Influence Of Preoperative Range Of Motion On The Efficacy Of Total Knee Arthroplasty

Objective:To analyze the influence of preoperative range of motion(ROM)on the efficacy of total knee arthroplasty(TKA).Methods:From January 2015 to December 2017,100 knees of 90 patients who were underwent total knee arthroplasty were enrolled in Affiliated Zhongshan Hospital of Dalian university,according to the specific screening criteria.According to the preoperative ROM of knee,these patients were divided into three groups,(ROM≤50°)20 knees,(50°<ROM<90°) 40 knees,(ROM≥90°) 40 knees.The knee joints of all patients were able to extend straight,with limited flexion.Blood biochemical examination and physical examination were performed before operation.For patients with basic diseases,relevant department were invited for consultation in order to actively treat and control the disease.We should exclude the contraindications of surgery to ensure the safety of anesthesia and operation to reduce the risk of postoperative complications.All patients were performed without patella resurfacing.All the prostheses were fixed with bone cement.The operations were performed by the same operator and team.Patients were given Routine antibiotics used to prevent infection,painkillers,anticoagulants and air pressure pumps to prevent thrombosis and under the guidance of doctors for rehabilitation.The function of knees was evaluated by the American knee society score(KSS).The preoperative and postoperative motion,KSS knee joint score and function score were recorded.ROM at surgery were recorded.The clinical outcomes of three groups were conducted statistical analysis.Results:The mean follow-up time was 25.4 months(12 to 48 months).ROM in ROM≤50° group increased to(93.05±7.67)° at the last follow-up,the knee joint score of KSS was increased to(85.18±4.61)points,and the function score score were increased to(83.80±4.21)points,higher than that in preoperation(P﹤0.01).ROM in 50°<ROM<90°group was increased to(101.93±8.32)° at the last follow-up,the knee joint score of KSS was increased to(85.18±4.61) points,and the function score score were increased to(83.80±4.21)points,higher than that in preoperation(P﹤0.01).ROM in ROM>90°group was increased to(111.13±8.39)° at the last follow-up,the knee joint score of KSS was increased to(88.25±4.71) points,and the function score score were increased to(87.20±6.26) points,higher than that in preoperation(P﹤0.01).There was a significant difference in ROM between the three groups during operation(P﹤0.01).Between the last follow-up of the three groups of patients:there were significant differences in ROM,the knee joint score of KSS and the function score(P﹤0.01).ROM,the knee joint score of KSS score and function score in ROM≤50° group were not as good as the other two groups at the last follow-up,but the improvement of ROM(57.80±13.07)° is significantly better than the other two groups;there was a similar degree of improvement in KSS score and function score,but no significant difference was found(P>0.05).Preoperative and postoperative ROM by Pearson correlation analysis(r=0.662,P﹤0.01),The postoperative ROM was related to preoperative ROM.By unitary regression analysis,the preoperative ROM was also related to postoperative ROM(correction R~2=0.432,P﹤0.01),the better ROM before operation,the better ROM after operation.All patients had no complaints of knee instability after operation.They were able to walk independently and complete their daily life.No complication such as nerve injury,infection and thromboembolism occurred.During the follow-up,X-ray images film of all patients showed that the force line of lower limbs and prosthesis were in good position,and the alignment showed no signs of loosening,subsiding and displacement.Conclusion:The postoperative ROM was related to postoperative ROM.Preoperative ROM is an important factor affecting postoperative ROM of TKA,which can play an important role in predicting postoperative ROM.Preoperative range of motion of knee influence on clinical efficacy of total knee arthroplasty,knees that have good preoperative ROM have better clinical postoperative efficacy than those with poor preoperative ROM.