Kubo Tatsuya, Takahashi Tsuneari, Takeshita Katsushi
Department of Orthopaedic Surgery Shin-Oyama City Hospital Oyama Japan.
Department of Orthopaedics Jichi Medical University Shimotsuke Japan.
J Exp Orthop. 2025 Sep 9;12(3):e70419. doi: 10.1002/jeo2.70419. eCollection 2025 Jul.
This study aimed to identify risk factors associated with deterioration in knee flexion range of motion (ROM) following cruciate-retaining total knee arthroplasty (CR-TKA).
A total of 129 consecutive patients who underwent CR-TKA and completed a 2-year follow-up were included. A decrease of ≥9° in flexion ROM was considered clinically significant. Patients were classified into two groups based on the change in flexion ROM at 2 years post-operatively: Group D (≥9° decrease; = 44) and Group C (<9° decrease; = 85). Demographic data were compared using Student's test or Fisher's exact test. Logistic regression analysis was performed to identify factors associated with ROM deterioration. Receiver operating characteristic (ROC) curve analysis was conducted to determine cut-off values for the identified factors.
Demographic characteristics were comparable between the two groups. Preoperative flexion ROM was significantly higher in Group D than in Group C (128.6 ± 9.5° vs. 115.5 ± 12.3°, < 0.001). Logistic regression analysis revealed that greater preoperative flexion ROM (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.10-1.27; < 0.001), a larger distal medial femoral resection (DMFR) (OR, 1.98; 95% CI, 1.14-3.43; = 0.015) and lower anterior-posterior translation at 30° of flexion 1 year post-operatively (1y30AP) (OR, 0.73; 95% CI, 0.57-0.93; = 0.012) were independently associated with a ≥9° reduction in flexion ROM. ROC analysis identified cut-off values of >130.0° for preoperative flexion ROM (AUC: 0.80, 95% CI: 0.72-0.88), >7.5 mm for DMFR (AUC: 0.60, 95% CI: 0.50-0.71) and <5.1 mm for 1y30AP (AUC: 0.62, 95% CI: 0.51-0.72).
Preoperative flexion ROM, DMFR and 1y30AP were associated with worse flexion ROM at 2 years following CR-TKA.
Level III, retrospective comparative study.
本研究旨在确定十字韧带保留型全膝关节置换术（CR-TKA）后膝关节屈曲活动度（ROM）恶化的相关危险因素。
纳入129例连续接受CR-TKA并完成2年随访的患者。屈曲ROM减少≥9°被认为具有临床意义。根据术后2年屈曲ROM的变化将患者分为两组：D组（减少≥9°；n = 44）和C组（减少<9°；n = 85）。使用Student's检验或Fisher精确检验比较人口统计学数据。进行逻辑回归分析以确定与ROM恶化相关的因素。进行受试者工作特征（ROC）曲线分析以确定所识别因素的临界值。
两组的人口统计学特征具有可比性。D组术前屈曲ROM显著高于C组（128.6±9.5°对115.5±12.3°，P<0.001）。逻辑回归分析显示，术前更大的屈曲ROM（优势比[OR]，1.18；95%置信区间[CI]，1.10 - 1.27；P<0.001）、更大的股骨远端内侧切除量（DMFR）（OR，1.98；95%CI，1.14 - 3.43；P = 0.015）以及术后1年屈曲30°时更低的前后向平移（1y30AP）（OR，0.73；95%CI，0.57 - 0.93；P = 0.012）与屈曲ROM减少≥9°独立相关。ROC分析确定术前屈曲ROM的临界值>130.0°（AUC：0.80，95%CI：0.72 - 0.88）、DMFR的临界值>7.5 mm（AUC：0.60，95%CI：0.50 - 0.71）和1y30AP的临界值<5.1 mm（AUC：0.62，95%CI：0.51 - 0.72）。
术前屈曲ROM、DMFR和1y30AP与CR-TKA术后2年较差的屈曲ROM相关。
III级，回顾性比较研究。
