Analysis Of The Influential Factors Of Functional Evaluation In Different Periods After Total Knee Arthroplasty

Objective: To describe the changes of functional evaluation after total knee arthroplasty,to explore the factors influencing functional evaluation in different periods after total knee arthroplasty,to determine the main factors influencing functional evaluation in different periods,and to provide the clinical guidelines for the rehabilitation guidance after total knee arthroplasty reference.Methods: A prospective cohort study was conducted to collect the clinical data of female patients(one year after surgery)who underwent unilateral total knee arthroplasty in our hospital from December 2015 to December 2016.64 patients were enrolled in this study using outpatient questionnaires and telephone follow-up.HSS score,visual analogue scale(VAS)pain score,timed up and go(TUG),knee range of motion,(ROM),quadriceps muscle strength level of five aspects,of which the degree of joint mobility measurement is divided into two items of flexion and extension of the content were calculated at 1 month,6 months and 12 months after operation.Pearson correlation analysis was conducted between the factors that may affect the functional evaluation of patients and the corresponding periods of HSS scores.The multiple factors of stepwise regression were used to determine the main factors affecting the functional evaluation of patients at different periods.Results: 1.HSS score,flexion,extension and quadriceps muscle strength of patients showed an increasing trend with time,VAS score,TUG showed a decreasing trend with time.2.According to the results of Pearson correlation analysis,it can be found that the functional evaluation of the first month after total knee arthroplasty is related to pain,functional level and joint activity.The VAS score,TUG and HSS score were negatively correlated,and the degree of flexion and extension were positively correlated with the HSS score.Functional evaluation at 6 and 12 months after total knee arthroplasty was associated with pain,functional level,joint activity,and quadriceps muscle strength.VAS score,TUG and HSS score were negatively correlated,and flexion,extension and quadriceps muscle strength were positively correlated with HSS score.3.The results of multivariate stepwise regression showed that the first month of flexion(P = 0.001)and the VAS score(P = 0.001)were included in the stepwise multiple regression equation.According to the standardized coefficient absolute value flexion(0.386)> VAS score(-0.373).TUG(P <0.001)and quadriceps muscle strength(P <0.001)at the 6th month after operation were included in the multivariate stepwise regression equation.According to the normalized ratio of absolute value of TUG(-0.654)> quadriceps muscle strength(0.472).TUG(P <0.001)and quadriceps muscle strength(P <0.001)at the 12 th month after operation were included in the multivariate stepwise regression equation.Quadriceps muscle strength(0.503)> TUG(-0.455)at the 12 th month after operation was recorded in the multivariate stepwise regression equation based on the standardized coefficient absolute value.Conclusion: 1.The functional evaluation of patients showed obvious changes with the change of time,most of the functional evaluation changes occurred in the first 6 months after operation,and the functional evaluation of patients showed a stable trend from 6 to 12 months after operation.2.The functional assessment of total knee arthroplasty was related to the pain,functional level,joint mobility and quadriceps muscle strength.3.Pain and flexion are the main factors that affect the early postoperative functional evaluation.The functional level and quadriceps muscle strength are the main factors that influence the later functional evaluation.4.In clinical practice,patients after total knee arthroplasty should be paid more attention to the management of flexion and pain in the early postoperative period,and paid more attention to the functional quadriceps exercises in the late postoperative period.