Do we need a gender-specific total knee replacement?

A randomised controlled trial comparing a high-flex and a gender-specific posterior design

M. G. Thomsen, H. Husted, J. Bencke, D. Curtis, G. Holm, A. Troelsen

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.

Footnotes

  • The authors would like to thank H. B. Lauridsen, MSc, for assistance in the preparation of the gait analysis data.

    No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

  • Supplementary material. Three tables detailing and defining i) the kinetic and kinematic parameters observed during a full gait cycle, ii) the temporospatial parameters observed during gait, and iii) the kinematic and temporal parameters observed during the sit-to-stand test, are available with the electronic version of this article on our website www.jbjs.boneandjoint.org.uk

  • Received November 23, 2011.
  • Accepted February 6, 2012.
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