The aim of this study was to investigate the pre-operative factors predicting the knee range of motion during stair ascending and descending a year after total knee arthroplasty.

The pre-operative and one year post-operative results of fifty six patients with osteoarthritis were analysed. Range of knee motion during stair ascent and descent was recorded using electrogoniometry. Pre-operative measures were grouped in three different domains; the Demographic Domain with age and Body Mass Index (BMI), the Body Function Domain with knee range of motion in long sitting (ROMsit), Knee extensor moment, Pain on a Visual Analogue Scale and the stiffness component of the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and thirdly the Psychosocial Domain with the Tampa scale for ‘fear of movement’ (TSK) and the sense of helplessness due to pain. Hierarchical Multiple Regression was used to analyse the relative importance of measures grouped into the three domain blocks on range of motion of the operated knee during stair ascent and descent. Model 1 contained domain block 1, model 2 included domain blocks 1 and 2 and model 3 included domain blocks 1,2 and 3.

Learned helplessness was a significant predicting factor for stair descent (beta; −0.538, p=0.025) while for stair ascent, age (beta 0.375, p=0.005) and ROMsit (beta 0.365, p=0.021) were significant predicting variables.

These results show that postoperative stair ascent and descent are predicted by different pre-operative factors. For stair ascent the demographic factors age and function factor ROM are important, while for stair descent, only the addition of the psychosocial factors in model 3 resulted in a significant change. These results indicate that treatment of patients with end-stage osteoarthritis should not only be aimed at improving range of motion of the knee but should also take into account psychosocial variables such as a sense of helplessness due to pain.

Purpose: This study aims to explore the role of pain, fear of movement and learned helplessness on functional knee range of motion and daily functioning in a patients awaiting total knee arthroplasty (TKA)

Methods and results: Sixty-five patients (mean age 69 years old) with osteoarthritis were assessed an average of 37 days prior to TKA. Dynamic knee angle was measured during 11 functional activities including getting up from a chair and walking up and down a slope and stairs using flexible electrogoniometry. Function was assessed using the function components of the Knee Society Score (KSS) and the Western Ontario & McMaster University Osteoarthritis Index (WOMAC). Other self-report measures included the 8 item Tampa scale for kinesiophobia to assess ‘activity avoidance’ (TSK-AA), and the 5 item Helplessness subscale of the rheumatology attitudes index.

The pain component of the WOMAC was negatively associated with the knee angle during sitting down and getting up from a low chair and stepping in and out of a bath (r=0.40–0.45), but not with the peak knee angle during ascending and descending a slope or walking speed. Higher scores of the activity avoidance and the helplessness scales however, were associated with reduced knee angles during descending a slope and a slower walking speed (r=0.31–0.38). Both psychosocial scales were also associated with function (r=0.39–0.45). Another important finding was that activity avoidance was not associated with pain.

Conclusions: Not only pain but also fear of movement and learned helplessness play a role on specific components of knee function in patients with final stage osteoarthritis of the knee. Further research into the impact of pain and psychosocial variables on functional outcome in ostearthritis is indicated.