• Nienke M Kosse, HeesterbeekPetra J CPJCSint Maartenskliniek Research, Sint Maartenskliniek, P.O. box 9011, 6500 GM, Nijmegen, The Netherlands. p.heesterbeek@maartenskliniek.nl., Koen C Defoort, Ate B Wymenga, and Gijs G van Hellemondt.
• Sint Maartenskliniek Research, Sint Maartenskliniek, P.O. box 9011, 6500 GM, Nijmegen, The Netherlands. n.m.kosse@gmail.com.
• Arch Orthop Trauma Surg. 2020 Oct 1; 140 (10): 1495-1501.

IntroductionPhysiological motion after total knee arthroplasty (TKA) should result in a large range of motion, which would lead to good clinical outcomes. An adjusted design of a bicruciate-stabilizing TKA was developed to reproduce physiological motion. The aim of this study was to (1) investigate the maximal knee flexion of this knee system, 1 year post-operatively; (2) determine the clinical and functional improvement and compare the outcomes between patients with and without high maximal flexion; and (3) evaluate the adverse events.Materials And MethodsIn this prospective study, 62 patients with osteoarthritis received a bicruciate-stabilizing TKA. Maximum flexion was measured on a lateral X-ray pre- and post-operatively. Clinical and functional scores and the adverse events were reported up until 2 years after surgery.ResultsPre-operatively, the median (range) maximal flexion was 131.5 (90-153)° and 1 year post-operatively, it was 130 (82-150)°. The results for the clinical scores showed an improvement between pre-operative values and post-operative values. The Kujala score and Knee Osteoarthritis Outcome Score (KOOS) symptoms, sport and quality of life score were better in patients with high maximal flexion (≥ 125°). Ten (serious) adverse device events were reported.ConclusionsIn conclusion, the bicruciate-stabilizing TKA obtained a maximal flexion comparable to the flexion pre-operatively and resulted in good clinical and functional outcomes. Patients with high flexion ability seem to perform better on clinical and functional outcomes. Furthermore, the adjusted design of the bicruciate-stabilizing TKA reduced the number of adverse events.Level Of EvidenceProspective cohort study, Level II.

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