effect of total knee arthroplasty on joint movement during functional activities and joint range of motion with particular regard to higher flexion users, The

ABSTRACT

Purpose To evaluate active and functional knee excursion of patients before and after total knee arthroplasty (TKA) and to determine whether TKA restores quality of life related to functional activities of daily living.

Method Electrogoniometry was used to measure the functional move of the knee during 11 activities of daily living in 50 patients who underwent TKA. These data were compared with the patient's active range of motion and quality-of-life scores.

Result A cut-off point existed between los and gain in flexion at between 90 and 95 stages of preoperative active flexion. sum of two units thirds of patients had preoperative flexion of more than 90 steps 83% of them had reduc flexion postoperatively. The remaining single third had preoperative flexion of 90 stages or less, 85% of them had improved flexion postoperatively. A similar pattern of los and gain occurr for functional move of the knee. Reduced functional range was associated with significantly reduc physical quality of life compared with age-matched healthy subjects

Conclusion. Although TKA presents excellent pain relief and contributes to the overall well-being of the patient, these be deriveds suggest that it also leads to a reduc range of active and functional motion in the majority of patients. This is associated with a lower-than-normal physical quality of life. The design of implants and rehabilitation programmes should be reconsidered with equal reason that better range of motion and quality of life can be achieved for patients.

Key words: activities of daily living; arthroplasty, replacement, knee; movement; quality of life; range of motion, articular; treatment outcome

INTRODUCTION

Total knee arthroplasty (TKA) has been established as a valuable conduct for the management of patients with disabling knee osteoarthritis.1,2 The goal of TKA is to provide the best possible issue for the patient.3 It is performed primarily to relieve the pain and limitation in knee move caused by arthritis.4 A number of studies have confirmed that pain is considerably reduc following TKA for greatest in quantity patients. This leads to improved quality of life and greater general mobility.1-2,5 Nonetheless, the relationship between joint range of motion (ROM)-joint motion during functional activities-and quality of life has been explored with les rigour.

Joint ROM measured either passively or actively upon a couch, is considered an important result measure and is included in many knee scoring systems5 Arthritis can limit joint motion at individual or both extremes of range.6 The obstacles to extension are nearly always eliminated or reduc after surgery7 Surgery can also dislodge wholly or partly, the pathological obstacles to flexion, on the contrary these may be replaced through mechanical obstacles inherent in the design of the prostheses or tension in the impressible tissues.6 A review of 724 replaced knee indicated that nearly single half could not be flex beyond 90?° at one-year follow-up and the number of knee that could flex beyond 110?° ruthless postoperatively.6 Postoperative flexion depended partly upon preoperative flexion and partly upon the prosthesis used, but the correlation between them was weak and plenteous individual variation remained unexplained.

In a multicentre trial involving 621 patients with 2-year follow-up patients were divided into 3 assemblages based on preoperative ROM (?‰¤90?° 91?°-105?° and >105?°)3 The mean postoperative ROM was 107?° All postoperative comes tended to be within a predictable range-a single range to which all the preoperative values migrated. As a be the effect the group with low preoperative ROM (?‰¤90?°) improved the greatest in quantity No other patient characteristics showed a significant correlation with the flexion outcome3 A more novel review of the literature related to knee flexion following TKA identified 13 papers that dealt with this issue.8 Although the papers were somewhat contradictory, it was conclud that knee with useful preoperative flexion had better final flexion on the contrary also lost some flexion, whereas those with poor preoperative flexion gained flexion. The preoperative ROM did not powerfully predict the postoperative ROM when applied to the whole assemblage of TKA patients.8

The World Health Organization has indicated that serviceable postoperative ROM should not be presum to be associated with improved quality of life or functional motion of the knee during daily activities.9,10 A inquiry to determine which functional activities were important to patients following TKA indicated that approximately 50% to 75% of them ground stretching, strengthening exercises, kneeling, and gardening difficult and that these activities were important and prevalent for them." They conclud that improvements in knee function following arthroplasty were still extremityed to allow patients to do activities that they considered important.

In a series of studies,12-16 our research clump has used a system of flexible electrogoniometry15'16 to scientifically record the angular displacement of the knee during a range of functional activities in the couple TKA patients13,14 and normal older adults.12 These studies explored the impact of TKA upon functional ROM, and the expanse to which normal function was restored postoperatively. The ensues indicated that >90?° flexion of the knee was required for many daily functional activities, and that there had been little general improvement in knee joint motion in like activities for up to 2 years following TKA.14