Does flexion of the femoral implant in total knee arthroplasty increase knee flexion: A randomised controlled trial

Murphy, Michael, Journeaux, Simon, Hides, Julie and Russell, Trevor (2014) Does flexion of the femoral implant in total knee arthroplasty increase knee flexion: A randomised controlled trial. The Knee, 21 1: 257-263. doi:10.1016/j.knee.2012.10.028


Author Murphy, Michael
Journeaux, Simon
Hides, Julie
Russell, Trevor
Title Does flexion of the femoral implant in total knee arthroplasty increase knee flexion: A randomised controlled trial
Journal name The Knee   Check publisher's open access policy
ISSN 0968-0160
1873-5800
Publication date 2014-01-01
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.knee.2012.10.028
Open Access Status
Volume 21
Issue 1
Start page 257
End page 263
Total pages 7
Place of publication Amsterdam, The Netherlands
Publisher Elsevier BV
Language eng
Subject 2732 Orthopedics and Sports Medicine
Abstract Introduction: Prosthetic and operative modifications in total knee arthroplasty (TKA) have been proposed to maximise post-operative knee flexion as it is essential in routine functional activities. Methods: We performed a double blind randomised controlled trial to compare clinical outcomes of primary cruciate-retaining TKA for osteoarthritis with the femoral component implanted in either 4° flexion in the sagittal plane (F) or in a neutral position (C). The primary outcome of knee flexion and secondary outcomes knee extension, quadriceps strength, WOMAC, SF-12v2, timed stand test, stair climb test and satisfaction were assessed at 1. year. Knee flexion and extension were also assessed intra-operatively. Implant flexion was measured from true lateral radiographs. Results: Thirty-nine participants (40 knees) were recruited, 20 knees per group. Three subjects from the control group and two from the flexed group were lost to 1. year follow-up but numbers were sufficient to satisfy the sample size calculation. Significant differences were found between the groups in knee flexion (F: 113.6. ±. 8.8° pre-operative, 122.4. ±. 6.0° intra-operative, 110.2. ±. 7.5° 1. year, C: 117.4. ±. 11.7°, 117.4. ±. 7.6°, 103.5. ±. 10.7°. p. = 0.031) and mental component score of the SF12-v2 (F 53.3. ±. 13.2, C 61.1. ±. 7.3, p. = 0.009) but there were no significant differences in other outcomes and patients were equally satisfied. Conclusion: Flexing the femoral implant in this cruciate retaining TKA system provided a significant difference in knee flexion compared to a neutral position. The improvement appears to occur predominantly at surgery and was not associated with a clinical or functional benefit at 1. year. (ACTRN12606000325505). Level of evidence: Level 1; randomised controlled trial.
Keyword Implant flexion
Knee flexion
Randomised controlled trial
Total knee arthroplasty
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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