Patel Nirav K, Chughtai Morad, Khlopas Anton, Gwam Chukwuweike, Sodhi Nipun, Sultan Assem A, McGinn Tanner, Bhave Anil, Mistry Jaydev B, Delanois Ronald E, Mont Michael A
Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
Surg Technol Int. 2017 Dec 22;31:201-206.
Knee stiffness following total knee arthroplasty (TKA) is a common complication, especially in obese patients. The initial, non-operative treatments for this complication includes splinting and physical therapy. If these measures fail, manipulation under anesthesia (MUA) or surgical exploration can be considered to restore range of motion (ROM). However, it is generally desirable to avoid these procedures. For these reasons, newer physical therapy protocols have been developed. However, it is unknown whether these protocols are efficacious for obese patients. Therefore, the purpose of this study was to evaluate and compare: 1) ROM; 2) the rate of MUA; 3) number of physical therapy visits; and 4) costs in patients who underwent innovative multimodal physical therapy (IMPT) and were either obese or non-obese.
A review of a consecutive series of patients undergoing TKA at a single center within a three-year period was performed. All patients received IMPT post-TKA. Patients were divided into obese (body mass index (BMI >30kg/m2) and non-obese (BMI <30 kg/m2) groups. One-hundred and forty-nine patients underwent TKA and had a mean age of 67 years (range, 42 to 88 years). There were 48 patients in the non-obese group and 101 in the obese group. The obese group was significantly younger (mean, 60 years; range 38 to 54 years vs. mean, 69 years; range, 50 to 88 years), with a similar gender distribution. Comparisons of ROM, MUA, number of physical therapy visits, and costs were performed using Student's t-tests and Chi-square tests as appropriate. Cost-analysis was also performed based on the number of visits to physical therapy (PT).
At latest follow-up, there were no significant differences in mean flexion (mean, 115°, range, 90 to 130° vs. mean, 113°, range 60 to 130°) and extension (mean, 0.81°, range, 0 to 10° vs. 0.54°, range 0 to 10°, p=0.469) between the two groups. The obese group had a 14% (n = 12) rate of MUA compared to 2% (n=1) in the non-obese group (p=0.045). Obese patients had a significantly higher number of mean visits to PT. There was significantly higher mean healthcare costs in the obese (mean, $3,919, range $1,043 to $11,749) as compared to the non-obese (mean, $2,950, range $741 to $7,865) group.
Although both cohorts have similar mean ROM at final follow-up, the obese cohort had a significantly higher proportion of patients who underwent MUAs following TKA as compared to non-obese patients, despite IMPT. At latest follow-up, the ROM achieved between the two groups was similar. Obese patients required more PT visits resulting in significantly higher mean healthcare costs.
全膝关节置换术（TKA）后膝关节僵硬是一种常见并发症，在肥胖患者中尤为常见。针对该并发症的初始非手术治疗包括夹板固定和物理治疗。如果这些措施失败，可以考虑在麻醉下进行手法操作（MUA）或手术探查以恢复活动范围（ROM）。然而，通常希望避免这些操作。出于这些原因，已经开发了更新的物理治疗方案。然而，这些方案对肥胖患者是否有效尚不清楚。因此，本研究的目的是评估和比较：1）ROM；2）MUA发生率；3）物理治疗就诊次数；4）接受创新多模式物理治疗（IMPT）的肥胖或非肥胖患者的费用。
对一个中心三年内连续接受TKA的一系列患者进行回顾。所有患者TKA后均接受IMPT。患者分为肥胖（体重指数（BMI）>30kg/m²）和非肥胖（BMI<30kg/m²）组。149例患者接受了TKA，平均年龄67岁（范围42至88岁）。非肥胖组有48例患者，肥胖组有101例患者。肥胖组明显更年轻（平均60岁；范围38至54岁，相比之下平均69岁；范围50至88岁），性别分布相似。使用学生t检验和卡方检验对ROM、MUA、物理治疗就诊次数和费用进行了比较。还根据物理治疗（PT）就诊次数进行了成本分析。
在最新随访时，两组之间的平均屈曲度（平均115°，范围90至130°，相比之下平均113°，范围60至130°）和伸展度（平均0.81°，范围0至10°，相比之下0.54°，范围0至10°，p=0.469）无显著差异。肥胖组MUA发生率为14%（n=12），而非肥胖组为2%（n=1）（p=0.045）。肥胖患者的平均PT就诊次数明显更多。与非肥胖组（平均2950美元，范围741至7865美元）相比，肥胖组的平均医疗费用明显更高（平均3919美元，范围1043至11749美元）。
尽管两个队列在最终随访时平均ROM相似，但与非肥胖患者相比，肥胖队列中TKA后接受MUA的患者比例明显更高，尽管接受了IMPT。在最新随访时，两组实现的ROM相似。肥胖患者需要更多的PT就诊次数，导致平均医疗费用明显更高。
