínicas funcionales son favorables en los tres diseños evaluados. Este estudio muestra que no hay diferencias significativas en la flexión final lograda, y resultados funcionales entre los dos primeros diseños entre sí, si siendo estos significativamente superiores al diseño del tercer grupo luego de un año de seguimiento. Palabras Claves: Prótesis total de rodilla, prótesis de alta flexión, prótesis convencionales, rango de movilidad
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Bonifacio, J. P., Costa Paz, M., Yacuzzi, C. H., & Carbo, L. (2016). Rango de movilidad y resultados funcionales en tres diseños diferentes de artroplastia de rodilla primaria. Estudio Comparativo. [Range of motion and functional results in three different designs of total knee arthroplasty]. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 81(4), 264-273. https://doi.org/10.15417/596
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Investigación Clínica
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Citas
1. R.W. Bassett. Results of 1,000 performance knees: Cementless versus cemented fixation. J Arthroplasty 1998; 13: 409–413.
2. M.A. Kelly, H.D Clarke. Long-term results of posterior cruciate-substituting total knee arthroplasty. Clin Orthop 2002; 404: 51–57.
3. Ranawat CS , Flyn WF, Saddler S, Hansraj KK, Maynard MJ. Long term results of the total condylar knee arthroplasty: a 15 year survivorship study. Clin Orthop 1993; 286: 94–102.
4. Insall JN, Lachiewicz PF, Burstein AH. The posterior stabilized condylar prosthesis: a modification of the total condylar design. Two- to four-year clinical experience. J Bone Joint Surg Am 1982; 64A: 1317.
5. Banks S, Bellemans J, Nozaki H, Whiteside LA, Harman, M Hodge WA. Knee motions during maximum flexion in fixed and mobile bearing arthroplasties. Clin Orthop 2003; 410:131.
6. Mizner RL, Petterson SC, Stevens JE, Axe MJ, Snyder-Macker L. Preoperative quadriceps strength predicts functional ability one year after total knee arthroplasty. J Rheumatol 2005; 32:1533-9.
7. Parent E, Moffet H. Preoperative predictors of locomotor ability two months after total knee arthroplasty for severe osteoarthritis. Arthritis Rheum 2003; 49:36-50.
8. Maohomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Foseel AH, Katz JN. The importance of patient expectations in prediction functional outcomes after total joint arthroplasty. J Rheumatol 2002; 29:1273-9.
9. Bin SI, Nam TS. Early results of high-flex total knee arthroplasty: comparison study at 1 year after surgery. Knee Surg Sports Traumatol Arthrosc 2007; 15:350-5.
10. Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 2000; 71:262.
11. Report on the Ontario Joint Replacement Registry. Edited; 2006 [Toronto, Ontario, Canada].
12. Sultan PG, Most E, Schule S, Li G, Rubash HE. Optimizing flexion after total knee arthroplasty: advances in prosthetic design. Clin Orthop 2003; 416:167-73.
13. Argenson JN, Komistek RD, Mahfouz M, Walker SA, Aubaniac JM, Dennis DA. A high flexion total knee arthroplasty design replicates healthy knee motion. Clin Orthop 2004; 428:174-9.
14. Bellemans J, Banks S, Victor J, Vandenneucker A, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. J Bone Joint Surg Br 2002; 84-B:50-3.
15. Massin P, Gournay A.Optimization of the posterior condylar offset, tibial slope and condylar roll-back in total knee arthroplasty. J Arthroplasty 2006; 21:889-96.
16. Most E, Sultan PG, Park SE, Papannagari R. Li G. Tibiofemoral contact behaviour is improved in high-flexion cruciate retaining TKA. Clin Orthop 2006; 452:59-64.
17. Coughlin KM, Incavo SJ, Doohen RR, Gamada K, Banks S, Beynnon BD. Kneeling kinematics after total knee arthroplasty: anterior-posterior contact position of a standard and a high-flex tibial insert design. J Arthroplasty 2007; 22:160-5.
18. Huang HT, Su JY, Wang GJ. The early results of high-flex total knee arthroplasty: a minimum of 2 years of follow-up. J Arthroplasty 2005; 20:674 9.
19. Huddleston JI, Scarborough DM, Goldvasser D, Freiberg A, Malchou H. How Often Do Patients with High-Flex Total Knee Arthroplasty Use High Flexion?. Clin Orthop Relat Res 2009; 467:1898–1906.
20. Kim YH, Sohn KS, Kim JS. Range of motion of standard and high-flexion posterior stabilized total knee prostheses: a prospective, randomized study. J Bone Joint Surg Am 2005; 87-A:1470-5.
21. Kim YH, Choi Y, Oh-Ryong K and Kim JS. Functional Outcome and Range of Motion of High-Flexion Posterior Cruciate-Retaining and High-Flexion Posterior Cruciate Substituting Total Knee Prostheses. A Prospective, Randomized Study. J Bone Joint Surg Am 2009; 91:753-760.
22. Laskin RS. The effect of a high-flex implant on postoperative flexion after primary total knee arthroplasty. Orthopedics 2007; 30(Suppl):86-8.
23. McCalden RW, MacDonald SJ, Bourne RB, Marr JT. A randomized controlled trial comparing “high-flex” vs “standard” posterior cruciate substituting polyethylene tibial inserts in total knee arthroplasty. J Arthroplasty 2009; 24(Suppl):33-8.
24. Mehin R, Burnett RS, Brasher PMA. Does the new generation of high-flex knee prostheses improve the post-operative range of movement? A meta-analysis. J Bone Joint Surg Br 2010; 92-B:1429-34.
25. Ng FY, Wong HL, Yau WP, Chiu KY, Tang WM. Comparison of range of motion after standard and high-flexion posterior stabilised total knee replacement. Int Orthop 2008; 32:795-8.
26. Nutton RW, Van der Linden ML, Rowe PJ, Gaston P, Wade FA. A prospective randomised double-blind study of functional outcome and range of flexion following total knee replacement with the NexGen standard and high flexion components. J Bone Joint Surg Br 2008; 90-B:37-42.
27. Seon JK, Park SJ, Lee KB, Yoon TR, Kozanek M, Song EK. Range of motion in total knee arthroplasty: a prospective comparison of high-flexion and standard cruciate-retaining designs. J Bone Joint Surg Am 2009; 91A:672-9.
28. Weeden SH, Schmidt R. A randomized, prospective study of primary total knee components designed for increased flexion. J Arthroplasty 2007; 22:349-52.
29. Gandhi R, Tso P, Davey JR, Mahomed NN. High-flexion implants in primary total knee arthroplasty: a meta-analysis. Knee 2009; 16(1): 14–17.
30. Luo SX, Su W, Zhao JM, Sha K, Wei QJ, Li XF. High-flexion vs. conventional prostheses total knee arthroplasty: a meta-analysis. J Arthroplasty 2011; 26(6): 847–54.
31. Wang Z, Wie M, Zhang Q, Zhang Z, Cui Y. Comparasion of High-Flexion and Conventional Implants in Total Knee Arthroplasty: A Meta-Analysis. Med Sci Monit 2015; 21:1679-1686.
32. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop 1989 ;(248):13-14.
33. Bellamy N, Buchanan WW. A preliminary evaluation of the dimensionality and clinical importance of pain and disability in osteoarthritis of the hip and knee. Clin Rheumatol 1986; 5:231-41.
34. Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME. Predicting Range of Motion After Total Knee Arthroplasty. Journal of Bone Joint Surg. Am 2003; 85-A 1278-1285.
35. Kawamura H, Bourne RB. Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci 2001; 6(3): 248–52.
36. Dennis DA, Komistek RD, Stiehl JB,Walker SA, Dennis KN. Range of motion after total knee arthroplasty The effect of implant design and weight-bearing conditions. J Arthroplasty 1998; 13(7): 748–52.
37. Malviya A, Lingard EA, Weir DJ, Deehan DJ. Predicting range of movement after knee replacement: the importance of posterior condylar offset and tibial slope. Knee Surg Sports Traumatol Arthrosc 2009; 17(5):491–98.
38. Murphy M, Journeaux S, Russell T. “High-Flexion Total Knee Arthroplasty: A Systematic Review.” International Orthopaedics 2009: 887–893.
39. Han HS, Kang SB, Yoon KS. High incidence of loosening of the femoral component in legacy posterior stabilized-flex total knee replacement. J Bone Joint Surg Br 2007; 89:1457–1461.
40. Ranawat CS. Design may be counterproductive for optimizing flexion after TKR. Clin Orthop Relat Res 2003; 416:174–176.
41. Park KK, Chang CB, Kang YG, Seong SC, Kim TK. Correlation of maximum flexion with clinical outcome after total knee replacement in Asian patients. J Bone Joint Surg Br 2007; 89:604– 608.
42. Malik A, Salas A, Ben Ari J, Ma Y, González Della Valle A. Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts. International Orthopaedics (SICOT) 2010; 34:965–972.
2. M.A. Kelly, H.D Clarke. Long-term results of posterior cruciate-substituting total knee arthroplasty. Clin Orthop 2002; 404: 51–57.
3. Ranawat CS , Flyn WF, Saddler S, Hansraj KK, Maynard MJ. Long term results of the total condylar knee arthroplasty: a 15 year survivorship study. Clin Orthop 1993; 286: 94–102.
4. Insall JN, Lachiewicz PF, Burstein AH. The posterior stabilized condylar prosthesis: a modification of the total condylar design. Two- to four-year clinical experience. J Bone Joint Surg Am 1982; 64A: 1317.
5. Banks S, Bellemans J, Nozaki H, Whiteside LA, Harman, M Hodge WA. Knee motions during maximum flexion in fixed and mobile bearing arthroplasties. Clin Orthop 2003; 410:131.
6. Mizner RL, Petterson SC, Stevens JE, Axe MJ, Snyder-Macker L. Preoperative quadriceps strength predicts functional ability one year after total knee arthroplasty. J Rheumatol 2005; 32:1533-9.
7. Parent E, Moffet H. Preoperative predictors of locomotor ability two months after total knee arthroplasty for severe osteoarthritis. Arthritis Rheum 2003; 49:36-50.
8. Maohomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Foseel AH, Katz JN. The importance of patient expectations in prediction functional outcomes after total joint arthroplasty. J Rheumatol 2002; 29:1273-9.
9. Bin SI, Nam TS. Early results of high-flex total knee arthroplasty: comparison study at 1 year after surgery. Knee Surg Sports Traumatol Arthrosc 2007; 15:350-5.
10. Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 2000; 71:262.
11. Report on the Ontario Joint Replacement Registry. Edited; 2006 [Toronto, Ontario, Canada].
12. Sultan PG, Most E, Schule S, Li G, Rubash HE. Optimizing flexion after total knee arthroplasty: advances in prosthetic design. Clin Orthop 2003; 416:167-73.
13. Argenson JN, Komistek RD, Mahfouz M, Walker SA, Aubaniac JM, Dennis DA. A high flexion total knee arthroplasty design replicates healthy knee motion. Clin Orthop 2004; 428:174-9.
14. Bellemans J, Banks S, Victor J, Vandenneucker A, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. J Bone Joint Surg Br 2002; 84-B:50-3.
15. Massin P, Gournay A.Optimization of the posterior condylar offset, tibial slope and condylar roll-back in total knee arthroplasty. J Arthroplasty 2006; 21:889-96.
16. Most E, Sultan PG, Park SE, Papannagari R. Li G. Tibiofemoral contact behaviour is improved in high-flexion cruciate retaining TKA. Clin Orthop 2006; 452:59-64.
17. Coughlin KM, Incavo SJ, Doohen RR, Gamada K, Banks S, Beynnon BD. Kneeling kinematics after total knee arthroplasty: anterior-posterior contact position of a standard and a high-flex tibial insert design. J Arthroplasty 2007; 22:160-5.
18. Huang HT, Su JY, Wang GJ. The early results of high-flex total knee arthroplasty: a minimum of 2 years of follow-up. J Arthroplasty 2005; 20:674 9.
19. Huddleston JI, Scarborough DM, Goldvasser D, Freiberg A, Malchou H. How Often Do Patients with High-Flex Total Knee Arthroplasty Use High Flexion?. Clin Orthop Relat Res 2009; 467:1898–1906.
20. Kim YH, Sohn KS, Kim JS. Range of motion of standard and high-flexion posterior stabilized total knee prostheses: a prospective, randomized study. J Bone Joint Surg Am 2005; 87-A:1470-5.
21. Kim YH, Choi Y, Oh-Ryong K and Kim JS. Functional Outcome and Range of Motion of High-Flexion Posterior Cruciate-Retaining and High-Flexion Posterior Cruciate Substituting Total Knee Prostheses. A Prospective, Randomized Study. J Bone Joint Surg Am 2009; 91:753-760.
22. Laskin RS. The effect of a high-flex implant on postoperative flexion after primary total knee arthroplasty. Orthopedics 2007; 30(Suppl):86-8.
23. McCalden RW, MacDonald SJ, Bourne RB, Marr JT. A randomized controlled trial comparing “high-flex” vs “standard” posterior cruciate substituting polyethylene tibial inserts in total knee arthroplasty. J Arthroplasty 2009; 24(Suppl):33-8.
24. Mehin R, Burnett RS, Brasher PMA. Does the new generation of high-flex knee prostheses improve the post-operative range of movement? A meta-analysis. J Bone Joint Surg Br 2010; 92-B:1429-34.
25. Ng FY, Wong HL, Yau WP, Chiu KY, Tang WM. Comparison of range of motion after standard and high-flexion posterior stabilised total knee replacement. Int Orthop 2008; 32:795-8.
26. Nutton RW, Van der Linden ML, Rowe PJ, Gaston P, Wade FA. A prospective randomised double-blind study of functional outcome and range of flexion following total knee replacement with the NexGen standard and high flexion components. J Bone Joint Surg Br 2008; 90-B:37-42.
27. Seon JK, Park SJ, Lee KB, Yoon TR, Kozanek M, Song EK. Range of motion in total knee arthroplasty: a prospective comparison of high-flexion and standard cruciate-retaining designs. J Bone Joint Surg Am 2009; 91A:672-9.
28. Weeden SH, Schmidt R. A randomized, prospective study of primary total knee components designed for increased flexion. J Arthroplasty 2007; 22:349-52.
29. Gandhi R, Tso P, Davey JR, Mahomed NN. High-flexion implants in primary total knee arthroplasty: a meta-analysis. Knee 2009; 16(1): 14–17.
30. Luo SX, Su W, Zhao JM, Sha K, Wei QJ, Li XF. High-flexion vs. conventional prostheses total knee arthroplasty: a meta-analysis. J Arthroplasty 2011; 26(6): 847–54.
31. Wang Z, Wie M, Zhang Q, Zhang Z, Cui Y. Comparasion of High-Flexion and Conventional Implants in Total Knee Arthroplasty: A Meta-Analysis. Med Sci Monit 2015; 21:1679-1686.
32. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop 1989 ;(248):13-14.
33. Bellamy N, Buchanan WW. A preliminary evaluation of the dimensionality and clinical importance of pain and disability in osteoarthritis of the hip and knee. Clin Rheumatol 1986; 5:231-41.
34. Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME. Predicting Range of Motion After Total Knee Arthroplasty. Journal of Bone Joint Surg. Am 2003; 85-A 1278-1285.
35. Kawamura H, Bourne RB. Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci 2001; 6(3): 248–52.
36. Dennis DA, Komistek RD, Stiehl JB,Walker SA, Dennis KN. Range of motion after total knee arthroplasty The effect of implant design and weight-bearing conditions. J Arthroplasty 1998; 13(7): 748–52.
37. Malviya A, Lingard EA, Weir DJ, Deehan DJ. Predicting range of movement after knee replacement: the importance of posterior condylar offset and tibial slope. Knee Surg Sports Traumatol Arthrosc 2009; 17(5):491–98.
38. Murphy M, Journeaux S, Russell T. “High-Flexion Total Knee Arthroplasty: A Systematic Review.” International Orthopaedics 2009: 887–893.
39. Han HS, Kang SB, Yoon KS. High incidence of loosening of the femoral component in legacy posterior stabilized-flex total knee replacement. J Bone Joint Surg Br 2007; 89:1457–1461.
40. Ranawat CS. Design may be counterproductive for optimizing flexion after TKR. Clin Orthop Relat Res 2003; 416:174–176.
41. Park KK, Chang CB, Kang YG, Seong SC, Kim TK. Correlation of maximum flexion with clinical outcome after total knee replacement in Asian patients. J Bone Joint Surg Br 2007; 89:604– 608.
42. Malik A, Salas A, Ben Ari J, Ma Y, González Della Valle A. Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts. International Orthopaedics (SICOT) 2010; 34:965–972.