title: Factors affecting range of motion in total knee arthroplasty using high flexion prosthesis: A prospective study.
abstract: BACKGROUND
  High flexion implants have been reported to provide better range of motion (ROM). The few studies analyzing the factors affecting the ROM are scarce. This study aims to find the factors that affect ROM when using a high flex knee design (INDUS knee).
  
  
  METHODS
  Two hundred and fifty three consecutive patients of total knee arthroplasty (TKA) done by using INDUS knee prosthesis between Sept 2008 and Sept 2009 were included in the study. The cases with osteoarthritis (OA) and Rheumatoid arthritis (RA) were included in study. 5 patients were lost to followup and 248 patients (267 knees, 19 bilateral, 221 OA, and 46 RA) were analyzed for the following factors - sex, age, body mass index (BMI), preoperative ROM, flexion deformity, preoperative total knee score and functional score, time of tourniquet release and patella resurfacing. Subgroup classification using above factors was performed and statistical analysis of effect of all the above factors on final knee ROM was done. Assessment was done preoperatively and at 3 months, 6 months and 1 year postoperatively. The final outcome evaluation was done at one year followup.
  
  
  RESULTS
  The mean age was 68.2 years (range 40-89 years) with 79 males and 189 females. The mean knee range improved from 97.62 ± 11° to 132 ± 8°. Factors that positively affect ROM of INDUS knee prosthesis at the end of 1 year were preoperative ROM, total knee score and functional score, and diagnosis of osteoarthritis, whereas BMI, preoperative flexion deformity has a negative influence on final flexion at the end of 1 year. Age and gender of the patients, patella resurfacing, and use of two different tourniquet protocols did not affect the final outcome.
  
  
  CONCLUSIONS
  Preoperative ROM and preoperative functional status are the most important factors affecting final range. Patients should be counseled accordingly and made to understand these factors.
authors.affiliation: Department of Arthroplasty, Sancheti Institute of Orthopaedics and Rehabilitation, 16 Shivaji Nagar, Pune, Maharashtra, India.
authors.forename: Kantilal H
authors.initials: KH
authors.lastname: Sancheti
authors.forename: Parag K
authors.initials: PK
authors.lastname: Sancheti
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Shyam
authors.forename: Rajeev
authors.initials: R
authors.lastname: Joshi
authors.forename: Kailash
authors.initials: K
authors.lastname: Patil
authors.forename: Anubhav
authors.initials: A
authors.lastname: Jain
keywords: High flex knee prosthesis; range of motion; total knee arthroplasty