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Chronic obstructive pulmonary disease, younger age and impaired preoperative flexion increase the risk of stiffness after total knee arthroplasty: a retrospective case–control study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2013 (English)In: European orthopaedics and traumatology, ISSN 1867-4577, Vol. 4, no 3, 137-145 p.Article in journal (Refereed) Published
Abstract [en]

Introduction

Knee stiffness after total knee arthroplasty (TKA) impairs patient satisfaction and can necessitate mobilisation under anaesthesia (MUA). We investigated what factors predispose towards the need for MUA after TKA.

Patients and methods

The study population was extracted from our local arthroplasty register. Within the setting of a retrospective case/control study, we compared patients who underwent MUA after TKA (n = 35) with a randomly selected control group that did not need MUA after TKA (n = 122) using binary logistic regression analysis.

Results

We found that the risk of MUA due to flexion below 90° was increased in patients suffering from chronic obstructive pulmonary disease (COPD) with a risk ratio (RR) of 12 (95 % confidence interval [CI] 1.7–84, p = 0.01). Increasing age decreased the risk of developing stiffness with a RR of 0.88 (CI 0.81–0.95, p < 0.001) per year. Greater preoperative flexion decreased the risk of stiffness with a RR of 0.97 (CI 0.94–1.0, p  = 0.03) per degree of flexion. Gender, body mass index, medical and psychiatric comorbidities, rheumatoid arthritis, the Insall–Salvati index, and the increase in sagittal femoral diameter induced by prosthesis insertion did not significantly affect the risk of stiffness. A certain type of knee prosthesis (Natural Knee 2) was overrepresented among patients requiring MUA.

Discussion and conclusion

We conclude that stiffness after TKA is more frequent in younger patients and in those with limited preoperative flexion. It is also suggested that postoperative stiffness may be associated with COPD and with the choice of certain implants.  

Place, publisher, year, edition, pages
2013. Vol. 4, no 3, 137-145 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-216220DOI: 10.1007/s12570-013-0169-3OAI: oai:DiVA.org:uu-216220DiVA: diva2:689265
Available from: 2014-01-20 Created: 2014-01-20 Last updated: 2016-02-17Bibliographically approved

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Publisher's full texthttp://rd.springer.com/article/10.1007%2Fs12570-013-0169-3#page-1

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Hailer, NilsHänni, MariWiderström, ErikMallmin, Hans

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