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Abstract: Background: We asked whether a high-flexion design implant improves patient functional outcomes or range of motion (ROM) after primary knee arthroplasty. Methods: We searched the major medical databases for randomized trials and comparison observational studies comparing high-flexion and conventional knee implants. After testing for publication bias and heterogeneity, the data were aggregated by random effect modeling. We estimated the weighted mean differences of functional outcomes scores and ROM with 95% confidence intervals. Results: Six studies met our inclusion criteria for review. We found no evidence of publication bias. The pooled mean difference for KSS scores was 0.144 (95% CI: −0.018 to 0.306), p =0.081. The pooled mean difference for the mean changes in ROM was 0.404 (95% CI: 0.139 to 0.669), p =0.003. Conclusion: High-flexion implant design improves overall ROM as compared to traditional implants but offers no clinical advantage over traditional implant designs in primary knee arthroplasty. [Copyright &y& Elsevier]

Abstract: We asked the question of what are the patient level predictors (age, gender, body mass index, education, ethnicity, mental health, and comorbidity) for a sustained functional benefit at a minimum of 1 year follow-up after total knee arthroplasty(TKA). Five hundred fifty-one consecutive patients were reviewed from our joint registry between the years of 1998 and 2005. Baseline demographic data and the outcome scores of the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and Medical Outcomes Short-Form 36 (SF36) scores were extracted from the database. Longitudinal regression modeling was performed to identify the predictive factors of interest. We had 27% of data points missing. The mean follow-up in our cohort was 3.0 years (range 1–8 years) and there were no revisions performed during this time. Clinical outcome scores were found to be relatively constant for 3–4 years after surgery and then demonstrated a gradual decline after that. Older age, year of follow-up, greater comorbidity, and a poorer mental health state at time of surgery were identified as negative prognostic factors for a sustained functional outcome following TKR (P <0.05). Knowledge of these factors that predict outcomes should be used in setting appropriate patient expectations of surgery. [Copyright &y& Elsevier]