| Purpose : Total knee arthroplasty(TKA)has become the main operation for the treatment of end-stage knee joint disease,which can effectively relieve pain symptoms,improve the quality of life of patients and increase the range of motion(ROM)of the knee joint,and at the same time,lower limb deformity has also been corrected.The success of knee arthroplasty has been proved to depend on limb alignment to achieve proper balance of flexion and extension space.Reconstruction of equal flexion and extension space has been considered as one of the important factors for the success of TKA surgery,which can reduce the incidence of postoperative complications such as knee ankylosis and instability.However,some studies have found that slightly increasing the flexion space during TKA will not only affect the stability of the knee joint,but also obtain a better range of motion of the knee joint.Methods:This study included 230 patients who received primary TKA treatment in the Affiliated Hospital of Qingdao University from October 2020 to January 2022.They were divided into two groups according to the ROM of knee joint before operation.The preoperative ROM of knee joint ≤ 80°is defined as stiffness of knee joint,and the ROM of knee joint between 80°and 100°is defined as slight reduction.The preoperative ROM of knee joint≤80°is 1 group,and the preoperative ROM of knee joint≥100 °is 2 groups.During the operation,the patients were further divided according to the measured gap difference.In group 1,group A: gap difference was 0 mm,group B: gap difference was1-2 mm,and group C: gap difference was 3 mm.Of the 2 groups of patients,Group D:gap difference is 0 mm,Group E: gap difference is 1-2 mm,Group F: gap difference was3 mm.The ROM of knee joint after operation was divided into poor(≤90°),satisfactory(91°-119°)or good(≥120°).The range of motion of knee joint,anteroposterior and lateral stability of knee joint,the incidence of flexion contracture and hyperextension deformities,the incidence of knee instability,WOMAC and FJS-12 scores of patients in each group were compared.Results: In group A,18.63% of patients flexion ≤ 90 °,41.13% of patients flexion91 °-119 °,24.63% of patients flexion ≥ 120 °.10.39% of patients in Group B flexion ≤90 °,55.83% flexion 91 °-119 °,43.78% flexion ≥ 120 °,7% flexion ≤ 90 °,59.67%flexion 91 °-119 °,33.33% flexion ≥ 120 °.Compared with Group A,patients in Group B and Group C have a greater probability of obtaining satisfactory and good knee joint range of motion,the difference is statistically significant(P<0.05).8.17% of patients in group D had flexion ≤90°.46.55% had flexion between 91° and 119°and 45.28% had flexion ≥120°.4.76% of patients in group E had flexion ≤90°.42.86% had flexion between 91° and 119° and 52.38% had flexion ≥120°.6.67% had flexion ≤90°.43.33% had flexion between 91° and 119°and 50% had flexion ≥120°respectively.There was no significant difference among the three groups(P > 0.05).There were no significant differences in the incidence of flexion contracture deformity among groups A,B and C.There was no hyperextension deformity among the three groups of patients.Compared with the A and B groups of patients,the C group of patients had poor stability in the anteroposterior and lateral sides during knee joint flexion,and the probability of flexion instability increased(P<0.05).There were no significant differences in the incidence of flexion contracture deformity among groups D,E and F.There was no hyperextension deformity among the three groups of patients.Compared with the D and E groups of patients,the F group of patients had poor stability in the anteroposterior and lateral sides during knee joint flexion,and the probability of flexion instability increased(P<0.05).There was no statistical difference in the average WOMAC score among group A,B and C(P > 0.05),and no statistical difference in the average WOMAC score among group D,E and F(P > 0.05).Compared with group A,patients in group B and group C obtained a higher average FJS-12 score,and the difference was statistically significant(P < 0.05).There was no significant difference in the average FJS-12 scores among the three groups(P > 0.05).Conclusion: In patients with preoperative knee joint mobility≤80 °(knee joint stiffness),increasing the flexion gap by 1-2mm during surgery will increase the postoperative knee joint range of motion and higher FJS-12 score,and will not affect the stability of the knee joint.However,when the flexion gap increases by 3mm,the probability of knee instability in patients increases.For patients with preoperative knee range of motion ≥100°,appropriate intraoperative increase of flexion space did not increase postoperative knee range of motion or achieve higher WOMAC and FCS-12 scores,when the flexion gap increases by 3mm,the probability of knee instability in patients increases.This study has important clinical significance,suggesting that for patients with preoperative knee stiffness,we should increase the flexion gap by 1-2mm during surgery to obtain better postoperative knee ROM and clinical results,while maintaining knee stability. |
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