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The Effect of Postoperative Range of Motion on Functional Activities After Posterior Cruciate-Retaining Total Knee Arthroplasty
Merrill A. Ritter, MD1; Joseph D. Lutgring, BS1; Kenneth E. Davis, MS1; Michael E. Berend, MD1
1 The Center for Hip and Knee Surgery, St. Francis Hospital, 1199 Hadley Road, Mooresville, IN 46158. E-mail address for M.A. Ritter: marittermd@yahoo.com
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Biomet. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Center for Hip and Knee Surgery, St. Francis Hospital, Mooresville, Indiana

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Apr 01;90(4):777-784. doi: 10.2106/JBJS.F.01022
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Background: Range of motion is recognized as an important indicator of the success of a total knee replacement; however, an optimal range of motion has yet to be defined. This study was designed to determine the optimal range of motion for knee function after total knee arthroplasty with a posterior cruciate-retaining prosthesis.

Methods: We retrospectively reviewed 5556 primary total knee arthroplasties performed with posterior cruciate-retaining prostheses between 1983 and 2003. The relationship between postoperative range of motion and pain, walking ability, stair-climbing ability, and knee function scores was examined at three to five years postoperatively. The relationship between a postoperative flexion contracture or hyperextension and knee function was also examined.

Results: Patients with 128° to 132° of motion obtained the highest scores for pain, walking, and knee function and the highest Knee Society scores. The outcomes became substantially compromised with motion of <118°. Patients with 133° to 150° of motion had the highest scores for stair-climbing. A postoperative flexion contracture and hyperextension were associated with lower scores for pain, walking, stair-climbing, and knee function.

Conclusions: The best functional results following total knee arthroplasty are achieved with 128° to 132° of motion. A postoperative flexion contracture and hyperextension of =10° are associated with a poorer outcome except that stair-climbing is improved with more motion.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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