Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code OP31, Portland, OR, 97239, USA.
J Orthop Surg Res. 2020 Feb 12;15(1):48. doi: 10.1186/s13018-020-1555-5.
Stiffness and pain from arthrofibrosis following total knee arthroplasty (TKA) is a challenging problem, and investigating methods to prevent or reduce the incidence of postoperative arthrofibrosis is critical. Studies have shown that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are efficacious at preventing fibrotic disorders in the lungs, liver, kidneys, and eyes. Our aim was to determine if ACEI or ARB use postoperatively reduces the incidence of arthrofibrosis in TKA patients.
In a retrospective review, we analyzed 141 consecutive TKAs performed at a single institution by a single surgeon from December 2010 to December 2014. Range of motion (ROM) in patients already taking ACEI, ARB, or neither medication was compared. Independent variables recorded were gender, age, BMI, presence of diabetes or preoperative opioid or statin use, preoperative ROM, and use of ACEIs or ARBs. Dependent variables recorded were postoperative knee flexion, extension, and total arc of motion. The primary outcome variable was success or failure of achieving 118 total arc of motion postoperatively, based on a study that found significant compromise of function in TKA patients who failed to obtain this goal. Secondary endpoints were postoperative knee flexion, extension, and total arc of motion.
The use of neither ACEIs nor ARBs showed a significant difference in attaining greater than 118° of motion postoperatively compared to controls at 6 months. Significant predictors of obtaining > 118° motion were BMI (p < 0.05), preoperative flexion (p < 0.001), and preoperative total arc of motion (p < 0.002). Significant predictors of secondary ROM outcomes were preoperative ROM and BMI.
Our study demonstrated that the principle predictor of postoperative ROM is BMI and preoperative ROM. The use of ACEIs or ARBs did not result in a greater likelihood of obtaining satisfactory ROM postoperatively.
全膝关节置换术后（TKA）的关节僵硬和疼痛是一个具有挑战性的问题，研究预防或减少术后关节纤维化发生的方法至关重要。研究表明，血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）在预防肺部、肝脏、肾脏和眼睛的纤维化疾病方面是有效的。我们的目的是确定 TKA 术后使用 ACEI 或 ARB 是否能降低关节纤维化的发生率。
在一项回顾性研究中，我们分析了 2010 年 12 月至 2014 年 12 月期间由一位外科医生在一家机构进行的 141 例连续 TKA。比较了已经服用 ACEI、ARB 或两者都不服用的患者的关节活动度（ROM）。记录的独立变量包括性别、年龄、BMI、是否患有糖尿病或术前使用阿片类药物或他汀类药物、术前 ROM 以及 ACEI 或 ARB 的使用情况。记录的因变量包括术后膝关节的屈曲、伸展和总活动度。主要观察变量是术后是否达到 118°的总活动度，这是基于一项研究，该研究发现 TKA 患者如果未能达到这一目标，其功能会显著受损。次要终点是术后膝关节的屈曲、伸展和总活动度。
与对照组相比，既不使用 ACEI 也不使用 ARB 的患者在术后 6 个月达到大于 118°运动的差异无统计学意义。获得>118°运动的显著预测因素是 BMI（p<0.05）、术前屈曲（p<0.001）和术前总活动度（p<0.002）。二次 ROM 结果的显著预测因素是术前 ROM 和 BMI。
我们的研究表明，术后 ROM 的主要预测因素是 BMI 和术前 ROM。使用 ACEI 或 ARB 并不能增加术后获得满意 ROM 的可能性。
