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Ohmi T, Katagiri H, Amemiya M, Ikematsu K, Miyazaki M, Koga H, Yagishita K. Gait analysis of patients with knee osteoarthiritis who can run versus cannot run. Gait Posture 2024; 112:67-72. [PMID: 38744023 DOI: 10.1016/j.gaitpost.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 04/15/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Many middle-aged and older adults participate in running to maintain their health and fitness; however, some have to stop running due to osteoarthritis-attributed knee pain. It was unclear whether gait biomechanics and knee physical findings differ between those who can and cannot run. RESEARCH QUESTION What are the gait and knee physical findings of patients with knee osteoarthritis who remain capable of running in comparison to those who are not capable of running? METHODS This was a cross-sectional study, which recruited 23 patients over the age of 40 who had been diagnosed with knee osteoarthritis. Their knee joint ranges of motion and muscle strength, knee pain, and the maximum gait speed (walk as fast as possible) were measured. Knee alignment was calculated from X-ray images, and the knee joint extension angle and adduction moment during a self-selected gait speed were determined using motion analysis. Participants were divided into two groups-those able to run (n=11) and those unable to run (n=12). The measured and calculated outcomes were compared between groups, and logistic regression analyses of significantly different outcomes were performed. RESULTS There were significant group differences in the maximum knee extension angle during stance phase (p = 0.027), maximum gait speed during the 10-m walk test (p = 0.014), knee pain during gait (p = 0.039) and medial proximal tibial angle by X-ray (p = 0.035). Logistic regression analyses revealed that the maximum knee extension angle during stance phase (OR: 1.44, 95%CI: 1.06¬1.94, p = 0.02) was a significant factor. SIGNIFICANCE The ability to extend the knee during gait is an important contributing factor in whether participants with knee osteoarthritis are capable of running.
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Affiliation(s)
- Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Hiroki Katagiri
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Masaki Amemiya
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Koji Ikematsu
- Department of Rehabilitation, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Midori Miyazaki
- Department of Rehabilitation, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Sappey-Marinier E, Fernandez A, Shatrov J, Batailler C, Servien E, Huten D, Lustig S. Management of fixed flexion contracture in primary total knee arthroplasty: recent systematic review. SICOT J 2024; 10:11. [PMID: 38530205 DOI: 10.1051/sicotj/2024007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/12/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION This study aimed to systematically review the literature and identify the surgical management strategy for fixed flexion contracture in primary total knee arthroplasty (TKA) surgery, pre-, intra-, and post-operatively. Secondary endpoints were etiologies and factors favoring flexion contracture. MATERIALS AND METHODS Searches were carried out in November 2023 in several databases (Pubmed, Scopus, Cochrane, and Google Scholar) using the following keywords: "flexion contracture AND TKA", "fixed flexion deformity AND TKA", "posterior capsular release AND TKA", "posterior capsulotomy in TKA", "distal femoral resection AND TKA". Study quality was assessed using the STROBE checklist and the Downs and Black score. Data concerning factors or strategies leading to the development or prevention of flexion contracture after TKA were extracted from the text, figures, and tables of the included references. The effect of each predictive factor on flexion contracture after TKA was recorded. RESULTS Thirty-one studies were identified to meet the inclusion and exclusion criteria. These studies described a variety of preoperative and intraoperative factors that contribute to the development or correction of postoperative flexion contracture. The only clearly identified predictor of postoperative flexion contracture was preoperative flexion contracture. Intraoperative steps described to correct flexion contracture were: soft-tissue balancing (in posterior and medial compartments), distal femoral resection, flexion of the femoral component, and posterior condylar resection. However, no study has investigated these factors in a global model. DISCUSSION This review identified various pre-, intra-, and post-operative factors predictive of post-operative flexion contracture. In practice, these factors are likely to interact, and it is therefore crucial to further investigate them in a comprehensive model to develop an algorithm for the management of flexion contracture. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Elliot Sappey-Marinier
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Andréa Fernandez
- Service de chirurgie Orthopédique, Centre chirurgical Emile Gallé, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Jobe Shatrov
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Cécile Batailler
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Elvire Servien
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Université Claude Bernard Lyon 1, Lyon, France
| | - Denis Huten
- Chirurgie Orthopédique, Réparatrice et Traumatologique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sébastien Lustig
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
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Fournier J, Trudel G, Feibel RJ, Uhthoff H, McGonagle D, Campbell TM. Asymmetric Flexion Contracture is Associated With Leg Length Inequality in Patients With Knee Osteoarthritis: Data From the Osteoarthritis Initiative. Arch Phys Med Rehabil 2023; 104:2067-2074. [PMID: 37209935 DOI: 10.1016/j.apmr.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To evaluate whether knee flexion contracture (FC) was associated with leg length inequality (LLI) and/or morbidity in knee osteoarthritis (OA). DESIGN We accessed 2 databases: (1) the Osteoarthritis Initiative (OAI) cohort, including participants with, or at-risk of OA, and (2) the Ottawa Knee Osteoarthritis cross-sectional database (OKOA), including participants with primary advanced knee OA. Both included demographics, radiographic data, knee range of motion, leg length, pain, and function scales. SETTING Tertiary care academic rheumatology and orthopedic clinics. PARTICIPANTS Patients with or at-risk of primary OA. We included 881 OAI and 72 OKOA participants (N=953). INTERVENTION Not applicable. MAIN OUTCOME MEASURES The primary outcome tested the association between the difference in knee extensions of the OA and contralateral knees (the knee extension difference, or KExD) and LLI. This was evaluated using bivariate regression, followed by a multivariable linear regression model. RESULTS OAI participants had less severe knee OA [Kellgren and Lawrence (KL) score 1.9±1.3] vs OKOA (KL score 3.4±0.6). The KExD correlated with LLI for both databases (OAI: R=0.167; P≤.001; OKOA: R=0.339; P=.004). Multivariable regression showed an effect of KExD on LLI in both databases (OAI: β=0.37[0.18,0.57]; P<.001, OKOA: β=0.73[0.20,1.26]; P=.007). When broken down by subgroup, the OAI moderate-severe OA group showed a significant effect of KExD on LLI (β=0.60 [0.34,0.85]; P<.001). CONCLUSIONS OA-related loss of knee extension was associated with LLI for those with moderate-severe OA. Because LLI correlates with worse knee OA symptoms, discovering an FC should cue clinicians to evaluate for LLI, an easily-treatable finding that may help reduce OA-associated morbidity for those approaching the need for arthroplasty.
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Affiliation(s)
- John Fournier
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Guy Trudel
- Bone and Joint Lab, Ottawa Hospital Research Institute, Ottawa, Canada; Department of Medicine, Division of Physical and Rehabilitation Medicine, Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | - Robert J Feibel
- The Ottawa Hospital, Division of Orthopedic Surgery, Ottawa, Canada
| | - Hans Uhthoff
- Bone and Joint Lab, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dennis McGonagle
- University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - T Mark Campbell
- Bone and Joint Lab, Ottawa Hospital Research Institute, Ottawa, Canada; Elisabeth Bruyère Hospital, Ottawa, Canada.
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Campbell TM, Westby M, Ghogomu ET, Fournier J, Ghaedi BB, Welch V. Stretching, Bracing, and Devices for the Treatment of Osteoarthritis-Associated Joint Contractures in Nonoperated Joints: A Systematic Review and Meta-Analysis. Sports Health 2023; 15:867-877. [PMID: 36691685 PMCID: PMC10606959 DOI: 10.1177/19417381221147281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
CONTEXT Many patients with osteoarthritis (OA) develop range of motion (ROM) restrictions in their affected joints (contractures), associated with worse outcomes and rising healthcare costs. Effective treatment guidance for lost ROM in OA-affected joints is lacking. OBJECTIVE A systematic review and meta-analysis evaluating the effectiveness of stretching and/or bracing protocols on native (nonoperated) joint ROM in the setting of radiographically diagnosed OA. DATA SOURCES Seven databases, English-language. STUDY SELECTION Studies including participants with radiographically diagnosed OA in any native joint evaluating the effect of stretching or bracing on ROM. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 2. DATA EXTRACTION Two reviewers independently screened articles for inclusion and assessed risk of bias in included trials. Primary outcomes were ROM, pain, and adverse events (AEs). RESULTS We identified 6284 articles. A total of 9 randomized controlled trials, all evaluating the knee, met eligibility criteria. For stretching, 3 pooled studies reported total ROM, which improved by mean difference (MD) of 9.3° (95% CI 5.0°,13.5°) versus controls. Two pooled studies showed improved knee flexion ROM (MD 10.8° [7.3°,14.2°]) versus controls. Five studies were pooled for knee extension with mean improvement 9.1° [3.4°,14.8°] versus controls. Seven pooled studies showed reduced pain (standardized MD 1.9 [1.2,2.6]). One study reported improved knee extension of 3.7° [2.9°,4.5°] with use of a device. No studies used orthoses. One study reported on AEs, with none noted. Performance bias was present in all included studies, and only 3 studies clearly reported blinding of outcome assessors. Strength of evidence for primary outcomes was considered moderate. CONCLUSION There was moderate-quality evidence that stretching is an effective strategy for improving knee total, flexion and extension ROM, and pain. Our findings suggest that stretching to regain joint ROM in OA is not futile and that stretching appears to be an appropriate conservative intervention to improve patient outcomes as part of a comprehensive knee OA treatment plan before arthroplasty.
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Affiliation(s)
- T. Mark Campbell
- Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bone and Joint Laboratory, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital, Department of Medicine, Ottawa, Ontario, Canada
- University of Ottawa, Department of Cellular and Molecular Medicine, Ottawa, Ontario, Canada
| | - Marie Westby
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | | | - John Fournier
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | | | - Vivian Welch
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Moya-Angeler J, León-Muñoz VJ, Jimenez-Soto C, Huber K, Christen B, Calliess T. Fixed Flexion Contracture Can Successfully Be Addressed with Exact Preservation of the Femoral Joint Line and Only Minimal Increase of Tibia Resection in the Concept of Kinematically Aligned Total Knee Arthroplasty. J Pers Med 2023; 13:jpm13050868. [PMID: 37241038 DOI: 10.3390/jpm13050868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
The aims of this study were to evaluate the outcomes of patients undergoing kinematic alignment (KA) robot-assisted (RA) total knee arthroplasty (TKA) with and without preoperative fixed flexion contracture (FFC) and address whether additional resection of the proximal tibia is required to address FFC. A retrospective review from 147 consecutive patients who received an RA-TKA with KA and a minimum one-year follow-up was performed. Preop and postop clinical and surgical data were collected. Groups were set based on preoperative extension deficits: group 1 (0-4°) (n = 64), group 2 (5-10°) (n = 64) and group 3 (>11°) (n = 27). There were no differences in patient demographics among the three groups. In group 3, the mean tibia resection was 0.85 mm thicker than group 1 (p < 0.05) and the preoperative extension deficit was improved from -17.22° (SD 3.49) preop to -2.41° (SD 4.47) postop (p < 0.05). Our results demonstrate that FFC can successfully be addressed in the RA-TKA with KA and rKA and that no additional femoral bone resection is needed to achieve full extension in patients with preoperative FFC when compared with patients without FFC. Only a slight increase in the amount of tibial resection was observed, but this was less than one millimetre.
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Affiliation(s)
- Joaquin Moya-Angeler
- Department of Orthopaedic Surgery, Hospital Universitario Reina Sofia, 30005 Murcia, Spain
- Instituto de Cirugía Avanzada de la Rodilla (ICAR), 30005 Murcia, Spain
| | - Vicente J León-Muñoz
- Department of Orthopaedic Surgery, Hospital Universitario Reina Sofia, 30005 Murcia, Spain
- Instituto de Cirugía Avanzada de la Rodilla (ICAR), 30005 Murcia, Spain
| | | | - Kim Huber
- Articon Spezialpraxis für Gelenkchirurgie, 3013 Berne, Switzerland
| | | | - Tilman Calliess
- Articon Spezialpraxis für Gelenkchirurgie, 3013 Berne, Switzerland
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Zhou G, Zhao M, Wang X, Geng X, Tian H. Demographic and radiographic factors for knee symptoms and range of motion in patients with knee osteoarthritis: a cross-sectional study in Beijing, China. BMC Musculoskelet Disord 2023; 24:378. [PMID: 37173724 PMCID: PMC10176682 DOI: 10.1186/s12891-023-06432-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/14/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) causes not only pain, stiffness, and dysfunction of the knee, but also the reduction of the joint range of motion (ROM). This study explored the demographic and radiographic factors for knee symptoms and ROM in patients with symptomatic KOA. METHODS The demographic variables, Kellgren-Lawrence (KL) grade, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) of patients with symptomatic KOA recruited in Beijing were collected. The knee ROM of all patients were also measured. We analyzed the influencing factors for WOMAC and ROM using a generalize linear model, respectively. RESULTS This study included a total of 2034 patients with symptomatic KOA, including 530 males (26.1%) and 1504 females (73.0%), with a mean age of 59.17 (± 10.22) years. Patients with advanced age, overweight or obesity, a family history of KOA, a moderate-to-heavy manual labor job and use of nonsteroidal anti-inflammatory drugs (NSAIDs) had significantly higher WOMAC and lower ROM (all P < 0.05). The more the comorbidities, the higher the WOMAC (all P < 0.05). Patients with higher education had better ROM than those with only an elementary education(β = 4.905, P < 0.05). Compared with those KL = 0/1, the WOMAC of patients whose KL = 4 were higher (β = 0.069, P < 0.05), but the WOMAC of those KL = 2 were lower (β = -0.068, P < 0.05). ROM decreased with the increase of KL grade (all P < 0.05). CONCLUSIONS KOA patients with advanced age, overweight or obesity, a family history of KOA in first-degree relatives, a moderate-to-heavy manual labor job tended to have more severe clinical symptoms and worse ROM. Patients with more severe imaging lesions tend to have poorer ROM. Symptom management measures and regular ROM screening should be taken early to these people.
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Affiliation(s)
- Ge Zhou
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Minwei Zhao
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xinguang Wang
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xiao Geng
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hua Tian
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, No.49 North Garden Road, Haidian District, Beijing, 100191, China.
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Additional Distal Femoral Resection Minimally Improves Terminal Knee Extension: A Systematic Review and Meta-Regression Challenging the Dogma. Arthroplast Today 2023; 19:101083. [PMID: 36845290 PMCID: PMC9947997 DOI: 10.1016/j.artd.2022.101083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/11/2022] [Indexed: 01/13/2023] Open
Abstract
Background Additional distal femoral resection is a common technique to address a flexion contracture during primary total knee arthroplasty (TKA) but can lead to midflexion instability and patella baja. Prior reports regarding the magnitude of knee extension obtained with additional femoral resection have varied. This study sought to systematically review research describing the effect of femoral resection on knee extension and to perform meta-regression to estimate this relationship. Methods A systematic review was conducted using MEDLINE, PubMed, and Cochrane databases by combining the terms ("flexion contracture" OR "flexion deformity") AND ("knee arthroplasty" OR "knee replacement") to identify 481 abstracts. In total, 7 articles reporting change in knee extension after additional femoral resection or augmentation across 184 knees were included. The mean value for knee extension, its standard deviation, and the number of knees tested were recorded for each level. Meta-regression was performed using weighted mixed-effects linear regression. Results Meta-regression estimated that each 1mm resected from the joint line produced a 2.5° gain of extension (95% confidence interval, 1.7 to 3.2). Sensitivity analyses excluding outlying observations estimated each 1mm resected from the joint line produced a 2.0° gain of extension (95% confidence interval, 1.9 to 2.2). Conclusions Each millimeter of additional femoral resection is likely to produce only a 2° improvement in knee extension. Thus, an additional resection of 2 mm is likely to improve knee extension by less than 5°. Alternative techniques, including posterior capsular release and posterior osteophyte resection, should be considered in correcting a flexion contracture during TKA.
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Chen YC, Lin KC, Yeh SH, Wang CH, Pan AW, Chen HL, Chen CJ. Associations among quality of life, activities, and participation in elderly residents with joint contractures in long-term care facilities: a cross-sectional study. BMC Geriatr 2022; 22:197. [PMID: 35279091 PMCID: PMC8917858 DOI: 10.1186/s12877-022-02870-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Joint contractures and degenerative osteoarthritis are the most common joint diseases in the elderly population, can lead to limited mobility in elderly individuals, can exacerbate symptoms such as pain, stiffness, and disability, and can interfere with social participation and quality of life, thus affecting mental health. However, relevant studies on this topic are very limited. This study describes the associations of joint contracture categories and sites in elderly residents in long-term care facilities with their quality of life, activities, and participation.
Methods
Elderly individuals with joint contractures who were residents in long-term care facilities were recruited. The World Health Organization (WHO) Quality of Life and the WHO Disability Assessment Schedule 2.0 were used to survey the participants. Correlations, multiple linear regressions, and multiple analyses of variance, with joint contractures as the response variable, were used in the statistical analysis.
Results
The final statistical analysis included 232 participants. The explanatory power of contracture sites on activities and participation had a moderate strength of association (η2 = .113). Compared with elderly residents with joint contractures and osteoarthritis isolated to the upper limbs, those with joint contractures and osteoarthritis in both the upper and lower limbs had significantly worse activity and participation limitations. No significant differences in activity and participation were found between elderly residents with joint contractures affecting only the upper limbs and those with joint contractures affecting only the lower limbs (F1,226 = 2.604 and F1,226 = 0.674, nonsignificant). Osteoarthritis had the greatest impact on activity limitations and participation restrictions among elderly residents with joint contractures affecting both the upper and lower limbs (F1,226 = 6.251, p = .014).
Conclusions
Elderly residents in long-term care facilities belonging to minority groups, with a history of stroke, and with osteoarthritis are at a high risk of developing activity limitations and participation restrictions. Moreover, compared with other contraction sites, regardless of osteoarthritis, joint contractures affecting both the upper and lower limbs were associated with the greatest activity limitations and participation restrictions.
Trial registration
This study has been registered in the Chinese Clinical Trial Registry, registration number and date:ChiCTR2000039889 (13/11/2020).
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Agarwal S, Chakrabarti D, Kong K, Mayo I, Morgan-Jones R. Results of revision knee replacement for patients with isolated fixed flexion deformity after primary or revision knee replacement. Knee 2021; 33:260-265. [PMID: 34739957 DOI: 10.1016/j.knee.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/26/2021] [Accepted: 10/03/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postoperative fixed flexion deformity is a known complication of knee replacement surgery. We present our results of revision surgery for treatment of isolated fixed flexion deformity after knee replacement. METHODS 32 patients had revision knee replacement for fixed flexion deformity and were included in this retrospective study. Minimum follow up period was 28 months. RESULTS Two different surgical interventions had been done in these patients. Group 1 (15 patients) had revision of the femoral component, posterior capsular release and tibial component was not revised. Group 2 (18 Patients) had revision of both femoral and tibial components. One patient was included in both groups as she had both interventions. The extent of preoperative flexion deformity in group 1 was from 15 to 40 deg (mean 20.6 deg). Postoperative range of extension was 0 to 20 deg (mean 8.2 deg). In group 2, preoperative flexion deformity was 10 to 25 deg (mean 16.9 deg) and postoperative flexion deformity was 0 to 20 deg (mean 4.2 deg). The difference in improvement between the two groups was not statistically significant on Mann Whitney U test (two tailed p value 0.181) for non normal distribution. Improvement in Oxford knee score following surgery was only 1 point in both groups. CONCLUSION Revision for isolated fixed flexion deformity leads to improvement in range of extension, but improvement in clinical score is marginal. The choice of preservation or revision of the tibial component did not make a significant difference to the outcome.
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Affiliation(s)
| | | | - Keh Kong
- University Hospital Llandough, Cardiff and Vale UHB, UK
| | - Issac Mayo
- University Hospital Llandough, Cardiff and Vale UHB, UK
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Kinoshita T, Hino K, Kutsuna T, Watamori K, Tsuda T, Miura H. Gender-specific difference in the recurrence of flexion contracture after total knee arthroplasty. J Exp Orthop 2021; 8:87. [PMID: 34617136 PMCID: PMC8494879 DOI: 10.1186/s40634-021-00409-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Range of motion after total knee arthroplasty (TKA) can impact patients’ daily lives. Nevertheless, flexion contracture (FC) often recurs after TKA, even upon achieving full extension intraoperatively. This study aimed to evaluate the relationship among preoperative, intraoperative, and postoperative knee extension angles, and clarify the risk factor for postoperative FC. Methods One hundred forty-seven knees undergoing TKA using a navigation system were evaluated. We measured the pre- and postoperative (6 months after TKA) extension angles using a goniometer, and intraoperative (before and after TKA) extension angle using a navigation system; the correlation between these angles at each time point was evaluated. Results The mean preoperative, intraoperative (before and after TKA) and postoperative extension angles were -9.9°, -6.8°, -0.1°, and -2.0°. Regarding intraoperative extension angle after TKA, 58 knees showed ≤ 5° hyperextension and six knees showed > 5° hyperextension. At 6 months, no cases showed hyperextension and 105 knees showed full extension. The mean intraoperative extension angle after TKA in the postoperative full extension group was 0.4°. A significant correlation was found among extension angles at each point (p<0.01, respectively). However, the intraoperative extension angle after TKA correlated with the postoperative extension angle only in females. Contrarily, the recurrence rate of FC was significantly higher in males than in females (p<0.01). Conclusion Intraoperative extension angles significantly correlated with pre- and postoperative extension angles in TKA. Moreover, intraoperative mild (≤ 5°) hyperextension is acceptable for postoperative full extension. There was a gender-specific difference in correlation between intra- and postoperative knee extension angles. Level of evidence III.
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Affiliation(s)
- Tomofumi Kinoshita
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kazunori Hino
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Tatsuhiko Kutsuna
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kunihiko Watamori
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takashi Tsuda
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hiromasa Miura
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Madara KC, Aljehani M, Marmon A, Dellose S, Rubano J, Zeni J. Pre-operative predictors of early mobility and knee motion in patients undergoing a total knee arthroplasty. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1947369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Adam Marmon
- Kinesiology and Applied Physiology, Newark, DE, USA
| | - Steven Dellose
- Department of Orthopaedics, Christiana Care Health System, Wilmington, DE, USA
| | - James Rubano
- Department of Orthopaedics, Christiana Care Health System, Wilmington, DE, USA
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Han HS, Yun KR, Cho K, Kim TW, Kang SB. Relationships between the changes in flexion contracture and standing flexion angle of the knee and sagittal spinal alignment after total knee arthroplasty. Knee 2021; 29:374-380. [PMID: 33706029 DOI: 10.1016/j.knee.2021.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/02/2020] [Accepted: 02/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The sagittal spinal alignment interacts with the lower extremity in patients with combined degenerative disease of the spine and lower extremity. This study aimed to clarify the relationships between the reciprocal changes in sagittal alignment of the knee, pelvis, and spine after total knee arthroplasty (TKA) in osteoarthritis patients. METHODS Prospectively, 36 patients who underwent primary TKA for severe knee osteoarthritis were enrolled. Their clinical and radiological evaluation included assessments of the knee flexion contracture (KFC) and standing knee flexion angle (KFA), as well as spinopelvic parameters and the global sagittal spinal alignment from standing whole-lower-extremity and whole-spine radiographs preoperatively and at postoperative 2 weeks, 6 weeks, 6 months, 1 year, and 2 years. Linear mixed models were used to assess the relationships between KFC/KFA and between spinopelvic/global sagittal spinal alignments. RESULTS The KFC decreased abruptly immediately after TKA, and the correction was maintained for 2 years postoperatively. The KFA decreased gradually and approached the value of the KFC after 2 years. Of the spinopelvic parameters, sacral slope and pelvic incidence decreased significantly, in ways related to changes in KFA. There was no significant relationship between sagittal spinal alignment and postoperative changes in KFC. CONCLUSION Although the flexion contracture was corrected immediately after TKA, the standing KFA improved gradually over 2 years. The pelvic parameters showed compensatory changes according to the KFA. The decompensated sagittal spinal malalignment was not related to a relapse in flexion contracture.
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Affiliation(s)
- Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Kuk-Ro Yun
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Kwanjae Cho
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea.
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LABORATORY BLOOD MARKERS DYNAMICS IN PATIENTS WITH GONARTHROSIS AND KNEE JOINT CONTRACTURE BEFORE AND AFTER TOTAL KNEE REPLACEMENT AND THEIR FURTHER REHABILITATION. WORLD OF MEDICINE AND BIOLOGY 2021. [DOI: 10.26724/2079-8334-2021-1-75-7-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Campbell TM, Ramsay T, Trudel G. Knee Flexion Contractures Are Associated with Worse Pain, Stiffness, and Function in Patients with Knee Osteoarthritis: Data from the Osteoarthritis Initiative. PM R 2020; 13:954-961. [DOI: 10.1002/pmrj.12497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/25/2020] [Accepted: 09/11/2020] [Indexed: 12/22/2022]
Affiliation(s)
- T Mark Campbell
- Department of Physical Medicine and Rehabilitation Elisabeth Bruyère Hospital Ottawa ON Canada
| | - Tim Ramsay
- Ottawa Hospital Research Institute Ottawa ON Canada
| | - Guy Trudel
- Department of Medicine, Division of Physical and Rehabilitation Medicine The Ottawa Hospital Ottawa ON Canada
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Rapid Versus Standard Recovery Protocol Is Associated With Improved Recovery of Range of Motion 12 Weeks After Total Knee Arthroplasty. J Am Acad Orthop Surg 2020; 28:e962-e968. [PMID: 32053526 DOI: 10.5435/jaaos-d-19-00597] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION With the increasing demand for total knee arthroplasty (TKA), rapid recovery protocols (RRPs) have been introduced to reduce costs and the length of stay (LOS). Little is known about the effects of RRPs on postoperative knee range of motion (ROM). METHODS We reviewed the medical charts of 323 patients who underwent primary TKA performed by a single orthopaedic surgeon at a university-based orthopaedic tertiary care safety net practice. Of the 323 patients, 129 were treated with a standard recovery protocol (SRP) between January 1, 2012, and December 10, 2013, and 194 with a RRP beginning December 11, 2013. Knee ROM was assessed at the preoperative visit and at scheduled postoperative visits for up to 1 year. Differences in mean LOS between the groups were compared using a Poisson regression with and without adjustment for covariates. Repeated measures analysis of covariance was used to evaluate the effects of recovery protocol, time, and the interaction of recovery protocol by time on flexion and flexion contracture. The probability of achieving flexion ≥120° and having a flexion contracture ≥10° was estimated using the SAS/STAT GLIMMIX procedure with a binary distribution and a logit link. RESULTS The mean LOS for the RRP and SRP groups was 0.8 and 2.5 days, respectively. RRP was associated with greater flexion at 2, 6, and 12 weeks and a higher probability of attaining flexion ≥120° at 6 and 12 weeks. Patients receiving a RRP had less severe flexion contracture and a lower probability of flexion contracture ≥10° at 2, 6, and 12 weeks. DISCUSSION During the first 12 weeks after TKA, patients who received a RRP had a markedly greater ROM than patients who received a SRP, suggesting that RRP may allow patients to do a greater variety of activities of daily living during the first 3 postoperative months while reducing health care costs. LEVEL OF EVIDENCE Level III.
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16
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Effect of additional distal femoral resection on flexion deformity in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28:2924-2929. [PMID: 31420688 DOI: 10.1007/s00167-019-05675-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/09/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE Flexion deformity after total knee arthroplasty (TKA) is associated with poor function and dissatisfaction and should, therefore, be avoided. In the case of preoperative flexion deformity, an increased distal resection of the femur may be necessary. The degree of resection required has only been determined for cruciate-retaining (CR) prostheses to date and varies considerably from study to study. Although, for many surgeons, the algorithm for the treatment of a flexion deformity includes the resection of the posterior cruciate ligament (PCL) before additional distal resection, the degree of resection necessary for posterior-stabilized (PS)-type prostheses is not known. METHODS Fifty consecutive patients (50 knees) who were due to undergo navigated TKA were included in this prospective study. At the end of the operation, the flexion deformity resulting from different sizes of distal femoral augmentations on the trial implants (0-8.5 mm) was determined using the navigation system. RESULTS A linear relationship of 2.2° ± 0.3° flexion deformity per mm distal femoral augmentation was found. This was not dependent on age, sex, the preoperative coronal alignment, or the preoperative flexion deformity. CONCLUSIONS In conclusion, after the removal of posterior osteophytes and posterior capsule release, around 5 mm of the distal femur must be further resected in the case of 10° flexion deformity and 9 mm in the case of 20° flexion deformity. LEVEL OF EVIDENCE II (Prospective cohort study).
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Knee Flexion Contracture Associated With a Contracture and Worse Function of the Contralateral Knee: Data From the Osteoarthritis Initiative. Arch Phys Med Rehabil 2020; 101:624-632. [DOI: 10.1016/j.apmr.2019.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/14/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022]
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Campbell TM, Ghaedi BB, Ghogomu ET, Westby M, Welch VA. Effectiveness of stretching and bracing for the treatment of osteoarthritis-associated joint contractures prior to joint replacement: a systematic review protocol. BMJ Open 2019; 9:e028177. [PMID: 31366647 PMCID: PMC6678023 DOI: 10.1136/bmjopen-2018-028177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Many patients with osteoarthritis (OA) develop restrictions in passive range of motion (ROM) of their affected joints (called contractures), leading to increased pain and reduced function. Effective treatment to reverse OA-associated contractures is lacking. Our aim is to evaluate the effectiveness of stretching and bracing on native (non-operated) joint contractures in people with radiographically diagnosed OA. METHODS AND ANALYSIS We will search the following databases without time restriction: Cochrane Library (CENTRAL, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database), MEDLINE, Embase, CINAHL, SCI-EXPANDED (ISI Web of Knowledge) and PEDro. Other sources will include WHO International Clinical Trials Registry Platform, reference lists of included studies, relevant systematic reviews and textbooks. We will include randomised controlled trials (RCTs), controlled clinical trials, controlled before-and-after studies, cohort studies and case-control studies that include participants ≥18 years of age with radiographic evidence of OA. Participants with inflammatory arthropathies or those that have undergone joint arthroplasty will be excluded. Interventions will include therapist-administered or patient-administered stretching, use of an orthosis (static or dynamic), use of serial casting and/or adjunctive modalities. Outcomes will include joint ROM (active and passive), pain (rest and/or activity related), stiffness, activity limitations, participation restrictions, quality of life and adverse events. Studies will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study inclusion, data extraction and quality assessment will be performed independently by two reviewers. Risk of bias will be assessed using appropriate tools for each study design. Data synthesis will be performed using Cochrane Review Manager software. If sufficient data are available, meta-analysis will be conducted. We will summarise the quality of evidence using Grading of Recommendations Assessment, and the effect size of interventions for RCT and non-RCT studies. ETHICS AND DISSEMINATION Ethics approval not required because individual patient data are not included. Findings will be disseminated in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019127244.
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Affiliation(s)
- T Mark Campbell
- Physical Medicine and Rehabilitation, Elisabeth-Bruyère Hospital, Ottawa, Ontario, Canada
| | - Bahareh Bahram Ghaedi
- Physical Medicine and Rehabilitation, Bruyère Research Institute, Ottawa, Ontario, Canada
| | | | - Marie Westby
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Vivian A Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
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Iliopoulos E, Galanis N, Iosifidis M, Zafeiridis A, Papadopoulos P, Potoupnis M, Geladas N, Vrabas IS, Kirkos J. Anterior cruciate ligament deficiency reduces walking economy in "copers" and "non-copers". Knee Surg Sports Traumatol Arthrosc 2017; 25:1403-1411. [PMID: 26231149 DOI: 10.1007/s00167-015-3709-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 07/13/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Patients with ACL injury requiring surgical treatment (non-copers) demonstrate altered neuromuscular control and gait pattern compared with those returning to their pre-injury activities without surgery (copers). Pathological gait pattern may increase the energy cost of walking. We compared the energy cost of flat, uphill, and downhill walking between ACL-deficient and healthy individuals and between "copers" and "non-copers". METHODS Nineteen young males with unilateral ACL injury were allocated into "copers" and "non-copers" according to their ability to return to pre-injury activity without ACL reconstruction. Lysholm and IKDC scales were recorded, and a control group (n = 10) matched for physical characteristics and activity levels was included. All participants performed 8-min walking tasks at 0, +10, and -10 % gradients. Energy cost was assessed by measurement of oxygen consumption (VO2). HR and ventilation (VE), respiratory exchange ratio (RER), and VE/VO2 were also measured. RESULTS VO2 and HR were higher in ACL-deficient patients than in controls during walking at 0, +10, and -10 % gradients (p < 0.01-0.05). There were no differences between "copers" and "non-copers" in VO2 and HR for any gradient. No differences were observed in VE, RER, and VE/VO2 among the three groups. CONCLUSIONS The walking economy of level, uphill, and downhill walking is reduced in ACL-deficient patients. Despite the improved functional and clinical outcome of "copers", their walking economy appears similar to that of "non-copers" but impaired compared with healthy individuals. The higher energy demand and effort during locomotion in "copers" and "non-copers" has clinical implications for designing safer rehabilitation programmes. The increased energy cost in "copers" may be another parameter to consider when deciding on the most appropriate therapeutic intervention (operative and non-operative), particularly for athletes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Efthymios Iliopoulos
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, Thessaloniki, 56403, Greece
| | - Nikiforos Galanis
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, Thessaloniki, 56403, Greece.
| | - Michael Iosifidis
- Sports Medicine Unit, 2nd Orthopaedic Department, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Pericles Papadopoulos
- 1st Department of Orthopaedics, Papanikolaou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Potoupnis
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, Thessaloniki, 56403, Greece
| | - Nikolaos Geladas
- Department of Sport Medicine and Biology of Exercise, School of Physical Education and Sport Science, University of Athens, Athens, Greece
| | - Ioannis S Vrabas
- Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - John Kirkos
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, Thessaloniki, 56403, Greece
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Erickson BJ, Campbell K, Cvetanovich GL, Harris JD, Bach BR, Sherman SL. Nonligamentous Soft Tissue Pathology About the Knee: A Review. Orthopedics 2016; 39:32-42. [PMID: 26709560 DOI: 10.3928/01477447-20151218-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/20/2015] [Indexed: 02/03/2023]
Abstract
Knee pain is one of the most frequent complaints evaluated by orthopedic surgeons. It encompasses a broad range of pathology and can present in a variety of ways. Most of this pain can be attributed to essential structures of the knee, including the menisci, cruciate or collateral ligaments, and articular cartilage. However, there are underrecognized structures in and around the knee that can frequently be a cause of knee pathology and pain. Knee pain stemming from these structures may be missed or incorrectly diagnosed, and these patients often present for second and third opinions because of failure to diagnose and treat the underlying pathology. The synovial plica, suprapatellar pouch, lateral retinaculum, infrapatellar fat pad, and infrapatellar branch of the saphenous nerve are less common but still significant causes of knee pain. Although initial treatment involves various nonoperative modalities, operative treatment is often warranted. Operative and nonoperative management of these soft tissue structures may occur in isolation or with concomitant procedures, including knee ligament reconstruction, total knee arthroplasty, tibial tuberosity osteotomy, or lysis of adhesions. With proper recognition of the role of these structures in knee pain, the orthopedic surgeon can offer a valuable primary or adjunctive treatment option for patients with knee pain, especially those without localizing signs of meniscal, ligamentous, or cartilage damage.
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Chen JY, Loh B, Woo YL, Chia SL, Lo NN, Yeo SJ. Fixed Flexion Deformity After Unicompartmental Knee Arthroplasty: How Much Is Too Much. J Arthroplasty 2016; 31:1313-1316. [PMID: 26748406 DOI: 10.1016/j.arth.2015.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/20/2015] [Accepted: 12/08/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The detrimental impact of postoperative fixed flexion deformity (FFD) after unicompartmental knee arthroplasty (UKA) is manifold. This study aims to define the amount of postoperative FFD that is clinically relevant after UKA. METHODS Between 2005 and 2012, 803 patients who underwent a primary UKA at a tertiary hospital were prospectively followed up. They were categorized into 3 groups based on the amount of postoperative FFD: (1) 0° (control); (2) 1°-10° (mild FFD); and (3) >10° (severe FFD). RESULTS There were 26 patients (3%) with severe FFD at 2 years after UKA. The Knee Society Function Score and Knee Score in the severe FFD group were 10 ± 4 and 10 ± 2 points lower than in the control group, respectively (P = .017 and P = .001). Similarly, the Oxford Knee Score and Physical Component Score in the severe FFD group was 5 ± 1 and 7 ± 2 points lower than in the control group, respectively (P = .033 and P < .001). CONCLUSION This study suggests that postoperative FFD of >10° after UKA is associated with significantly poorer functional outcomes.
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Affiliation(s)
- Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Bryan Loh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Yew Lok Woo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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