Key result
Pre-anesthetic knee flexion angle demonstrated the highest positive correlation with the 6-month postoperative knee flexion angle (r = 0.771, p<0.05) compared to other perioperative timepoints.
Why the study?
The knee flexion angle measurement timepoint that best predicts knee flexion angle at 6 months after total knee arthroplasty had not yet been established.
Does pre-anesthetic KFA measurement better predict 6-month postoperative KFA compared to post-anesthetic or intraoperative measurements in patients undergoing unilateral primary TKA?
Cohort (n=165)
No
Does pre-anesthetic KFA measurement better predict 6-month postoperative KFA compared to post-anesthetic or intraoperative measurements in patients undergoing unilateral primary TKA?
Effect estimate: r = 0.771
p-value: p=<0.05
Pre-anesthetic knee flexion angle measurement is the most accurate predictor of 6-month postoperative knee flexion angle in patients undergoing total knee arthroplasty.
Pre-anesthetic KFA may best inform ROM expectations; extends observational predictors but leaves open clinical adoption without RCTs.
INTRODUCTION: Knee flexion angle (KFA) is one of the most critical factors for evaluating patient functional outcomes after total knee arthroplasty (TKA). Preoperative KFA and intraoperative drop leg test are both accepted as predictors of postoperative KFA after TKA. Preoperative testing performed after anesthesia helps overcome pain-related limitations; however, the KFA measurement timepoint that best predicts KFA at 6 months after TKA has not yet been established. METHODS: This prospective cohort study recruited patients who underwent unilateral primary TKA at Siriraj Hospital (Bangkok, Thailand) during August 2012 to August 2017. We recorded KFA at the pre-anesthetic phase, post-anesthetic phase, intraoperation using drop leg test, and at 6-months post-operation. Pearson's correlation coefficient was used to evaluate correlation between different measurement timepoints and 6 months after surgery. Those same relationships were evaluated for overall patients, and for patients with KFA <90° (poor KFA), 90-120° (average KFA), and >120° (high KFA). RESULTS: A total of 165 patients with a mean age of 68.7 years were recruited. Pre-anesthetic KFA measurement had the highest positive correlation with the 6-month KFA (r = 0.771, p<0.05). Post-anesthetic measurement and intraoperative drop leg KFA measurement had moderate positive correlation (r = 0.561, p<0.05) and low positive correlation (r = 0.368, p<0.05) with the 6-month KFA, respectively. The average KFA group had the highest positive correlation between pre-anesthetic KFA measurement and the 6-month KFA (r = 0.711, p<0.05). Predicted 6-month KFA (degrees) adjusted for pre-anesthetic KFA is 45.378 + [0.596 x pre-anesthetic KFA (degrees)] (r = 0.67, p <0.05). CONCLUSIONS: Pre-anesthetic KFA demonstrated the highest correlation with the final KFA at six months after unilateral primary TKA, especially in the patients who had a preoperative KFA within 90-120°.
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Ruangsomboon et al. (2023) conducted a cohort in Primary knee osteoarthritis (n=165). Pre-anesthetic knee flexion angle measurement vs. Post-anesthetic and intraoperative knee flexion angle measurements was evaluated on Correlation between perioperative knee flexion angle and 6-month postoperative knee flexion angle (r = 0.771, p=<0.05). Pre-anesthetic knee flexion angle demonstrated the highest positive correlation with the 6-month postoperative knee flexion angle (r = 0.771, p<0.05) compared to other perioperative timepoints.
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