FACTORS RELATED TO POST-OPERATIVE KNEE EXTENSION AT SIX WEEKS, FOLLOWING A TOTAL KNEE ARTHROPLASTY

Abstract

Flexion contracture in total knee arthroplasty (TKA) remains a challenge. Soft tissue management and additional bone resection are traditional options for flexion contracture correction. Our hypothesis was that the post implant computer aided measurements would not be significantly different to the extension angles measured at six weeks post-operatively in the follow-up clinic.

One hundred continuous TKA were performed by a single consultant using the OrthoPilot^® (BBraun, Aesculap) navigation system and Columbus implants. Of the group, 45 were male and 55 were female. Average age was 68 (range 49–87), mean BMI was 32.86 (22.26–51.86) and mean Oxford score preoperatively was 42 (range 21–56) and post-operatively 28 (range15–50). Data recorded at the preoperative assessment clinic included clinical flexion contracture and Oxford scores. Intra-operatively data were recorded using the navigation system. These included pre-operative flexion and extension angles, actual bone cuts of tibia and femur (both medial and lateral), postoperative correction of flexion and extension angles and soft tissue releases. At six weeks post operation, patients were seen in the follow clinic and clinical flexion contracture and Oxford score reassessed by the Arthroplasty outcome service.

Measurements were grouped and comparisons were made using a Pearson Chi-square test. There was no relationship between post-implant extension angle measurements (by computer) and extension angles at six weeks (by goniometer) (p=0.682). Also, there was no relationship between pre-operative measurement angles collected at the pre-assessment (by goniometer) and the pre-implant angles measured on the table (by computer) (p=0.682). We found that BMI (up to 35) and postoperative Oxford scores were significantly related to the extension levels with values of (p=0.008) and (p=0.027) respectively. Pre-operative Oxford scores, pre-operative extension, amount of bony resection and soft-tissue releases did not show any significant relationship with the post-operative extension obtained at six weeks.

The conclusions that we draw from this study are that there might be other factors that are likely to influence extension lag between the operation and the follow-up at six weeks. One of the factors that we could identify was the BMI. Attention to extensor lag is important because it leads to a poorer knee function, as indicated by the Oxford scores. Despite most of the post-implant measurement angles showing no extensor lag, about 20% of our patients still had more than five degrees flexion contracture at six weeks.