Do we need a gender-specific total knee replacement? A randomised controlled trial comparing a high-flex and a gender-specific posterior design

University Hospital of Hvidovre, Department of Orthopedics, Kettegård Allé 30, 2650 Hvidovre, Denmark.
The Bone & Joint Journal (Impact Factor: 3.31). 06/2012; 94(6):787-92. DOI: 10.1302/0301-620X.94B6.28781
Source: PubMed

ABSTRACT The purpose of this study was to investigate whether a gender-specific high-flexion posterior-stabilised (PS) total knee replacement (TKR) would offer advantages over a high-flex PS TKR regarding range of movement (ROM), 'feel' of the knee, pain and satisfaction, as well as during activity. A total of 24 female patients with bilateral osteoarthritis entered this prospective, blind randomised trial in which they received a high-flex PS TKR in one knee and a gender-specific high-flexion PS TKR in the other knee. At follow-up, patients were assessed clinically measuring ROM, and questioned about pain, satisfaction and daily 'feel' of each knee. Patients underwent gait analysis pre-operatively and at one year, which yielded kinematic, kinetic and temporospatial parameters indicative of knee function during gait. At final follow-up we found no statistically significant differences in ROM (p = 0.82). The median pain score was 0 (0 to 8) in both groups (p = 0.95). The median satisfaction score was 9 (4 to 10) in the high-flex group and 8 (0 to 10) in the gender-specific group (p = 0.98). The median 'feel' score was 9 (3 to 10) in the high-flex group and 8 (0 to 10) in the gender-specific group (p = 0.66). Gait analysis showed no statistically significant differences between the two prosthetic designs in any kinematic, kinetic or temporospatial parameters. Both designs produced good clinical results with significant improvements in several gait parameters without evidence of any advantage in the gender-specific design.

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    • "Gait analysis could provide more objective parameters , such as measurements of sagittal plane kinematics and kinetics (Börjesson et al. 2005, Catani et al. 2012). A recent gait analysis study suggested that there was no difference between the 2 knee prosthesis designs in terms of kinematic, kinetic, and temporo-spatial parameters (Thomsen et al. 2012). Given the inadequate correlations between knee scores and gait parameters, further gait analysis studies monitoring the functional benefit of design in TKAs are needed (Liebensteiner et al. 2008). "
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    ABSTRACT: Background and purpose There is no consensus regarding the clinical relevance of gender-specific prostheses in total knee arthroplasty (TKA). We summarize the current best evidence in a comparison of clinical and radiographic outcomes between gender-specific prostheses and standard unisex prostheses in female patients. Methods We used the PubMed, Embase, Cochrane, Science Citation Index, and Scopus databases. We included randomized controlled trials published up to January 2013 that compared gender-specific prostheses with standard unisex prostheses in female patients who underwent primary TKAs. Results 6 trials involving 423 patients with 846 knee joints met the inclusion criteria. No statistically significant differences were observed between the 2 designs regarding pain, range of motion (ROM), knee scores, satisfaction, preference, complications, and radiographic results. The gender-specific design (Gender Solutions; Zimmer Inc, Warsaw, Indiana) reduced the prevalence of overhang. However, it had less overall coverage of the femoral condyles compared to the unisex group. In fact, the femoral prosthesis in the standard unisex group matched better than that in the gender-specific group. Interpretation Gender-specific prostheses do not appear to confer any benefit in terms of clinician- and patient-reported outcomes for the female knee.
    Acta Orthopaedica 06/2014; 85(4):1-7. DOI:10.3109/17453674.2014.931194 · 2.77 Impact Factor
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    ABSTRACT: The last few years have witnessed significant advancements in arthroplasty. The procedure is mainly used to treat osteoarthritis of the hip and knee joint. Other joints such as the shoulder or ankle are also being successfully replaced by arthroplasty. The success of the operation depends on the implantation technique as well as the choice of material and fixation technique. Excellent results have been achieved especially in hip arthroplasty, with long-term survival rates of 90 %. However, the potential complications and sequelae are also worthy of mention, although they concern just a fraction of the treated patients. Careful preoperative planning, informing the patient accurately about the chances of success, and discussing the patient's expectations are essential aspects of the treatment.
    Wiener Medizinische Wochenschrift 04/2013; 163(9). DOI:10.1007/s10354-013-0199-z
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    ABSTRACT: BACKGROUND: Few data exist regarding the impact of socioeconomic factors on results of current TKA in young patients. Predictors of TKA outcomes have focused primarily on surgical technique, implant details, and individual patient clinical factors. The relative importance of these factors compared to patient socioeconomic status is not known. QUESTIONS/PURPOSES: We determined whether (1) socioeconomic factors, (2) demographic factors, or (3) implant factors were associated with satisfaction and functional outcomes after TKA in young patients. METHODS: We surveyed 661 patients (average age, 54 years; range, 18-60 years; 61% female) 1 to 4 years after undergoing modern primary TKA for noninflammatory arthritis at five orthopaedic centers. Data were collected by an independent third party with expertise in collecting healthcare data for state and federal agencies. We examined specific questions regarding satisfaction, pain, and function after TKA and socioeconomic (household income, education, employment) and demographic (sex, minority status) factors. Multivariable analysis was conducted to examine the relative importance of these factors for each outcome of interest. RESULTS: Patients reporting incomes of less than USD 25,000 were less likely to be satisfied with TKA outcomes and more likely to have functional limitations after TKA than patients with higher incomes; no other socioeconomic factors were associated with satisfaction. Women were less likely to be satisfied and more likely to have functional limitations than men, and minority patients were more likely to have functional limitations than nonminority patients. Implants were not associated with outcomes after surgery. CONCLUSIONS: Socioeconomic factors, in particular low income, are more strongly associated with satisfaction and functional outcomes in young patients after TKA than demographic or implant factors. Future studies should be directed to determining the causes of this association, and studies of clinical results after TKA should consider stratifying patients by socioeconomic status. LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 04/2013; 472(1). DOI:10.1007/s11999-013-3002-y · 2.77 Impact Factor
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