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Chronic obstructive pulmonary disease, younger age and impaired preoperative flexion increase the risk of stiffness after total knee arthroplasty: a retrospective case–control study

  • Original Article
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European Orthopaedics and Traumatology

Abstract

Introduction

Knee stiffness after total knee arthroplasty (TKA) impairs patient satisfaction and can necessitate mobilisation under anaesthesia (MUA). We investigated what factors predispose towards the need for MUA after TKA.

Patients and methods

The study population was extracted from our local arthroplasty register. Within the setting of a retrospective case/control study, we compared patients who underwent MUA after TKA (n = 35) with a randomly selected control group that did not need MUA after TKA (n = 122) using binary logistic regression analysis.

Results

We found that the risk of MUA due to flexion below 90° was increased in patients suffering from chronic obstructive pulmonary disease (COPD) with a risk ratio (RR) of 12 (95 % confidence interval [CI] 1.7–84, p = 0.01). Increasing age decreased the risk of developing stiffness with a RR of 0.88 (CI 0.81–0.95, p < 0.001) per year. Greater preoperative flexion decreased the risk of stiffness with a RR of 0.97 (CI 0.94–1.0, p = 0.03) per degree of flexion. Gender, body mass index, medical and psychiatric comorbidities, rheumatoid arthritis, the Insall–Salvati index, and the increase in sagittal femoral diameter induced by prosthesis insertion did not significantly affect the risk of stiffness. A certain type of knee prosthesis (Natural Knee 2) was overrepresented among patients requiring MUA.

Discussion and conclusion

We conclude that stiffness after TKA is more frequent in younger patients and in those with limited preoperative flexion. It is also suggested that postoperative stiffness may be associated with COPD and with the choice of certain implants.

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Acknowledgements

No external funding was received in support of this study.

Competing interests

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Institute of Surgical Sciences, Department of Orthopaedics, Uppsala University Hospital, 751 85, Uppsala, Sweden

    Nils P. Hailer, Erik Widerström & Hans Mallmin

  2. Institute of Radiology, Oncology and Radiotherapy, Department of Radiology, Uppsala University Hospital, 751 85, Uppsala, Sweden

    Mari Hänni

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  1. Nils P. Hailer
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  2. Mari Hänni
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Correspondence to Nils P. Hailer.

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Hailer, N.P., Hänni, M., Widerström, E. et al. Chronic obstructive pulmonary disease, younger age and impaired preoperative flexion increase the risk of stiffness after total knee arthroplasty: a retrospective case–control study. Eur Orthop Traumatol 4, 137–145 (2013). https://doi.org/10.1007/s12570-013-0169-3

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  • DOI: https://doi.org/10.1007/s12570-013-0169-3

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