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Higher risk of decreased flexion after TKA found for women, minorities
Women, minorities should be counseled on potential need for prolonged physical therapy after surgery.
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Following elective primary total knee arthroplasty, women, black patients and patients with lower preoperative Knee Society knee-specific scores were at a higher risk of developing a decrease in flexion, according to study results.
“Without some of these well-recognized risk factors, patients may still develop decrease postoperative knee flexion following a primary total knee replacement,” Jared M. Newman, MD, of the Department of Orthopaedic Surgery at the Cleveland Clinic, told Orthopedics Today.
Newman and colleagues compared 37 knees with osteoarthritis (OA) in the study group and 111 knees with primary OA in the control group. Patients in the study group had a preoperative knee flexion of 120° or higher and had a 12-month postoperative range of motion of 110° or lower, while control patients had a preoperative and 12-month postoperative range of motion of 120° or higher. All patients underwent total knee arthroplasty, and none of the patients had previous open knee surgery.
Results showed patients in the study group had significantly lower knee-specific and functional Knee Society scores and flexion at 6 weeks and 4 months postoperatively vs. the control group. At 1 year postoperatively, researchers found significantly lower knee-specific and functional Knee Society scores, flexion and extension among patients in the study group. The study group and control group had significantly different postoperative posterior condylar offset, according to results.
Multiple logistic regression analysis showed an odds ratio of 0.95 for developing a reduction of knee flexion postoperatively among patients with a low preoperative knee-specific Knee Society score. Researchers noted a 3.48-times greater risk of developing a poor postoperative knee flexion for women vs. men and a 5.11-times greater risk for black patients vs. white patients.
“We were interested to see, from all the factors that we looked at, which ones would actually pose risk factors,” Newman said. “We looked at a number of different comorbidities which had been shown in other studies to be risk factors, but they did not seem to have an effect in our study.”
Newman noted future research should further investigate the etiology of postoperative decreased flexion and increased stiffness, as well as “why, in this particular study, are females and why are black patients at an increased risk for it.” He added treatment methods, such as injections, manipulations under anesthesia or additional surgery, should be reviewed for effectiveness.
“These patients [need] to be counseled [on] their risk for potentially developing a decreased flexion after their surgery, and they may need to have prolonged physical therapy after their surgery,” Newman said. “They may need to use a [continuous passive motion] CPM machine after surgery, and they also need to be followed closely by their surgeon to ensure that they are getting to the range of motion which is expected after surgery.” – by Casey Tingle
- Reference:
- Newman JM, et al. J Arthroplasty. 2016;doi:10.1016/j.arth.2015.10.038.
- For more information:
- Jared M. Newman, MD, can be reached at the Department of Orthopaedic Surgery at the Cleveland Clinic, 9500 Euclid Ave., A41, Cleveland, OH 44195; email: elyk@ccf.org.
Disclosure: Newman reports no relevant financial disclosures.