Machine Learning Algorithm to Predict Worsening of Flexion Range of Motion After Total Knee Arthroplasty

Saiki, Yoshitomo; Kabata, Tamon; Ojima, Tomohiro; Okada, Shogo; Hayashi, Seigaku; Tsuchiya, Hiroyuki

doi:10.1016/j.artd.2022.07.011

Cited by 4 publications

(3 citation statements)

References 32 publications

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“…Thus, differences could have been associated with the patient cohort's age. Previous research has identified associations between poorer knee flexion range and increased age and other factors such as higher BMI, suggesting that these variables should be considered as factors at play [23]. However, the relationship between age and function remains contested in the literature, with other authors reporting no difference in knee flexion ranges between younger (<75 years old) and older (>80 years old) patients [24].…”

Section: Discussionmentioning

confidence: 99%

Gait kinematics and knee stability 10‐years following posterior‐stabilised total knee arthroplasty comparable to healthy adults >55

Tawy,

Biant,

McNicholas

2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to compare the long‐term objective biomechanical and functional parameters of a high‐flexion total knee arthroplasty (TKA) design against healthy older adults to determine whether knee biomechanics are comparable in both populations.MethodsOne cohort of patients with a primary TKA, and a cohort of healthy adults over 55 years old with no musculoskeletal deficits or arthritis participated. Bilateral knee range of motion (RoM) was assessed with a goniometer, and gait patterns were analysed with a three‐dimensional‐motion capture system. An arthrometer quantified the anterior‐posterior laxity of each knee. Statistical analyses were performed in SPSS software (α = 0.05).ResultsTwenty‐three knees were replaced in 20 patients. At 9.8 ± 3.1 years postoperatively, patients' knees had a statistically significantly poorer RoM than healthy controls' knees (n = 23) due to limited flexion; p < 0.0001. Patients also failed to achieve the same degree of knee flexion as controls during downhill gait. No kinematic differences were observed during mid‐flexion in level nor downhill gait; a state that has been associated with instability (p = 0.614; not significant [n.s]). There were no differences between groups in knee laxity (n.s).ConclusionPatients in this study had similar gait patterns to healthy older adults during mid‐flexion and were no more likely than the healthy controls to exhibit anterior‐posterior translation of the knee > 7 mm; a known risk factor of instability. However, the knee flexion range was poorer. This likely led to bilateral pathological knee flexion patterns during downhill gait.Level of Evidence: Level III.

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Section: Discussionmentioning

confidence: 99%

Gait kinematics and knee stability 10‐years following posterior‐stabilised total knee arthroplasty comparable to healthy adults >55

Tawy,

Biant,

McNicholas

2024

Knee surg. sports traumatol. arthrosc.

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“…The relative importance of preoperative ROM in determining ROM following TKA is unclear with some studies reporting that preoperative ROM is an important predictor of postoperative ROM 15 , 22 , 23 and other studies finding more important predictors of postoperative ROM than preoperative ROM. 24 , 25 In fact, the relationship between preoperative and postoperative ROM following TKA may be nonlinear with patients with the highest preoperative ROM tending to experience the least improvement ROM and those with the worst preoperative ROM tending to gain the most ROM. 25 , 26 …”

Section: Discussionmentioning

confidence: 99%

Optimal Duration of Physical Therapy Following Total Knee Arthroplasty

Benes,

Adams,

Dubic

et al. 2024

Geriatr Orthop Surg Rehabil

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Aims & Objectives The purpose of this study was to identify patient characteristics associated with engagement and completion of physical therapy (PT) following total knee arthroplasty (TKA) and examine the relationship between number of PT sessions attended and outcomes during the first 12 weeks after surgery. Methods Patients underwent unilateral primary TKA by a single surgeon and were advised to complete 17 PT sessions over 6 weeks at a hospital-affiliated facility. Analyses examined predictors of PT engagement (attendance of ≥2 sessions) and completion (attendance of 17 ± 1 sessions) within 6 weeks and associations between number of PT sessions attended and changes in range of motion (ROM) and Knee Injury and Osteoarthritis Outcome Score (KOOS) values. Results Patients living <40 km were more likely to be engaged in PT than those living ≥40 km from the clinic ( P < .0001). Among patients who completed PT within 6 weeks, 95.0%, 85.1%, and 56.4% achieved flexion of, respectively, ≥90°, ≥100°, and ≥110°. Among engaged patients, the active flexion thresholds of ≥90°, ≥100°, and ≥110° were achieved by, respectively, 94.4%, 82.5%, and 58.1% by 6 weeks and by 96.7%, 92.1%, and 84.2% by 12 weeks. Improvement in KOOS Symptoms ( P = .029), Function in daily living ( P = .030) and quality of life ( P = .031) linearly decreased as number of PT sessions increased. Conclusions These results raise the question of whether patients who meet satisfactory outcomes before completing 6 weeks of prescribed PT and those who attend more PT sessions than prescribed may be over-utilizing healthcare resources without additional benefit.

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“…A machine learning algorithm was able to predict the worsening of the flexion range of motion after primary TKA. The random-forest model had the best accuracy, and variables of importance were joint-line change, postoperative femorotibial angle, and hemoglobin A1c 64 . Yeramosu et al 65 compared a multivariable logistic regression model and diverse machine learning techniques and found that 1 of the models (random forest) had an accuracy (AUC) of 0.810 for identifying candidates for same-day discharge after revision TKA.…”

Section: Machine Learning and Artificial Intelligencementioning

confidence: 99%

What’s New in Adult Reconstructive Knee Surgery

Villa,

Hosseinzadeh,

Higuera-Rueda

2023

Journal of Bone and Joint Surgery

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In the current Guest Editorial, we evaluate and summarize the most relevant findings from recent, meaningful, peer-reviewed publications in different research areas. Articles at various Levels of Evidence were included, but increased attention was paid to Level-I and award-winning reports. EconomicsConsiderable debate continues with regard to the economics of reconstructive knee surgery. An updated Medicare projection revealed that, by 2040, the annual number of revision total knee arthroplasties (TKAs) performed would be 115,147, whereas, by 2060, it would be 286,740. These values are important for understanding the future health-care resource utilization involving revision TKA, which is only expected to increase 1 . A secondary analysis of a randomized clinical trial (RCT) evaluating health-care resource utilization up to 12 months after primary TKA, among dissatisfied and satisfied patients, showed that patients dissatisfied with their return to function incurred a mean cost of $19,007.70, compared with $13,523.83 for satisfied patients (p = 0.07). Although the cost difference was not significant, its magnitude deserves attention 2 . Data from the New Zealand Joint Registry indicated that patients undergoing TKA have a mortality rate 8% higher than that of the general population 3 . Assessing mortality after primary TKA is relevant for future economic analyses.

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Machine Learning Algorithm to Predict Worsening of Flexion Range of Motion After Total Knee Arthroplasty

Cited by 4 publications

References 32 publications

Gait kinematics and knee stability 10‐years following posterior‐stabilised total knee arthroplasty comparable to healthy adults >55

Gait kinematics and knee stability 10‐years following posterior‐stabilised total knee arthroplasty comparable to healthy adults >55

Optimal Duration of Physical Therapy Following Total Knee Arthroplasty

What’s New in Adult Reconstructive Knee Surgery

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