Chronic obstructive pulmonary disease, younger age and impaired preoperative flexion increase the risk of stiffness afte
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ORIGINAL ARTICLE
Chronic obstructive pulmonary disease, younger age and impaired preoperative flexion increase the risk of stiffness after total knee arthroplasty: a retrospective case–control study Nils P. Hailer & Mari Hänni & Erik Widerström & Hans Mallmin
Received: 4 December 2012 / Accepted: 30 January 2013 # EFORT 2013
Abstract Introduction Knee stiffness after total knee arthroplasty (TKA) impairs patient satisfaction and can necessitate mobilisation under anaesthesia (MUA). We investigated what factors predispose towards the need for MUA after TKA. Patients and methods The study population was extracted from our local arthroplasty register. Within the setting of a retrospective case/control study, we compared patients who underwent MUA after TKA (n=35) with a randomly selected control group that did not need MUA after TKA (n=122) using binary logistic regression analysis. Results We found that the risk of MUA due to flexion below 90° was increased in patients suffering from chronic obstructive pulmonary disease (COPD) with a risk ratio (RR) of 12 (95 % confidence interval [CI] 1.7–84, p=0.01). Increasing age decreased the risk of developing stiffness with a RR of 0.88 (CI 0.81–0.95, p < 0.001) per year. Greater preoperative flexion decreased the risk of stiffness with a RR of 0.97 (CI 0.94–1.0, p=0.03) per degree of flexion. Gender, body mass index, medical and psychiatric comorbidities, rheumatoid arthritis, the Insall–Salvati index, and the increase in sagittal femoral diameter induced by prosthesis insertion did not significantly affect the risk of stiffness. A certain type of knee prosthesis (Natural Knee 2) was overrepresented among patients requiring MUA. N. P. Hailer (*) : E. Widerström : H. Mallmin Institute of Surgical Sciences, Department of Orthopaedics, Uppsala University Hospital, 751 85, Uppsala, Sweden e-mail: [email protected] M. Hänni Institute of Radiology, Oncology and Radiotherapy, Department of Radiology, Uppsala University Hospital, 751 85, Uppsala, Sweden
Discussion and conclusion We conclude that stiffness after TKA is more frequent in younger patients and in those with limited preoperative flexion. It is also suggested that postoperative stiffness may be associated with COPD and with the choice of certain implants. Keywords TKA . Total knee arthroplasty . Knee replacement . Mobilisation under anaesthesia . Stiffness . Risk factors
Introduction “Stiffness” of the knee after total knee arthroplasty (TKA) impairs knee function and reduces patient satisfaction to a large extent [1]. Sometimes, this stiffness necessitates mobilisation under anaesthesia (MUA) in order to improve the postoperative range of knee motion. Stiffness of the knee is not very well defined in the literature, and authors describing the occurrence and treatment of this phenomenon have chosen different degrees of limitation when defining their patients as suffering from a stiff knee. Flexion contracture of at least 15° and maximum flexion of 75° [2], a postoperative range of motion (ROM) smaller than 10–
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