J Knee Surg 2022; 35(02): 204-214
DOI: 10.1055/s-0040-1713897
Original Article

Comparison between Mid-Term Results of Total Knee Arthroplasty with Single-Radius versus Multiple-Radii Posterior-Stabilized Prostheses

1   Sichuan University West China Hospital–Orthopedics, Chengdu, Sichuan, China
,
Kai Zhou
1   Sichuan University West China Hospital–Orthopedics, Chengdu, Sichuan, China
,
Haoyang Wang
1   Sichuan University West China Hospital–Orthopedics, Chengdu, Sichuan, China
,
Fuxing Pei
1   Sichuan University West China Hospital–Orthopedics, Chengdu, Sichuan, China
,
1   Sichuan University West China Hospital–Orthopedics, Chengdu, Sichuan, China
› Author Affiliations
Funding None.

Abstract

Single-radius (SR) prostheses and multiple-radii (MR) prostheses have different theoretical advantages; however, few comparative studies have been reported. The aim of the study was to compare mid-term clinical, radiological, and survival outcomes of SR and MR posterior-stabilized prostheses in total knee arthroplasty (TKA). Two hundred consecutive patients who underwent TKA between January 2012 and July 2013 were enrolled in the SR group (100 patients) and an MR group (100 patients), with a minimum follow-up of 5 years. Functional, radiological, satisfaction, and survival rates were evaluated. There was a significantly higher range of motion (ROM) in the SR group than in the MR group (flexion, 123.65 ± 10.12 degrees vs. 115.52 ± 10.03 degrees, p < 0.001). Quadriceps strength (3.05 ± 0.43 vs. 2.68 ± 0.58 kg, p = 0.025) and chair test results (80 [93.02%] vs. 69 [83.13%], p = 0.027) were better in the SR group than in the MR group. The SR group also had significantly less anterior knee pain (6 [6.98%] vs. 15 [18.07%], p < 0.05) and a better satisfaction rate than those in the MR group. No significant differences were observed in clinical scale scores such as Hospital for Special Surgery (HSS), Knee Society Score (KSS), and Short-Form 12 (SF-12), radiological results in terms of component position and radiolucent lines. The Kaplan–Meier survival curve estimates at 5 years were not significantly different (96.91% [95% confidence interval [CI]: 93.5–99.5%] vs. 94.86% [95% CI: 90.6–98.6%], p = 0.4696). The SR prosthesis design was better than that of the MR in terms of ROM, reduced anterior knee pain, contributions to better recovery of the extension mechanism, and higher satisfaction rates. The SR had similar results in clinical scales such as HSS, KSS, SF-12, radiological, or survival results to MR prostheses. More accurate measurements and longer-term follow-up are required.



Publication History

Received: 11 February 2019

Accepted: 25 May 2020

Article published online:
13 July 2020

© 2020. Thieme. All rights reserved.

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

 
  • References

  • 1 Gioe TJ, Killeen KK, Grimm K, Mehle S, Scheltema K. Why are total knee replacements revised?: analysis of early revision in a community knee implant registry. Clin Orthop Relat Res 2004; (428) 100-106
  • 2 Wang H, Simpson KJ, Ferrara MS, Chamnongkich S, Kinsey T, Mahoney OM. Biomechanical differences exhibited during sit-to-stand between total knee arthroplasty designs of varying radii. J Arthroplasty 2006; 21 (08) 1193-1199
  • 3 Jenny JY, Miehlke R, Saragaglia D. et al. Single-radius, multidirectional total knee replacement. Knee Surg Sports Traumatol Arthrosc 2013; 21 (12) 2764-2769
  • 4 Wolterbeek N, Nelissen RG, Valstar ER. No differences in in vivo kinematics between six different types of knee prostheses. Knee Surg Sports Traumatol Arthrosc 2012; 20 (03) 559-564
  • 5 Shimizu N, Tomita T, Yamazaki T, Yoshikawa H, Sugamoto K. In vivo movement of femoral flexion axis of a single-radius total knee arthroplasty. J Arthroplasty 2014; 29 (12) 2407-2411
  • 6 Frankel VH, Burstein AH, Brooks DB. Biomechanics of internal derangement of the knee. Pathomechanics as determined by analysis of the instant centers of motion. J Bone Joint Surg Am 1971; 53 (05) 945-962
  • 7 Kennedy JC, Fowler PJ. Medial and anterior instability of the knee. An anatomical and clinical study using stress machines. J Bone Joint Surg Am 1971; 53 (07) 1257-1270
  • 8 Churchill DL, Incavo SJ, Johnson CC, Beynnon BD. The transepicondylar axis approximates the optimal flexion axis of the knee. Clin Orthop Relat Res 1998; (356) 111-118
  • 9 Ranawat CS, White PB, West S, Ranawat AS. Clinical and radiographic results of attune and PFC sigma knee designs at 2-year follow-up: a prospective matched-pair analysis. J Arthroplasty 2017; 32 (02) 431-436
  • 10 Hollister AM, Jatana S, Singh AK, Sullivan WW, Lupichuk AG. The axes of rotation of the knee. Clin Orthop Relat Res 1993; (290) 259-268
  • 11 Eckhoff DG, Bach JM, Spitzer VM. et al. Three-dimensional mechanics, kinematics, and morphology of the knee viewed in virtual reality. J Bone Joint Surg Am 2005; 87 (Suppl. 02) 71-80
  • 12 Mahoney OM, McClung CD, dela Rosa MA, Schmalzried TP. The effect of total knee arthroplasty design on extensor mechanism function. J Arthroplasty 2002; 17 (04) 416-421
  • 13 Hamilton DF, Burnett R, Patton JT. et al. Implant design influences patient outcome after total knee arthroplasty: a prospective double-blind randomised controlled trial. Bone Joint J 2015; 97-B (01) 64-70
  • 14 Mencière ML, Epinette JA, Gabrion A, Arnalsteen D, Mertl P. Does high flexion after total knee replacement really improve our patients' quality of life at a short-term follow-up?: a comparative case-control study with hyperflex PFC Sigma versus a Triathlon knee series. Int Orthop 2014; 38 (10) 2079-2086
  • 15 D'Lima DD, Poole C, Chadha H, Hermida JC, Mahar A, Colwell Jr CW. Quadriceps moment arm and quadriceps forces after total knee arthroplasty. Clin Orthop Relat Res 2001; (392) 213-220
  • 16 Mizner RL, Petterson SC, Stevens JE, Vandenborne K, Snyder-Mackler L. Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am 2005; 87 (05) 1047-1053
  • 17 Browne C, Hermida JC, Bergula A, Colwell Jr CW, D'Lima DD. Patellofemoral forces after total knee arthroplasty: effect of extensor moment arm. Knee 2005; 12 (02) 81-88
  • 18 Jo AR, Song EK, Lee KB, Seo HY, Kim SK, Seon JK. A comparison of stability and clinical outcomes in single-radius versus multi-radius femoral design for total knee arthroplasty. J Arthroplasty 2014; 29 (12) 2402-2406
  • 19 Clary CW, Fitzpatrick CK, Maletsky LP, Rullkoetter PJ. The influence of total knee arthroplasty geometry on mid-flexion stability: an experimental and finite element study. J Biomech 2013; 46 (07) 1351-1357
  • 20 Larsen B, Jacofsky MC, Jacofsky DJ. Quantitative, comparative assessment of gait between single-radius and multi-radius total knee arthroplasty designs. J Arthroplasty 2015; 30 (06) 1062-1067
  • 21 Kim DH, Kim DK, Lee SH, Kim KI, Bae DK. Is single-radius design better for quadriceps recovery in total knee arthroplasty?. Knee Surg Relat Res 2015; 27 (04) 240-246
  • 22 Molt M, Ljung P, Toksvig-Larsen S. Does a new knee design perform as well as the design it replaces?. Bone Joint Res 2012; 1 (12) 315-323
  • 23 Oliviu RC, Zazgyva A, Septimiu S, Örs N, Sorin PT. Mid-term results of total knee replacement with single-radius versus multi-radius posterior-stabilized implants. Acta Orthop Traumatol Turc 2016; 50 (02) 125-131
  • 24 Palmer J, Sloan K, Clark G. Functional outcomes comparing Triathlon versus Duracon total knee arthroplasty: does the Triathlon outperform its predecessor?. Int Orthop 2014; 38 (07) 1375-1378
  • 25 Stoddard JE, Deehan DJ, Bull AM, McCaskie AW, Amis AA. The kinematics and stability of single-radius versus multi-radius femoral components related to mid-range instability after TKA. J Orthop Res 2013; 31 (01) 53-58
  • 26 Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010; 92 (12) 2143-2149
  • 27 Liu S, Long H, Zhang Y, Ma B, Li Z. Meta-analysis of outcomes of a single-radius versus multi-radius femoral design in total knee arthroplasty. J Arthroplasty 2016; 31 (03) 646-654
  • 28 Collados-Maestre I, Lizaur-Utrilla A, Gonzalez-Navarro B. et al. Better functional outcome after single-radius TKA compared with multi-radius TKA. Knee Surg Sports Traumatol Arthrosc 2017; 25 (11) 3508-3514
  • 29 Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 1989; (248) 9-12
  • 30 Sarmah SS, Patel S, Hossain FS, Haddad FS. The radiological assessment of total and unicompartmental knee replacements. J Bone Joint Surg Br 2012; 94 (10) 1321-1329
  • 31 Wellman SS, Klement MR, Queen RM. Performance comparison of single-radius versus multiple-curve femoral component in total knee arthroplasty: a prospective, randomized study using the lower quarter Y-balance test. Orthopedics 2017; 40 (06) e1074-e1080
  • 32 Calliess T, Bauer K, Stukenborg-Colsman C, Windhagen H, Budde S, Ettinger M. PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 2017; 25 (06) 1743-1748