Effect of Body Mass Index on Range of Motion and Manipulation After Total Knee Arthroplasty

Gadinsky, Naomi E.; Ehrhardt, Jessica; Urband, Christopher E.; Westrich, Geoffrey H.

doi:10.1016/j.arth.2010.12.004

Cited by 72 publications

(45 citation statements)

References 17 publications

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“…Final post-MUA flexion regressed toward pre-TKA flexion as demonstrated by nearly equivalent flexion arcs (100.3°versus 100.6°). Comorbidities may prognosticate final ROM after TKA [2,11,30]. In this study, patients with diabetes mellitus experienced 12.8°lower final ROM versus patients without diabetes mellitus.…”

Section: Discussionmentioning

confidence: 82%

“…Pre-TKA patient characteristics such as age, race, body mass index, and comorbidities also may affect final ROM [3,15,30]. Patients with lower body mass indices have been associated with greater pre-TKA ROM and are less likely to require manipulation under anesthesia (MUA) to manage stiffness after TKA [11]. Patients with diabetes mellitus have lower ROM and experience more stiffness after surgery [2,22,31].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Range of Motion in Patients Undergoing Manipulation After TKA

Bawa

Wera

Kraay

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Predictors of Range of Motion in Patients Undergoing Manipulation After TKA

Bawa

Wera

Kraay

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Park et al demonstrated that obesity significantly reduced the ROM for multiple joints [23]. Gadinsky et al reported that patients with higher BMI values had lower ROMs of the knee joint after total knee arthroplasty [24]. However, there was no report that described the ROM in obese patients after THA.…”

Section: Discussionmentioning

confidence: 90%

“…Karlson et al revealed an association between increased BMI and the risk of developing osteoarthritis of the hip of sufficient severity to warrant surgical intervention [9]. Several studies demonstrated the interaction of obesity with ROM [23,24]. Park et al demonstrated that obesity significantly reduced the ROM for multiple joints [23].…”

Section: Discussionmentioning

confidence: 99%

Obese patients may have more soft tissue impingement following primary total hip arthroplasty

Hayashi

Nishiyama

Fujishiro

et al. 2012

International Orthopaedics (SICOT)

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Purpose Several studies have reported a risk of dislocation in obese patients after total hip arthroplasty. In this study, we evaluated the interaction between obesity and dislocation by kinematic analysis using a navigation system. Methods The intraoperative range of motion (ROM) and postoperative impingement-free ROM were measured in 38 patients, and we compared the impingement-free ROM in obese and non obese patients. Results The postoperatively simulated ROM was similar in the obese and non obese groups. The intraoperative ROM was smaller in the obese group. The difference values between the intraoperative ROM and postoperatively simulated ROM were larger in the obese group. These results indicate that obese patients have less ROM following primary total hip arthroplasty even when the implant positioning is performed correctly. Conclusions Dislocations are multifactorial problems including soft tissue impingement. Therefore, the risk of dislocation caused by soft tissue impingement in obese patients may be increased.

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“…This suggests that TKA related factors other than reduced ROM, may be responsible for reduced knee flexion in stair descent [7]. Also factors outside joint mechanics may be considered, such as weakness of the knee and hip muscles [11][12][13][14], fear of movement [15], reduced proprioception [16], leg length discrepancy [17], obesity [18][19][20], pain [7,21,22], time since TKA surgery [13,23], age [24], and habitual gait patterns [1].…”

mentioning

confidence: 99%

Peak Knee Flexion Angles During Stair Descent in TKA Patients

Bjerke

Öhberg

Nilsson

et al. 2014

The Journal of Arthroplasty

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Keywords:total knee arthroplasty gait analysis range of motion kinematics Reduced peak knee flexion during stair descent (PKSD) is demonstrated in subjects with total knee arthroplasty (TKA), but the underlying factors are not well studied. 3D gait patterns during stair descent, peak passive knee flexion (PPKF), quadriceps strength, pain, proprioception, demographics, and anthropometrics were assessed in 23 unilateral TKA-subjects~19 months post-operatively, and in 23 controls. PKSD, PPKF and quadriceps strength were reduced in the TKA-side, but also in the contralateral side. A multiple regression analysis identified PPKF as the only predictor (57%) to explain the relationship with PKSD. PPKF was, however sufficient for normal PKSD. Deficits in quadriceps strength in TKA-group suggest that strength is also contributing to smaller PKSD. Increased hip adduction at PKSD may indicate both compensatory strategy and reduced hip strength.© 2013 Elsevier Inc. All rights reserved.Studies show that total knee arthroplasty (TKA) gives rise to various movement abnormalities, such as gait asymmetries including reduced knee flexion [1]. Functional performance following knee arthroplasty may be assessed in stair gait [2]. Descending stairs requires more knee flexion than ascending stairs [3], and there is evidence of reduced knee flexion in stair descent after TKA [4,5]. Although it is concluded that flexion in the prosthetic knee is reduced during stair descent [2,[4][5][6], the underlying mechanisms are uncertain. Although knee flexion is restricted due to the mechanics of the prosthesis [7], stair studies show that the range of motion (ROM) leaves a margin of 6°-16°, theoretically permitting sufficient knee flexion for normal stair descent [4][5][6]. There are, however also other qualities with TKA that may be important to consider, such as reduced or increased sagittal laxity in the prosthetic knee joint [8][9][10]. In posterior cruciate retaining knee prostheses a paradoxical forward slide instead of a normal rollback of the tibio-femoral contact point occurs with increasing flexion. This suggests that TKA related factors other than reduced ROM, may be responsible for reduced knee flexion in stair descent [7]. Also factors outside joint mechanics may be considered, such as weakness of the knee and hip muscles [11][12][13][14] Studies on level walking propose that asymmetrical gait after TKAsurgery is retained from the pre-surgery gait and characterized by a specific walking pattern, presumably for unloading the affected knee [1]. Asymmetrical gait patterns are shown to be retained up to 18 months after surgery in spite of little or no pain [21]. Similarly, subjects with osteoarthritis have demonstrated decreased knee flexion during stair descent compared to knee-healthy subjects [25]. Asymmetrical gait patterns after a TKA may predispose the individual to contralateral joint degeneration [1], and the risk of the contralateral knee to progress to TKA due to osteoarthritis has been estimated to be 37.2% within 10 years [26...

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Effect of Body Mass Index on Range of Motion and Manipulation After Total Knee Arthroplasty

Cited by 72 publications

References 17 publications

Predictors of Range of Motion in Patients Undergoing Manipulation After TKA

Predictors of Range of Motion in Patients Undergoing Manipulation After TKA

Obese patients may have more soft tissue impingement following primary total hip arthroplasty

Peak Knee Flexion Angles During Stair Descent in TKA Patients

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