Issa Kimona, Rifai Aiman, Boylan Matthew R, Pourtaheri Sina, McInerney Vincent K, Mont Michael A
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
Clin Orthop Relat Res. 2015 Jan;473(1):143-7. doi: 10.1007/s11999-014-3772-x.
One of the most important goals of primary total knee arthroplasty (TKA) is to achieve a functional range of motion (ROM). However, up to 20% of patients fail to do so, which can impair activities of daily living.
QUESTIONS/PURPOSES: The purpose of this study was to evaluate the effect of various (1) demographic factors; (2) comorbidities; and (3) knee-specific factors on the frequency of manipulation under anesthesia, which was used as an indicator of knee stiffness after a primary TKA.
We evaluated the registries of two high-volume centers and reviewed all 3182 TKAs that were performed between 2005 and 2011 to identify all patients who had undergone manipulation under anesthesia (MUA). A total of 156 knees in 133 patients underwent MUA after an index arthroplasty. These patients were compared in a one-to-four ratio with a group of patients with satisfactory ROM drawn from the same database who met prespecified criteria and who had not undergone MUA. Effects of various factors, including age, sex, body mass index, race, comorbidities, and the underlying cause of knee arthritis, were compared between these two cohorts using multivariable logistic regressions.
After controlling for various confounding, nonwhite race was associated with an increase (odds ratio [OR], 2.01; p=0.03), and age≥65 years (OR, 0.17; 95% confidence interval [CI], 0.04-0.74; p=0.0179) was associated with a reduction in the incidence of MUA. In comorbidities, diabetes (OR, 1.72; 95% CI, 1.02-2.32; p=0.03), high cholesterol levels (OR, 2.70; p=0.03), and tobacco smoking (OR, 1.59; 95% CI, 1.03-2.47; p=0.03) were associated with an increase in frequency of MUA. In knee-specific factors, preoperative knee ROM of less than 100° (OR, 0.80; p<0.0001) and knee osteonecrosis (p=3.61; 95% CI, 1.29-10.1; p=0.014) were associated with increased frequency of MUA.
We identified several demographic, medical, and knee-specific factors that were associated with poor postoperative ROM in our patients undergoing TKA. Patients who have multiple risk factors may benefit from preoperative counseling to set realistic ROM expectations.
Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
初次全膝关节置换术（TKA）最重要的目标之一是实现功能活动范围（ROM）。然而，高达20%的患者未能达到这一目标，这可能会损害日常生活活动能力。
问题/目的：本研究的目的是评估各种（1）人口统计学因素；（2）合并症；以及（3）膝关节特异性因素对麻醉下手法操作频率的影响，麻醉下手法操作被用作初次TKA后膝关节僵硬的指标。
我们评估了两个高容量中心的登记资料，并回顾了2005年至2011年间进行的所有3182例TKA，以确定所有接受麻醉下手法操作（MUA）的患者。索引关节置换术后，133例患者的156个膝关节接受了MUA。这些患者与从同一数据库中抽取的一组符合预先设定标准且未接受MUA的ROM满意的患者以1:4的比例进行比较。使用多变量逻辑回归比较这两个队列之间各种因素的影响，包括年龄、性别、体重指数、种族、合并症和膝关节关节炎的潜在病因。
在控制了各种混杂因素后，非白种人与MUA发生率增加相关（比值比[OR]，2.01；p = 0.03），年龄≥65岁（OR，0.17；95%置信区间[CI]，0.04 - 0.74；p = 0.0179）与MUA发生率降低相关。在合并症方面，糖尿病（OR，1.72；95% CI，1.02 - 2.32；p = 0.03）、高胆固醇水平（OR，2.70；p = 0.03）和吸烟（OR，1.59；95% CI，1.03 - 2.47；p = 0.03）与MUA频率增加相关。在膝关节特异性因素方面，术前膝关节ROM小于100°（OR，0.80；p < 0.0001）和膝关节骨坏死（p = 3.61；95% CI，1.29 - 10.1；p = 0.014）与MUA频率增加相关。
我们确定了几个与接受TKA的患者术后ROM不佳相关的人口统计学、医学和膝关节特异性因素。有多种风险因素的患者可能受益于术前咨询，以设定现实的ROM预期。
III级，预后研究。有关证据水平的完整描述，请参阅作者指南。
