Factors determining the range of motion in primary total knee arthroplasty
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20195793Keywords:
Total knee arthroplasty, Range of motion, Body mass index, Posterior femoral condylar offset, Posterior tibial slopeAbstract
Background: Total knee arthroplasty (TKA) is one of the most successful surgical procedure with over 90% survival rate at 10 to 15 years. It provides a stable, pain free range of motion (ROM) for day to day activities. The aim of this study is to evaluate various factors determining ROM after TKA.
Methods: 348 patients with 390 knees treated with TKA using cruciate retaining (CR) and posterior stabilized (PS) prosthesis were included and analysed. Mean follow up period was 18 months. Patients were analysed for factors like age, sex, diagnosis, body mass index (BMI), pre-operative exercises, ROM, deformity, posterior femoral condylar offset (PFCO), posterior tibial slope (PTS), post-operative rehabilitation and implant design (CR vs PS). Statistical analysis of above factors on knee ROM was done. Patients were assessed pre-operatively, at 6 weeks, 3, 6, 12 and 18 months post-operatively.
Results: Age and sex did not affect the final ROM. The mean knee ROM improved from 86.87° to 96.95°. Factors like BMI, deformity had negative correlation and Pre-operative diagnosis, exercises, knee scores, good preoperative ROM, PFCO, PTS had positive correlation on ROM.
Conclusions: Pre-operative exercises, diagnosis, ROM, deformity, BMI, PFCO and PTS were important factors which influence ROM in TKA. Patient selection and preoperative counselling are important for good clinical outcome.
References
Ranawat CS, Padgett DE, Ohashi Y. Total knee arthroplasty for patients younger than55 years. Clin Orthop Relat Res. 1989;248:27–33.
Rand JA, Trounsdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am. 2003;85(2):259–65.
Scuderi GR, Insall JN, Windsor RE, Moran MC. Survivorship of cemented knee replacements. J Bone Joint Surg Br. 1989;71(5):798–803.
Gioe TJ, Killeen KK, Grimm K, Mehle S, Scheltema K. Why are total knee replacements revised?Analysis of early revision in a community knee implant registry. Clin Orthop Relat Res. 2004;428:100–06.
Kim JH. Effect of Posterior Femoral Condylar Offset and Posterior Tibial Slope on Maximal Flexion Angle of the Knee in Posterior Cruciate Ligament Sacrificing Total Knee Arthroplasty. Knee Surg Relat Res. 2013;25(2):54-5.
Maloney WJ, Schurman DJ. The effects of implant design on range of motion after total kneearthroplasty. Total condylar versus posterior stabilized total condylar designs. Clin Orthop. 1992;278:147.
Parsley BS, Engh GA, Dwyer KA. Pre-operative flexion. Does it influence postoperative flexion after posterior - cruciate–retaining total knee arthroplasty? Clin Orthop. 1992;275:204.
Harvey IA, Barry K, Kirby SP, Johnson R, Elloy MA. Factors affecting the range of movement of total knee arthroplasty. J Bone Joint Surg Br. 1993;75:950.
Ritter MA, Campbell ED. Effect of range of motion on the success of a total knee arthroplasty. J Arthroplasty. 1987;2:95.
Shoji H, Solomonow M, Yoshino S, D'Ambrosia R, Dabezies E. Factors affecting postoperative flexion in total knee arthroplasty. Orthopedics. 1990;13:643.
Tew M, Forster IW, Wallace WA. Effect of total knee arthroplasty on maximal flexion. Clin Orthop. 1989;247:168.
Laubenthal KN, Smidt GL, Kettelkamp DB. A quantitative analysis of knee motion during activities of daily living. Phys Ther. 1972;52:34-43.
Sancheti KH, Sancheti PK, Shyam AK, Joshi R, Patil K, Jain A. Factors affecting range of motion in total knee arthroplasty using high flexion prosthesis: a prospective study. Indian J Orthop. 2013;47(1):50–6.
Schurman DJ, Matityahu A, Good SB, Maloney W, Woolson S, Shi H, et al. Prediction of postoperative knee flexion in Insall- Burstein II total knee arthroplasty. Clin Orthop. 1998;353:175.
Kotani A, Yonekura A, Bourne RB. Factors affecting range of motion after contemporary total knee arthroplasty. J Arthroplasty. 2005;7:850–6.
Horikawa K, Wakabayashi H, Uchida A. Factors influencing the postoperative range of motion after total knee arthroplasty. J Chubu Seisai. 2005;20(7):850-6.
Anouchi YS, McShane M, Kelly F, Elting J, Stiehl J. Range of motion in total knee replacement. Clin Orthop. 1996;331:87.
Ritter MA, Stringer EA. Predictive range of motion after total knee replacement. Clin Orthop Relat Res. 1979;143:115–9.
Shoji H, Solomonow M, Yoshino S, D'Ambrosia R, Dabezies E. Factors affecting postoperative flexion in total knee arthroplasty. Orthopedics. 1990;13:643.
Lizaur A, Marco L, Cebrian R. Preoperative factors influencing the range of movement after total knee arthroplasty for severe osteoarthritis. J Bone Joint Surg Br. 1997;79:629.
Farahini H, Moghtadaei M, Bagheri A, Akbarian E. Factors Influencing Range of Motion after Total Knee Arthroplasty. Iran Red Crescent Med J. 2012;14(7):417–21.
Kurosaka M, Yoshiya S, Mizuno K, Yamamoto T. Maximizing flexion after total knee arthroplasty. J Arthroplasty. 2002;17:59.
Kawamura H, Bourne RB. Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci. 2001;6:248.
Hanratty BM, Thompson NW, Wilson RK, Beverland DE. The influence of posterior condylar offset on knee flexion after total knee replacement using a cruciate-sacrificing mobile-bearing implant. J Bone Joint Surg Br. 2007;89:915-8.
Kim JH. Effect of Posterior Femoral Condylar Offset and Posterior Tibial Slope on Maximal Flexion Angle of the Knee in Posterior Cruciate Ligament Sacrificing Total Knee Arthroplasty. Knee Surg Relat Res. 2013;25(2):54-5.
Kim KH, Bin SI, Kim JM. The correlation between posterior tibial slope and maximal angle of flexion after total knee arthroplasty. Knee Surg Relat Res. 2012;24(3):158–63.
Bellemans J, Robijns F, Duerinckx J, Banks S, Vandenneucker H. The influence of tibial slope on maximal flexion after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2005;13(3):193-6.
Braun V, Biasca N, Romero J. Factors influencing postoperative flexion after mobile bearing total knee arthroplasty. J Bone Joint Surg Br. 2001;83(2):133.
Kansara D, Markel DC. The effect of posterior tibial slope on range of motion after total knee arthroplasty. J Arthroplasty. 2006;21:809-13.
Matassi F, Duerinckx J, Vandenneucker H, Bellemans J. Range of motion after total knee arthroplasty: the effect of a preoperative home exercise program. Knee Surg Sports Traumatol Arthrosc. 2012;22(3):703–9.
Calatayud J, Casaña J, Ezzatvar Y, Jakobsen MD, Sundstrup E, Andersen LL. High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25:2864–72.
Jacobs WC, Clement DJ, Wymenga AB. Retention versus sacrifice of the posterior cruciate ligament in total knee replacement for treatment of osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev. 2005;4:CD004803.
Bercik MJ, Joshi A, Parvizi J. Posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty: a meta-analysis. J Arthrop. 2013;28(3):439-44.
Jiang C, Liu Z, Wang Y, Bian Y, Feng B, Weng X. Posterior Cruciate Ligament Retention versus Posterior Stabilization for Total Knee Arthroplasty: A Meta-Analysis. PLoS One. 2016;11(1):e0147865.
Franklin PD, Li W, Ayers DC. The Chitranjan Ranawat Award: Functional outcome after total knee replacement varies with patient attributes. Clin Orthop Relat Res. 2008;466:2597-604.
Bellemans J, Robijns F, Duericnkx J, Banks S, Vandenneucker J. The influence of tibial slope on maximal flexion after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2005;13:193-6.
