Gender-specific difference in the recurrence of flexion contracture after total knee arthroplasty

Abstract

Background Range of motion after total knee arthroplasty (TKA) can impact patients’ daily lives. Nevertheless, flexion contracture (FC) often recurs after TKA, even upon achieving full extension intraoperatively. This study aimed to evaluate the relationship among preoperative, intraoperative, and postoperative knee extension angles, and clarify the risk factor for postoperative FC. Methods One hundred forty-seven knees undergoing TKA using a navigation system were evaluated. We measured the pre- and postoperative (6 months after TKA) extension angles using a goniometer, and intraoperative (before and after TKA) extension angle using a navigation system; the correlation between these angles at each time point was evaluated. Results The mean preoperative, intraoperative (before and after TKA) and postoperative extension angles were -9.9°, -6.8°, -0.1°, and -2.0°. Regarding intraoperative extension angle after TKA, 58 knees showed ≤ 5° hyperextension and six knees showed > 5° hyperextension. At 6 months, no cases showed hyperextension and 105 knees showed full extension. The mean intraoperative extension angle after TKA in the postoperative full extension group was 0.4°. A significant correlation was found among extension angles at each point (p<0.01, respectively). However, the intraoperative extension angle after TKA correlated with the postoperative extension angle only in females. Contrarily, the recurrence rate of FC was significantly higher in males than in females (p<0.01). Conclusion Intraoperative extension angles significantly correlated with pre- and postoperative extension angles in TKA. Moreover, intraoperative mild (≤ 5°) hyperextension is acceptable for postoperative full extension. There was a gender-specific difference in correlation between intra- and postoperative knee extension angles. Level of evidence III.

Management of fixed flexion contracture in primary total knee arthroplasty: recent systematic review

“…Five of the included studies [ 11 – 13 , 19 – 46 ] correlated patient preoperative factors with the incidence of postoperative flexion contracture. Predictors of postoperative flexion contracture were male gender, older age, and preoperative flexion contracture.…”

“…However, BMI was not a risk factor. Kinoshita et al [ 19 ] found a significantly greater risk of postoperative flexion in male patients with preoperative flexion. In contrast, a later study by Lustig et al [ 21 ] disagreed with all factors, finding no significant difference between patients with and without flexion contracture of at least 5° at one year postoperatively in terms of gender or age.…”

Factors Influencing Knee Flexion Range of Movement after Primary Total Knee Arthroplasty : Study of a Consecutive Series over Ten Years

“…Only osteoarthritic patellae were resurfaced in our series and the difference in postoperative flexion was not significant. Other preoperative predictive factors as quadriceps weakness [17], kinematics [18], education level [19], gender [20], and hip stiffness [21] have been reported. Authors still claim that high knee flexion is not necessary for patient satisfation [22].…”

Factors influencing the postoperative flexion angle in cruciate-sacrificing rotating platform of total knee arthroplasty

“…Although the CSRP type has no particular restrictions on the sagittal alignment of the femoral component, excessive exion insertion may cause postoperative exion contracture [43]. In particular, it has been reported that males are signi cantly more likely to develop postoperative exion contracture of 5 °after TKA than females are [44].…”