Characterizing the recovery trajectories of knee range of motion for one year after total knee replacement

Mehta, Saurabh P.; Rigney, Andrew; Webb, Kyle M.; Wesney, Jacob; Stratford, Paul W.; Shuler, Franklin D.; Oliashirazi, Ali

doi:10.1080/09593985.2018.1482980

Cited by 8 publications

(3 citation statements)

References 41 publications

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“…47 It has been shown that mean flexion of 114 o can be achieved by three months post-operatively and further small increases can occur between three months and 12 months post-operatively. 49,50 In another study, the mean range of motion was 114 o in patients who were able to kneel and 110 o in patients unable to kneel, 47 highlighting that flexion is not an important cause of kneeling problems. However, flexion is an important outcome after TKR and innovations in implant design which aim to increase flexion have been evaluated.…”

Section: Aetiologymentioning

confidence: 98%

Kneeling ability after total knee replacement

et al. 2019

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Kneeling ability is consistently the poorest patient-rated outcome after total knee replacement (TKR), with 60–80% of patients reporting difficulty kneeling or an inability to kneel. Difficulty kneeling impacts on many activities and areas of life, including activities of daily living, self-care, leisure and social activities, religious activities, employment and getting up after a fall. Given the wide range of activities that involve kneeling, and the expectation that this will be improved with surgery, problems kneeling after TKR are a source of dissatisfaction and disappointment for many patients. Research has found that there is no association between range of motion and self-reported kneeling ability. More research is needed to understand if and how surgical factors contribute to difficulty kneeling after TKR. Discrepancies between patients’ self-reported ability to kneel and observed ability suggests that patients can kneel but elect not to. Reasons for this are multifactorial, including knee pain/discomfort, numbness, fear of harming the prosthesis, co-morbidities and recommendations from health professionals. There is currently no evidence that there is any clinical reason why patients should not kneel on their replaced knee, and reasons for not kneeling could be addressed through education and rehabilitation. There has been little research to evaluate the provision of healthcare services and interventions for patients who find kneeling problematic after TKR. Increased clinical awareness of this poor outcome and research to inform the provision of services is needed to improve patient care and allow patients to return to this important activity. Cite this article: EFORT Open Rev 2019;4:460-467. DOI: 10.1302/2058-5241.4.180085

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Section: Aetiologymentioning

confidence: 98%

Kneeling ability after total knee replacement

et al. 2019

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“…Active knee flexion ROM was measured by two orthopedic doctors before surgery (baseline), at the end of inpatient stay, and at outpatient follow-up admissions. After inpatient discharge, each patient was asked to admit outpatient follow-up clinic one to two times per month until a full recovery of knee flexion ROM (i.e., 130 to 135 degrees [62,63]) was achieved. In addition, the outpatient follow up for each patient was continued for a time period as long as nine months to ensure the maximum gains in knee ROM after TKR, despite recovery of knee flexion ROM reaching a peak at 3−6 months after TKR [13,62].…”

Section: Measurement and Follow Up Of Knee Flexion Range Of Motionmentioning

confidence: 99%

Effects of Sarcopenic Obesity and Its Confounders on Knee Range of Motion Outcome after Total Knee Replacement in Older Adults with Knee Osteoarthritis: A Retrospective Study

Liao

Huang

et al. 2021

Nutrients

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Sarcopenic obesity is closely associated with knee osteoarthritis (KOA) and has high risk of total knee replacement (TKR). In addition, poor nutrition status may lead to sarcopenia and physical frailty in KOA and is negatively associated with surgery outcome after TKR. This study investigated the effects of sarcopenic obesity and its confounding factors on recovery in range of motion (ROM) after total knee replacement (TKR) in older adults with KOA. A total of 587 older adults, aged ≥60 years, who had a diagnosis of KOA and underwent TKR, were enrolled in this retrospective cohort study. Sarcopenia and obesity were defined based on cutoff values of appendicular mass index and body mass index for Asian people. Based on the sarcopenia and obesity definitions, patients were classified into three body-composition groups before TKR: sarcopenic-obese, obese, and non-obese. All patients were asked to attend postoperative outpatient follow-up admissions. Knee flexion ROM was measured before and after surgery. A ROM cutoff of 125 degrees was used to identify poor recovery post-surgery. Kaplan-Meier curve analysis was performed to measure the probability of poor ROM recovery among study groups. Cox multivariate regression models were established to calculate the hazard ratios (HRs) of postoperative poor ROM recovery, using potential confounding factors including age, sex, comorbidity, risk of malnutrition, preoperative ROM, and outpatient follow-up duration as covariates. Analyses results showed that patients in the obese and sarcopenic-obese groups had a higher probability of poor ROM recovery compared to the non-obese group (all p < 0.001). Among all body-composition groups, the sarcopenic-obese group yielded the highest risk of postoperative physical difficulty (adjusted HR = 1.63, p = 0.03), independent to the potential confounding factors. Sarcopenic obesity is likely at the high risk of poor ROM outcome following TKR in older individuals with KOA.

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“…Additionally, concomitant factors like age and pre-surgery knee ROM are associated with the gains in knee ROM. They should also be factored into the approximation of expected knee ROM at a given follow-up interval after TKA [26]. Balance and proprioception improved as compared to pre-operative levels at 1year post operatively [27].…”

mentioning

confidence: 99%

Evaluation Of Average Length of Follow-Up Duration Post Total Knee Arthroplasty: A Survey

Natu¹,

Bhole²

2022

IJPR

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Background: Among the various diseases in the world, osteoarthritis (OA) is a major contributing factor of disability. Total Knee Arthroplasty (TKA) is a widely performed procedure for advanced arthritis of the knee joint. Both subjective and objective assessments are necessary to evaluate the outcomes post TKA. The physiotherapy treatment program following the surgery is designed in a manner which is best suitable to the patient’s need, the efficacy of which will only be determined with regular follow up sessions. Objectives: The primary objective is to find out length of duration of follow up sessions post TKA with the Physiotherapist. The secondary objectives are to determine whether the reason for termination of follow-up is physiotherapist-based or patient-based and to determine whether the discharge criteria are based on measurable assessment tools. Purpose: In spite of the surgery being routinely performed, records of time period of follow up with the surgeons and physiotherapists are not maintained. It is also not documented whether the discharge occurs on the basis of formal functional assessments. Methodology: Pilot study was performed on a group of 10 physiotherapists to calculate the sample size. It was found to be 73. For the final study, candidates fitting in the inclusion criteria were chosen. Oral consent was taken. Self-designed questionnaire in the form of “Google-Form” was administered. The candidates were requested to fill the same. Descriptive analysis of the data obtained was performed to find out the average duration of follow-up post Total Knee Arthroplasty using PRISM Graph-Pad software. Results: Average (median) length of follow-up duration post TKA was found to be 6.000 weeks. Furthermore, the termination criteria of follow-up were more physiotherapist based and objective in nature. Conclusion: The time period of follow-up post TKA is inconsistent with the minimum period required for optimal functional recovery of various clinical parameters. Clinical Implication: A standardized protocol of follow-up post TKA must be devised. The decision making process of termination of follow-up which is based on measurable tools of assessment should be in line with current research findings. KEYWORDS: Total Knee Arthroplasty, Follow-up, Functional Recovery.

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Characterizing the recovery trajectories of knee range of motion for one year after total knee replacement

Cited by 8 publications

References 41 publications

Kneeling ability after total knee replacement

Kneeling ability after total knee replacement

Effects of Sarcopenic Obesity and Its Confounders on Knee Range of Motion Outcome after Total Knee Replacement in Older Adults with Knee Osteoarthritis: A Retrospective Study

Evaluation Of Average Length of Follow-Up Duration Post Total Knee Arthroplasty: A Survey

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