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Guidelines for the Early Restoration of Active Knee Flexion After Total Knee Arthroplasty: Implications for Rehabilitation and Early Intervention

  • Jay R. Ebert
    Correspondence
    Corresponding author Jay R. Ebert, PhD, The School of Sport Science, Exercise and Health (M408), The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
    Affiliations
    School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Perth, WA; and Hollywood Functional Rehabilitation Clinic, Nedlands, Perth, WA, Australia
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  • Claire Munsie
    Affiliations
    School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Perth, WA; and Hollywood Functional Rehabilitation Clinic, Nedlands, Perth, WA, Australia
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  • Brendan Joss
    Affiliations
    School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Perth, WA; and Hollywood Functional Rehabilitation Clinic, Nedlands, Perth, WA, Australia
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Published:March 05, 2014DOI:https://doi.org/10.1016/j.apmr.2014.02.015

      Abstract

      Objectives

      To investigate the association between active knee flexion at initial (1–2wk) and final (7wk) outpatient visits after total knee arthroplasty (TKA), and to develop a guide for the expected progression of knee flexion in the subacute postoperative phase.

      Design

      Prospective case series.

      Setting

      Rehabilitation clinic.

      Participants

      Consecutive sample of patients (N=108) who underwent TKA between December 2007 and August 2012.

      Intervention

      TKA followed by a standardized, 5-week outpatient rehabilitation program (2 sessions per week) immediately after hospital discharge.

      Main Outcome Measure

      Active knee flexion was recorded on the patient's first outpatient visit (1–2wk) and then biweekly throughout the patient's 5-week outpatient rehabilitation program.

      Results

      Active knee flexion at initial (1–2wk) and final (7wk) outpatient visits were significantly correlated (r=.86, P<.001). Mean active knee flexion significantly improved (P<.001) across all patients from 90.4° at initial outpatient visit to 110° at final outpatient visit. At 7 weeks postsurgery, a value of 100° was determined as the cut-off point for an acceptable active knee flexion, which corresponded with 80° of active knee flexion at initial outpatient presentation at 1 to 2 weeks.

      Conclusions

      Active knee flexion at the initial outpatient visit exhibits a strong correlation with knee flexion at 7 weeks after TKA. These knee flexion guidelines may allow for the provision of individualized rehabilitation, allow practitioners to provide patients with realistic goals of progression throughout the subacute phase, and allow the early identification of patients at risk for poor long-term outcomes who may benefit from further intensive care or other early intervention.

      Keywords

      List of abbreviations:

      OA (osteoarthritis), ROM (range of motion), TKA (total knee arthroplasty)
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      References

        • Nicholas J.
        Rehabilitation of patients with rheumatological disorders.
        in: Bradom R. Physical medicine and rehabilitation. 2nd ed. WB Saunders, Philadelphia2000: 750-751
        • Peterson L.
        Articular cartilage injuries treated with autologous chondrocyte transplantation in the human knee.
        Acta Orthop Belg. 1996; 62: 196-200
        • Brittberg M.
        • Lindahl A.
        • Nilsson A.
        • Ohlsson C.
        • Isaksson O.
        • Peterson L.
        Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.
        N Engl J Med. 1994; 331: 889-895
        • Access Economics
        Painful realities: the economic impact of arthritis in Australia in 2007.
        Arthritis Australia, Canberra2007
        • Elders M.J.
        The increasing impact of arthritis on public health.
        J Rheumatol Suppl. 2000; 60: 6-8
        • Lawrence R.C.
        • Helmick C.G.
        • Arnett F.C.
        • et al.
        Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States.
        Arthritis Rheum. 1998; 41: 778-799
        • Anouchi Y.S.
        • McShane M.
        • Kelly Jr., F.
        • Elting J.
        • Stiehl J.
        Range of motion in total knee replacement.
        Clin Orthop Relat Res. 1996; 331: 87-92
        • Ranawat C.S.
        • Ranawat A.S.
        • Mehta A.
        Total knee arthroplasty rehabilitation protocol: what makes the difference?.
        J Arthroplasty. 2003; 18: 27-30
        • Devers B.N.
        • Conditt M.A.
        • Jamieson M.L.
        • Driscoll M.D.
        • Noble P.C.
        • Parsley B.S.
        Does greater knee flexion increase patient function and satisfaction after total knee arthroplasty?.
        J Arthroplasty. 2011; 26: 178-186
        • Rowe P.J.
        • Myles C.M.
        • Walker C.
        • Nutton R.
        Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life?.
        Gait Posture. 2000; 12: 143-155
        • Tew M.
        • Forster I.W.
        • Wallace W.A.
        Effect of total knee arthroplasty on maximal flexion.
        Clin Orthop Relat Res. 1989; 247: 168-174
        • Mockford B.J.
        • Thompson N.W.
        • Humphreys P.
        • Beverland D.E.
        Does a standard outpatient physiotherapy regime improve the range of knee motion after primary total knee arthroplasty?.
        J Arthroplasty. 2008; 23: 1110-1114
        • Miner A.L.
        • Lingard E.A.
        • Wright E.A.
        • Sledge C.B.
        • Katz J.N.
        Knee range of motion after total knee arthroplasty: how important is this as an outcome measure?.
        J Arthroplasty. 2003; 18: 286-294
        • Ritter M.A.
        • Campbell E.D.
        Effect of range of motion on the success of a total knee arthroplasty.
        J Arthroplasty. 1987; 2: 95-97
        • Dennis D.A.
        • Komistek R.D.
        • Stiehl J.B.
        • Walker S.A.
        • Dennis K.N.
        Range of motion after total knee arthroplasty: the effect of implant design and weight-bearing conditions.
        J Arthroplasty. 1998; 13: 748-752
        • Harvey I.A.
        • Barry K.
        • Kirby S.P.
        • Johnson R.
        • Elloy M.A.
        Factors affecting the range of movement of total knee arthroplasty.
        J Hand Surg [Br]. 1993; 75: 950-955
        • Maloney W.J.
        • Schurman D.J.
        The effects of implant design on range of motion after total knee arthroplasty. Total condylar versus posterior stabilized total condylar designs.
        Clin Orthop Relat Res. 1992; 278: 147-152
        • Menke W.
        • Schmitz B.
        • Salm S.
        Range of motion after total condylar knee arthroplasty.
        Arch Orthop Trauma Surg. 1992; 111: 280-281
        • Parsley B.S.
        • Engh G.A.
        • Dwyer K.A.
        Preoperative flexion. Does it influence postoperative flexion after posterior-cruciate-retaining total knee arthroplasty?.
        Clin Orthop Relat Res. 1992; 275: 204-210
        • Schurman D.J.
        • Matityahu A.
        • Goodman S.B.
        • et al.
        Prediction of postoperative knee flexion in Insall-Burstein II total knee arthroplasty.
        Clin Orthop Relat Res. 1998; 353: 175-184
        • Schurman D.J.
        • Parker J.N.
        • Ornstein D.
        Total condylar knee replacement. A study of factors influencing range of motion as late as two years after arthroplasty.
        J Hand Surg [Am]. 1985; 67: 1006-1014
        • Farahini H.
        • Moghtadaei M.
        • Bagheri A.
        • Akbarian E.
        Factors influencing range of motion after total knee arthroplasty.
        Iran Red Crescent Med J. 2012; 14: 417-421
        • Ryu J.
        • Saito S.
        • Yamamoto K.
        • Sano S.
        Factors influencing the postoperative range of motion in total knee arthroplasty.
        Bull Hosp Jt Dis. 1993; 53: 35-40
        • Davies D.M.
        • Johnston D.W.
        • Beaupre L.A.
        • Lier D.A.
        Effect of adjunctive range-of-motion therapy after primary total knee arthroplasty on the use of health services after hospital discharge.
        Can J Surg. 2003; 46: 30-36
        • Naylor J.M.
        • Ko V.
        • Rougellis S.
        • et al.
        Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 2.
        J Eval Clin Pract. 2012; 18: 652-658
        • Finch E.
        • Walsh M.
        • Thomas S.G.
        • Woodhouse L.J.
        Functional ability perceived by individuals following total knee arthroplasty compared to age-matched individuals without knee disability.
        J Orthop Sports Phys Ther. 1998; 27: 255-263
        • Walsh M.
        • Woodhouse L.J.
        • Thomas S.G.
        • Finch E.
        Physical impairments and functional limitations: a comparison of individuals 1 year after total knee arthroplasty with control subjects.
        Phys Ther. 1998; 78: 248-258
        • Dawson B.
        • Trapp R.G.
        Basic & clinical biostatistics.
        4th ed. Lange Medical Books/McGraw-Hill, New York2004
        • Lizaur A.
        • Marco L.
        • Cebrian R.
        Preoperative factors influencing the range of movement after total knee arthroplasty for severe osteoarthritis.
        J Hand Surg [Br]. 1997; 79: 626-629
        • O'Connor M.I.
        Implant survival, knee function, and pain relief after TKA: are there differences between men and women?.
        Clin Orthop Relat Res. 2011; 469: 1846-1851
        • Ritter M.A.
        • Berend M.E.
        • Harty L.D.
        • Davis K.E.
        • Meding J.B.
        • Keating E.M.
        Predicting range of motion after revision total knee arthroplasty: clustering and log-linear regression analyses.
        J Arthroplasty. 2004; 19: 338-343
        • Ritter M.A.
        • Harty L.D.
        • Davis K.E.
        • Meding J.B.
        • Berend M.E.
        Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis.
        J Hand Surg [Am]. 2003; 85: 1278-1285
        • Chiu K.Y.
        • Ng T.P.
        • Tang W.M.
        • Yau W.P.
        Review article: knee flexion after total knee arthroplasty.
        J Orthop Surg (Hong Kong). 2002; 10: 194-202
        • Naylor J.M.
        • Ko V.
        • Rougellis S.
        • et al.
        Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 1.
        J Eval Clin Pract. 2012; 18: 644-651
        • Bulthuis Y.
        • Drossaers-Bakker K.W.
        • Taal E.
        • et al.
        Arthritis patients show long-term benefits from 3 weeks intensive exercise training directly following hospital discharge.
        Rheumatology (Oxford). 2007; 46: 1712-1717