Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 1

Naylor, Justine; Ko, Victoria; Rougellis, Steve; Green, Nick; Hackett, Danella; Magrath, Ann; Barnett, Arnold; Kim, Grace; White, Megan; Nathan, Priya; Harmer, Alison R.; Mackey, Martin; Heard, Rob; Yeo, Anthony E. T.; Adie, Sam; Harris, Ian A.; Mittal, Rajat; Cho, Adam

doi:10.1111/j.1365-2753.2011.01655.x

Cited by 10 publications

(14 citation statements)

References 25 publications

(35 reference statements)

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“…The measurements on postoperative day 2 in this study were not related to long-term outcomes. However, in Australian studies 28,29 in which hospital stays are longer, inpatient ROM measurements of extension performed at discharge on postoperative days 6–8 were related to long-term extension ROM; the same relationship was not observed for flexion.…”

Section: Discussionmentioning

confidence: 85%

Predicting Functional Performance and Range of Motion Outcomes After Total Knee Arthroplasty

Bade

Kittelson

Kohrt

et al. 2014

American Journal of Physical Medicine &Amp; Rehabilitation

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Objective The aim of this study was to assess the predictive value of functional performance and range of motion measures on outcomes after total knee arthroplasty. Design This is a secondary analysis of two pooled prospective randomized controlled trials. Sixty-four subjects (32 men and 32 women) with end-stage knee osteoarthritis scheduled to undergo primary total knee arthroplasty were enrolled. Active knee flexion and extension range of motion, Timed Up and Go (TUG) test time, and 6-min walk test distance were assessed. Results Preoperative measures of knee flexion and extension were predictive of long-term flexion (β = 0.44, P < 0.001) and extension (β = 0.46, P < 0.001). Acute measures of knee flexion and extension were not predictive of long-term flexion (β= 0.09, P = 0.26) or extension (β = 0.04, P = 0.76). Preoperative TUG performance was predictive of long-term 6-min walk performance (β = −21, P < 0.001). Acute TUG performance was predictive of long-term functional performance on the 6-min walk test, after adjusting for the effects of sex and age (P = 0.02); however, once adjusted for preoperative TUG performance, acute TUG was no longer related to long-term 6-min walk performance (P = 0.65). Conclusions Acute postoperative measures of knee range of motion are of limited prognostic value, although preoperative measures have some prognostic value. However, acute measures of functional performance are of useful prognostic value, especially when preoperative functional performance data are unavailable.

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Section: Discussionmentioning

confidence: 85%

Predicting Functional Performance and Range of Motion Outcomes After Total Knee Arthroplasty

Bade

Kittelson

Kohrt

et al. 2014

American Journal of Physical Medicine &Amp; Rehabilitation

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“…Eligible patients were invited to participate. To improve generalizability, patients with other co-morbidities and other musculoskeletal pain were not excluded, as patients who undergo TKA commonly present with multiple co-morbidities and other joint disease [18,19]. However, the following exclusion criteria were used to ensure patient safety during walk test performance: unstable angina, myocardial infarction, or cardiopulmonary, spinal or lower limb surgery in the previous six months; a recent history of uncontrolled hypertension; and inability to comprehend English.…”

Section: Methodsmentioning

confidence: 99%

The six-minute walk test is an excellent predictor of functional ambulation after total knee arthroplasty

Naylor

Harris

et al. 2013

BMC Musculoskelet Disord

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BackgroundThe Six-minute walk (6MW) and Timed-Up-and-Go (TUG) are short walk tests commonly used to evaluate functional recovery after total knee arthroplasty (TKA). However, little is known about walking capacity of TKA recipients over extended periods typical of everyday living and whether these short walk tests actually predict longer, more functional distances. Further, short walk tests only correlate moderately with patient-reported outcomes. The overarching aims of this study were to compare the performance of TKA recipients in an extended walk test to healthy age-matched controls and to determine the utility of this extended walk test as a research tool to evaluate longer term functional mobility in TKA recipients.MethodsThe mobility of 32 TKA recipients one year post-surgery and 43 healthy age-matched controls were assessed using the TUG, 6MW and 30-minute walk (30MW) tests. The latter test was repeated one week later. Self-reported function was measured using the WOMAC Index and a physical activity questionnaire.Results30MW distance was significantly shorter amongst TKA recipients (mean 2108 m [95% CI 1837 to 2381 m]; Controls 3086 m [2981 to 3191 m], P < 0.001). Test-retest repeatability was high (ICC = 0.97, TKA; 0.96, Controls). Amongst TKA recipients, the 30MW distance correlated strongly with the shorter tests (6MW, r = 0.97, P < 0.001; TUG, r = −0.82, P < 0.001). Multiple regression modeling found 6MW distance to be the only significant predictor (P < 0.001) of 30MW distance, explaining 96% of the variability. The TUG test models were moderate predictors of WOMAC function (55%) and physical activity (36%) and were stronger predictors than 6MW and 30 MW tests.ConclusionsThough TKA recipients are able to walk for 30 minutes one year post-surgery, their performance falls significantly short of age-matched norms. The 30MW test is strongly predicted by 6MW test performance, thus providing strong construct validity for the use of the 6MW test in the TKA population. Neither a short nor long walk test is a strong predictor of patient-reported function after TKA.

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“…The Oxford Knee Score was scored out of 48 (0 denoting worst and 48 denoting best status). Knee ROM (supine, passive flexion and extension) was measured from photographs using a method previously described 19 . Similarly, quadriceps lag was also measured from a photograph.…”

Section: Methodsmentioning

confidence: 99%

Tourniquet application only during cement fixation in total knee arthroplasty: a double‐blind, randomized controlled trial

Mittal

Adie

et al. 2012

ANZ Journal of Surgery

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Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 1

Cited by 10 publications

References 25 publications

Predicting Functional Performance and Range of Motion Outcomes After Total Knee Arthroplasty

Predicting Functional Performance and Range of Motion Outcomes After Total Knee Arthroplasty

The six-minute walk test is an excellent predictor of functional ambulation after total knee arthroplasty

Tourniquet application only during cement fixation in total knee arthroplasty: a double‐blind, randomized controlled trial

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