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. 2018 Jun 1;30(2):161-166.
doi: 10.5792/ksrr.17.071.

Comparison of Revision Rates Due to Aseptic Loosening Between High-Flex and Conventional Knee Prostheses

Free PMC article

Comparison of Revision Rates Due to Aseptic Loosening Between High-Flex and Conventional Knee Prostheses

Young-Joon Choi et al. Knee Surg Relat Res. .
Free PMC article


Purpose: The purpose was to evaluate and compare the revision rate due to aseptic loosening between a high-flex prosthesis and a conventional prosthesis.

Materials and methods: Two thousand seventy-eight knees (1,377 patients) with at least 2 years of follow-up after total knee arthroplasty were reviewed. Two types of implants were selected (LPS-Flex and LPS, Zimmer) to compare revision and survival rates and sites of loosened prosthesis component.

Results: The revision rate of the LPS-Flex (4.9%) was significantly higher than that of the conventional prosthesis (0.6%) (p<0.001). The 5-, 10-, and 15-year survival rates were 98.9%, 96.2% and 92.0%, respectively, for the LPS-Flex and 99.8%, 98.5% and 93.5%, respectively, for the LPS. The survival rate of the high-flex prosthesis was significantly lower than that of the conventional prosthesis, especially in the mid-term period (range, 5 to 10 years; p=0.002). The loosening rate of the femoral component was significantly higher in the LPS-Flex prosthesis (p=0.001).

Conclusions: The LPS-Flex had a higher revision rate due to aseptic loosening than the LPS prosthesis in the large population series with a long follow-up. The LPS-Flex should be used carefully considering the risk of femoral component aseptic loosening in the mid-term (range, 5 to 10 years) follow-up period after initial operation.

Keywords: Arthroplasty; Aseptic loosening; Femoral component; High-Flex prosthesis; Knee; Revision.

Conflict of interest statement

Conflict of Interest

No potential conflict of interest relevant to this article was reported.


Fig. 1
Fig. 1
Cementing technique for the femoral component. Cement was applied onto the distal and anterior aspects of the distal femur (A) and posterior aspect of the femoral implant (B), and manual pressurization was applied (C).
Fig. 2
Fig. 2
Sequential plain lateral radiographs of the right knee after the initial total knee arthroplasty. No abnormal findings were seen 1 year postoperatively (A) and until 4 years postoperatively (B). A small radiolucent line was seen on the anterior aspect of the distal femur 7 years postoperatively (C). Ten years postoperatively, the distal anterior gap became wider than before. The anterior gap also became wider, and the posterior gap was seen (D). Osteolysis of the distal femur caused the implant to hang over the bone 11 years postoperatively (E).
Fig. 3
Fig. 3
Intraoperative findings in revision surgery: synovial hypertrophy beyond prosthesis (A) and debonding of cement (B, C) were seen.
Fig. 4
Fig. 4
Kaplan-Meier survival rates of the two groups using revision total knee arthroplasty owing to aseptic loosening as the endpoint.

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