Zondervan Robert L, Riggle Patrick K, Cien Adam J, Penny Philip C, Cochran Jason M
McLaren Greater Lansing Hospital, Lansing, MI, USA.
Sparrow Hospital, Lansing, MI, USA.
Spartan Med Res J. 2024 Sep 9;9(3):35-42. doi: 10.51894/001c.123412. eCollection 2024.
Total knee arthroplasty (TKA) is an orthopaedic operation that improves quality of life and reduces pain in patients with disabling arthritis of the knee. One commonly recognized postoperative complication is flexion contracture of the knee. While early physical therapy and range of motion (ROM) exercises have helped improve ROM postoperatively, flexion contractures still remain a significant postoperative complication of TKA.This study evaluated postoperative sleeping position and its effect on terminal knee extension and ROM following primary TKA. We hypothesized that patients who slept in the supine position would achieve earlier knee extension and ROM when compared to those in the lateral recumbent position.
A total of 150 consecutive primary total knee arthroplasties (TKAs) were conducted by a single surgeon (JMC). Prospective data collection included assessments of preoperative range of motion (ROM), postoperative ROM, patient-reported outcome measures, and sleeping positions. Functional outcomes and patient-reported measures were compared between pre- and postoperative phases, as well as across different sleeping position groups.
Postoperative follow up was a mean of 29.6 days. Mean postoperative terminal extension ROM at one month was 2.98 degrees in the supine group versus 6.03 degrees in the lateral group (P < 0.001). Overall, there was significant improvement in patient reported outcome measures (WOMAC, Oxford, and pain) after surgery, but no difference existed between sleeping groups. For knee extension, a two-way ANOVA revealed that there was a statistically significant interaction between the effects of surgery and sleep position (p = 0.0053).
Our results demonstrate that sleeping position does affect initial postoperative knee terminal extension; however, there is no effect on patient reported outcomes. We found a statistically significant difference in extension when comparing patients in the supine versus lateral group. Patients who slept in the lateral position lacked 6.03 degrees of extension which is greater than the 5 degrees threshold needed for normal gait mechanics. Conversely, those in the supine group only lacked 2.98 degrees of extension, allowing for normal gait mechanics. This study identifies an easy, effective means of increasing patient knee range of motion following TKA.
全膝关节置换术（TKA）是一种骨科手术，可改善生活质量并减轻膝关节致残性关节炎患者的疼痛。一种常见的术后并发症是膝关节屈曲挛缩。虽然早期物理治疗和活动范围（ROM）锻炼有助于改善术后的ROM，但屈曲挛缩仍然是TKA的一个重要术后并发症。本研究评估了初次TKA术后的睡眠姿势及其对膝关节终末伸展和ROM的影响。我们假设，与侧卧位睡眠的患者相比，仰卧位睡眠的患者将更早实现膝关节伸展和ROM。
由单一外科医生（JMC）连续进行了150例初次全膝关节置换术（TKA）。前瞻性数据收集包括术前活动范围（ROM）、术后ROM、患者报告的结局指标和睡眠姿势的评估。比较术前和术后阶段以及不同睡眠姿势组之间的功能结局和患者报告的指标。
术后平均随访29.6天。仰卧组术后1个月时膝关节终末伸展ROM的平均值为2.98度，而侧卧组为6.03度（P<0.001）。总体而言，术后患者报告的结局指标（WOMAC、牛津评分和疼痛）有显著改善，但睡眠组之间没有差异。对于膝关节伸展，双向方差分析显示手术和睡眠姿势的影响之间存在统计学上的显著交互作用（p = 0.0053）。
我们的结果表明，睡眠姿势确实会影响术后初期膝关节的终末伸展；然而，对患者报告的结局没有影响。我们发现仰卧组和侧卧组患者在伸展方面存在统计学上的显著差异。侧卧睡眠的患者缺少6.03度的伸展，这大于正常步态力学所需的5度阈值。相反，仰卧组患者仅缺少2.98度的伸展，可实现正常步态力学。本研究确定了一种增加TKA术后患者膝关节活动范围的简单、有效方法。
