- Post Operative ROM:
- most important factor predicting ultimate ROM is range of motion before surgery;
- patients with significant stiffness before surgery will have the most difficulty gaining range of motion;
-
lateral retinacular release & sacrifice or retention of
posterior cruciate ligament, do not significantly
affect knee range of motion after surgery;
- final ROM after knee arthroplasty is fairly similar among various prosthetic designs, and usually approximates 100 to 115 degrees;
- Continuous Passive Motion:
- may decrease
DVT/PE in TKR:
- use of CPM may result in faster recovery of motion immediately after surgery, but appears not to ultimately increase ROM at one year post surgery;
- the downside of CPM is possible wound healing problems, which is due in part to decreased transcutaneous pO2;
- some recommend that maximum flexion be limited to 40 deg for first 3 days is recommended;
- references:
-
Beneficial effects of continuous passive motion after total condylar knee arthroplasty.
-
A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty.
-
Deep-vein thrombosis and continuous passive motion after total knee arthroplasty.
-
The influence of continuous passive motion on outcome in total knee arthroplasty.
-
The role of continuous passive motion following total knee arthroplasty.
-
The effect of continuous passive motion on wound-healing and joint mobility after knee arthroplasty.
- The effect of continuous passive motion on wound healing and joint mobility after knee arthroplasty. Johnson DP. J Bone Joint Surg Am. 1990; 72A:421-426.
-
A Comparison of 2 Continuous Passive Motion Protocols After Total Knee Arthroplasty: A Controlled and Randomized Study
-
Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion.
- Early Loss of ROM:
- manipulation may be indicated in some cases of limited postoperative knee flexion;
- manipulation with in the first few postoperative weeks may result in early gains in ROM, but at one year there is no significant difference in
the ROM of those patients undergoing manipulation vs those patients who did not undergo knee manipulation;
- references:
- The role of manipulation following total knee replacement. JL Fox and R Poss. JBJS. Vol 63-A. 1981. p 357-362.
- Total condylar KR: A study of factors influencing range of motion as late as two years after arthroplasty. JBJS Vol 67-A. 1985. p 1006-1014.
-
Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion.
-
Stiffness After Total Knee Arthroplasty. Prevalence of the Complication and Outcomes of Revision.
-
Management of Stiffness Following Total Knee Arthroplasty.
- arthroscopy following TKR:
- manipulation:
- manipulation at 2-3 weeks post op can significantly increase knee flexion, but ultimate ROM may not show any improvement over knees
which did not receive CPM;
- in the study by CNA Esler et al, manipulation under anesthesia was performed on 47 knees;
- patients were considered for manipulation if their flexion was less than 80 deg at at mean of 11 weeks postop;
- goal was to overcome intra-articular adhesions.
- the authors felt that delaying manipulation well beyond the timing of earlier studies was important in maintaining gains in flexion;
- it was found that the mean gain in flexion at one year was 33 deg;
-
complications:
-
hemarthrosis;
- supracondylar femur fracture;
- wound dehiscence
- patellar tendon rupture;
- references:
- Manipulation of total knee replacements. Is the flexion gained retained? CNA Esler et al. JBJS. Vol 81-B. No 1. Jan 1999. p 27.
Range of Motion Correlates with Patient Perception of TKA Outcome.
A conservative approach is feasible in unexplained pain after knee replacement. A SELECTED COHORT STUDY
