title: Effect of different postoperative flexion regimes on the outcomes of total knee arthroplasty: randomized controlled trial.
abstract: OBJECTIVE
  A consistent limb position strategy could be an attractive and easier alternative to reduce blood loss and increase range of motion following total knee arthroplasty. The aim of this study was to understand the proper amount of flexion required to improve functional outcomes with limited patients' discomfort.
  
  
  METHODS
  Eighty-five patients undergoing total knee arthroplasty were randomly assigned to receive mild (30° of knee flexion) or high-flexion protocol (70° of knee flexion), 48 h after surgery. The same daily rehabilitation scheme was followed. Total blood loss, hidden blood loss, haemoglobin and haematocrit levels, fixed flexion deformity, range of motion and limb circumference at the superior patellar pole were evaluated preoperatively and 7 days after surgery.
  
  
  RESULTS
  Demographics, blood parameters and preoperative range of motion did not show any significant difference between the two groups. No complications were recorded in both groups. High-flexion group had greater rate of dropout due to excessive patients' discomfort. A significantly lower Hb at day 1 was found in the high-flexion group. No differences were recorded regarding the remaining parameters.
  
  
  CONCLUSIONS
  No significant differences were found between the high-flexion and mild-flexion protocols; however, mild-flexion protocol was better tolerated by patients. We therefore recommend a 30° flexion protocol to be routinely used 48 h postoperatively after total knee arthroplasty. This is an easy strategy to improve functional outcomes, which is a fundamental issue considering the steady increase in knee prostheses utilization.
  
  
  METHODS
  Randomized controlled trial, Level II.
authors.affiliation: General Orthopaedic Surgery, Rizzoli Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, Bagheria, PA, Italy. marcello.define@gmail.com.
authors.forename: Marcello
authors.initials: M
authors.lastname: De Fine
authors.affiliation: General Orthopaedic Surgery, Rizzoli Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, Bagheria, PA, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Traina
authors.affiliation: Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, Bologna, Italy.|Laboratory of Tissue Engineering - Innovative Technology Platforms for Tissue Engineering, Rizzoli Orthopedic Institute, Palermo, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giavaresi
authors.affiliation: Rehabilitation Service, University of Messina, Messina, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Leo
authors.affiliation: Section of Orthopaedics and Traumatology, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Sanzarello
authors.affiliation: General Orthopaedic Surgery, Rizzoli Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, Bagheria, PA, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Perna
authors.affiliation: Rehabilitation Service, University of Messina, Messina, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Dattola
authors.affiliation: General Orthopaedic Surgery, Rizzoli Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, Bagheria, PA, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Faldini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D010352:Patient Dropouts; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D016059:Range of Motion, Articular
chemical_list: D006454:Hemoglobins
keywords: Blood loss; Outcomes; Range of motion; Rehabilitation; Total knee arthroplasty