Goudie Stuart T, Deakin Angela H, Ahmad Aftab, Maheshwari Rohit, Picard Frederic
Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland, United Kingdom.
Orthopedics. 2011 Dec 6;34(12):e855-9. doi: 10.3928/01477447-20111021-18.
Function and satisfaction after total knee arthroplasty (TKA) are partially linked to postoperative range of motion (ROM). Fixed flexion contracture is a recognized complication of TKA that reduces ROM and is a source of morbidity for patients. This study aimed to identify preoperative risk factors for developing fixed flexion contracture following TKA and to quantify the effect of fixed flexion contracture on outcomes (Oxford knee score 12-60 and patient satisfaction) at 2 years. Pre-, intra-, and postoperative data for 811 TKAs were retrospectively reviewed. At 2 years postoperatively, the incidence of fixed flexion contracture was 3.6%. Men were 2.6 times more likely than women to have fixed flexion contracture (P=.012), and patients with preimplant fixed flexion contracture were 2.3 times more likely than those without to have fixed flexion contracture (P=.028). Increasing age was associated with an increased rate of fixed flexion contracture (P=.02). Body mass index was not a risk factor (P=.968). Incidence of fixed flexion contracture for those undergoing computer navigated TKA was 3.9% compared with 3.4% for those having conventional surgery (P=.711). Patients with fixed flexion contracture had poorer outcomes with a median [interquartile range] Oxford Knee Score of 25 [15] compared with 20 [11] for those without (P=.003) and lower patient satisfaction (P=.036). These results support existing literature for incidence of fixed flexion contracture after TKA, risk factors, and outcomes, indicating that these figures can be extrapolated to a wide population. They also clarify a previously contentious point by excluding body mass index as a risk factor.
全膝关节置换术（TKA）后的功能和满意度部分与术后活动范围（ROM）相关。固定性屈曲挛缩是TKA公认的并发症，会降低ROM，是患者发病的一个原因。本研究旨在确定TKA后发生固定性屈曲挛缩的术前危险因素，并量化固定性屈曲挛缩对2年时结局（牛津膝关节评分12 - 60和患者满意度）的影响。对811例TKA的术前、术中和术后数据进行了回顾性分析。术后2年时，固定性屈曲挛缩的发生率为3.6%。男性发生固定性屈曲挛缩的可能性是女性的2.6倍（P = 0.012），植入前有固定性屈曲挛缩的患者发生固定性屈曲挛缩的可能性是无此情况患者的2.3倍（P = 0.028）。年龄增加与固定性屈曲挛缩发生率增加相关（P = 0.02）。体重指数不是危险因素（P = 0.968）。接受计算机导航TKA的患者固定性屈曲挛缩发生率为3.9%，而接受传统手术的患者为3.4%（P = 0.711）。有固定性屈曲挛缩的患者结局较差，牛津膝关节评分中位数[四分位间距]为25[15]，而无固定性屈曲挛缩的患者为20[11]（P = 0.003），患者满意度也较低（P = 0.036）。这些结果支持了现有关于TKA后固定性屈曲挛缩发生率、危险因素和结局的文献，表明这些数据可外推至广泛人群。它们还通过排除体重指数作为危险因素，澄清了一个先前有争议的问题。
