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Factors Influencing Range of Motion in Total Knee Arthroplasty Designs

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The document discusses factors that influence range of motion (ROM) after total knee arthroplasty (TKA), including patient factors like obesity, surgical technique, and prosthetic design. It finds that posterior stabilized (PS) designs can provide higher ROM than posterior cruciate retaining designs, and that the LPS High Flex PS design further increases ROM, with reported passive flexion of 130-140 degrees in many cases. However, it also notes there may be increased risks of wear, synovitis, and anterior knee pain with such high flexion.

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Design Factors Influencing Range of Motion in TKA James B. Stiehl, MD Medical College of Wisconsin Milwaukee, Wisconsin
Factors Determining ROM in TKA ,[object Object],[object Object],[object Object],[object Object],[object Object],130
Patient Factors: Obesity ,[object Object],[object Object],[object Object],[object Object],[object Object]
Active vs Passive Range of Motion in TKA ,[object Object],[object Object],[object Object],[object Object]
Balanced Flexion Gap ,[object Object],[object Object],[object Object]
Tibia Cut First Surgical Technique ,[object Object],[object Object],[object Object],[object Object]
Kinematic “Conflict”, circa 2007 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LCS Design Issues for ROM ,[object Object],[object Object],[object Object],[object Object],[object Object]
LCSPS Design Flaws
LPS High Flex TKA ,[object Object],[object Object],[object Object],[object Object]
LPS Design Considerations Longer Cam; Posterior Condyle 2mm > LPS High Flex LPS
Patellar Impingement Impingement LPS LPS High Flex
LPS High Flex Mobile ROM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Literature Review: PS vs PS Flex <.05 135  120  50 Weeden, et.al. =0.41 138  135  50* Kim, et.al. <.05 138  126  50 Huang, et.al. <.05 129  124  180 Bin, et.al. SD PS High Flex PS N Author
Kinematics of LPS High Flex ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Kinematics of LPS High Flex ,[object Object],[object Object],[object Object],[object Object],[object Object]
LPS High Flex Mobile Results 150 ° Passive Flexion
LPS High Flexion Sitting 9 Inch Stool, >135 ° Flexion
LPS High Flex- Down Stairs
LCS Versus LPS High Flex in Passive Flexion Left- LPS High Flex- 115  Right- LCS - 105 
What Do I Tell My Patients? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Is There A Liabilty to High Flexion in TKA ,[object Object],[object Object],[object Object],[object Object]
CONCLUSION ,[object Object],[object Object],[object Object],[object Object]
 
Detrimental Kinematics Of A Flat on Flat Condylar TKA Stiehl, CORR, 1999 Medial Condyle Lateral Condyle
LPS High Flex on Stairs
Functional Outcome after TKA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LPS High Flex Walking
LCS PS Mobile Bearing TKA
Clinical Experience With LCSPS (Stiehl) ,[object Object],[object Object],[object Object],[object Object],[object Object]

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