title: Influence of preoperative factors on the gain in flexion after total knee arthroplasty.
abstract: Final flexion mobility after a total knee arthroplasty is an important factor in patient comfort. Some patients gain in flexion mobility, others do not. Is it possible to identify the clinical factors related to the patient that predicted the final gain in flexion?
  
  
  METHODS
  A multicenter retrospective study directed by the Société française de la hanche et du genou (SFHG) was conducted on 1601 cases of total knee arthroplasty that had presented no complications and a minimal follow-up of 2 years. The gain in flexion was assessed by the difference between the preoperative and the final range of flexion. The range of the gain in flexion was tested based on eight factors: age, gender, etiology, body mass index, frontal deformity, preoperative flexum deformity and four levels of preoperative mobility: < 90°, 90°-109°, 110°-129°, and ≥ 130°.
  
  
  RESULTS
  A mean gain in flexion of 8.4°±14° was found for the overall series. In 66% of cases, we found an increase of flexion and in 19% a loss of flexion. In cases with BMI higher than 35, varus deformity with an HKA angle<166°, or flessum greater than 5°, the gain in flexion was significantly higher. A significantly different gain in flexion (P<0.0001) was found in the four levels of preoperative flexion: the greatest gain in flexion was found in the "<90°" group, then this gain was less in the next two groups, to become a significant decrease in the "≥130°" group. A decrease in flexion was noted in 51% of the cases in the latter group. Other factors such as age, sex, and etiology had no influence on the gain in flexion.
  
  
  CONCLUSIONS
  After TKA, a gain in flexion was often noted. The amount of gain depended on the preoperative range of flexion: the lower this level was, the more flexion increased. The presence of a varus deformity, morbid obesity, or flessum was associated with greater gain in flexion, even if the final flexion was lower than the mean flexion in the overall population. The search for these factors made it possible to predict a gain in flexion and discuss this with the patient.
  
  
  METHODS
  Level IV. Multicenter retrospective study.
authors.affiliation: Université de Lille-Nord-de-France, 59000 Lille, France; Service d'orthopédie, hôpital Roger-Salengro, CHRU de Lille, rue Emile-Laine, 59037 Lille, France. Electronic address: gpasquier@nordnet.fr.
authors.forename: G
authors.initials: G
authors.lastname: Pasquier
authors.affiliation: Clinique des Bonnettes, parc des Bonnettes, 2, rue du docteur Forgeois, 62012 Arras, France.
authors.forename: B
authors.initials: B
authors.lastname: Tillie
authors.affiliation: Aix-Marseille université, 58, boulevard Charles-Livon, 13284 Marseille, France; Hôpitaux Sud, AP-HM, 249, boulevard Sainte-Marguerite, 13274 Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Parratte
authors.affiliation: Hôpital de la Pitié-Salpétrière, 83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Catonné
authors.affiliation: Clinique d'Argonay, 685, route de Menthonnex, 74371 Pringy, Haute-Savoie, France.
authors.forename: J
authors.initials: J
authors.lastname: Chouteau
authors.affiliation: Centre orthopédique, 71640 Dracy-Le-Fort, France.
authors.forename: G
authors.initials: G
authors.lastname: Deschamps
authors.affiliation: Aix-Marseille université, 58, boulevard Charles-Livon, 13284 Marseille, France; Hôpitaux Sud, AP-HM, 249, boulevard Sainte-Marguerite, 13274 Marseille, France.
authors.forename: J-N
authors.initials: JN
authors.lastname: Argenson
authors.affiliation: Espace médical Vauban, 2A, avenue Ségur, 75007 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Bercovy
authors.affiliation: Laboratoire de biostatistique, CHRU de Lille, 59037 Lille, France.
authors.forename: J
authors.initials: J
authors.lastname: Salleron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000502:physiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D057234:Preoperative Period; D016059:Range of Motion, Articular; D012189:Retrospective Studies
keywords: Flexion; Knee arthroplasty; Lower limb misalignment; Obesity