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Knee Flexion Angle Following Total Knee Arthroplasty Relates to a Preoperative Range of Motion of the Hip

Nakano, Naoki Kubo, Seiji Sato, Yutaka Takayama, Koji Mizuno, Kiyonori Kuroda, Ryosuke Matsumoto, Tomoyuki 神戸大学

2021.08

概要

Background Many factors have been reported to affect postoperative range of knee flexion after total knee arthroplasty (TKA); however, no study has reported the impact of preoperative range of motion of the hip to the postoperative flexion angle of the knee thus far. Methods Of 38 consecutive patients who underwent posterior-stabilized TKA, we assessed 21 patients after excluding 17 patients who met exclusion criteria. The range of motion of the knee and the hip, age, body-mass index, serum albumin level, HbA1c, Kellgren-Lawrence grade, knee extension strength and radiological femorotibial angle as well as postoperative knee flexion angle at three months were evaluated. The preoperative data and the knee flexion angle at three months after TKA were compared using Spearman's rank correlation coefficient. Results Knee flexion angle at three months after TKA was positively correlated with preoperative flexion (rho = 0.616, p = 0.007) and external rotation angle (rho = 0.576, p = 0.012) of the hip as well as preoperative knee flexion angle (rho = 0.797, p = 0.001). There were no correlations between postoperative knee flexion angle and other preoperative data. Conclusions Patients with restricted flexion and/or external rotation of the hip may have contractures of Gluteus maximus, Gluteus medius and Tensor fasciae latae, which can cause hypertension of iliotibial tract. It may cause decreased internal rotation of the tibia when the knee is flexed, which affects postoperative knee flexion angle, thus limited flexion and/or external rotation of the hip might restrict knee flexion angle following TKA.

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Figure 1

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Vanguard Posterior-Stabilized; Zimmer Biomet, Warsaw, IN, USA

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24

Figure 1

Table 1

Exclusion criteria of the study

TKA: total knee arthroplasty

TKA for valgus deformity of the knee (femorotibial angle by long leg X-ray <

170°)

Simultaneous bilateral TKA

Patients who had surgery in the ipsilateral knee or hip (e.g., total hip

arthroplasty, high tibial osteotomy, fracture surgery, and hip osteotomy)

Patients with severe bony defect requiring bone graft or augmentation

Revision TKA

TKA using other prostheses (i.e., not Vanguard Posterior-Stabilized)

TKA not due to osteoarthritis or osteonecrosis (e.g., rheumatoid arthritis,

trauma, and tumour)

Patients with active knee joint infection

Patients who had postoperative rehabilitation with different protocols

Table 2

Results of Spearman's rank correlation coefficient between the preoperative data

and the knee flexion angle at three months after total knee arthroplasty

SD: standard deviation

Postoperative

knee

angle

flexion

Mean ± SD

Correlation

p-value

(range)

coefficient

(*: < 0.05)

.797

.001*

.223

.0332

.616

.007*

- .226

.325

- .009

.337

- .192

.403

.576

.012*

121.2 ± 7.2 °

(95 - 130)

Preoperative values

Knee flexion

124.8 ± 11.1 °

(90 - 140)

Knee extension

-7.6 ± 4.4 °

(-15 - 0)

Hip flexion

124.8 ± 11.1 °

(100 - 135)

Hip extension

7.6 ± 5.8 °

(-5 - 20)

Hip abduction

33.3 ± 6.4 °

(25 - 50)

Hip adduction

8.8 ± 5.2 °

(0 - 20)

Hip external rotation

24.3 ± 9.1 °

(5 - 45)

Hip internal rotation

27.4 ± 11.7 °

.128

.582

- .034

.780

.003

.989

.098

.672

.342

.130

(5 - 45)

Age

74.4 ± 6.7 years

(62 - 83)

Body Mass Index

26.7 ± 2.8 kg/m2

(22.3 - 32.8)

Serum albumin

4.0 ± 0.3 g/dl

(3.5 - 4.7)

HbA1c

5.7 ± 0.4 %

(5.1 - 6.6)

Kellgren-Lawrence grade

III: 1, IV: 20

.038

.871

Knee extension strength

14.3 ± 30.3 N/kg

.295

.194

178.5 ± 5.0 °

- .185

.423

Femorotibial angle

(170 - 186)

...

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