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      Factors Affecting Squatting Ability in Total Knee Arthroplasty Using High Flexion Prosthesis


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          Total knee arthroplasty (TKA) is widely used as a treatment for knee osteoarthritis. Few studies have analysed the factors affecting the squatting ability of patients after TKA. The purpose of this study was to comprehensively analyse the factors affecting squatting ability after TKA and to determine which ones are important.

          Patients and Methods

          Three hundred primary TKA cases with a minimum 3-year follow-up were retrospectively analysed. All patients received a conventional posterior-stabilized TKA implant and underwent a standard perioperative care pathway. The patients were divided into two groups according to the squatting position and knee flexion angle while weight-bearing (Group I – inability to squat group, Group II – ability to squat group). Demographic, operative, and clinical data were collected. Radiographic assessment included joint line elevation, patellar position, posterior condylar offset (PCO), etc. Statistical analysis of the effect of all the above factors on squatting ability was performed.


          The preoperative range of motion and joint line of Group I were 82.9±12.6 and 3.24±1.07, respectively, and those of Group II were 107±9.6 and 1.83±0.89 respectively. The univariate analysis showed that age, prosthesis size, preoperative ROM and joint line position were correlated with squatting ability. But in the final multivariate analysis, joint line position and preoperative ROM were independent influencing factors that affected squatting ability after TKA (p value < 0.01).


          Preoperative ROM and joint line position were independent influencing factors affecting squatting ability after TKA. Patients should be counseled accordingly and be made to understand these factors. To ensure that patients can squat postoperatively, we should improve surgical techniques to control joint line elevation.

          Graphical Abstract

          Most cited references40

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          Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?

          Despite substantial advances in primary TKA, numerous studies using historic TKA implants suggest only 82% to 89% of primary TKA patients are satisfied. We reexamined this issue to determine if contemporary TKA implants might be associated with improved patient satisfaction. We performed a cross-sectional study of patient satisfaction after 1703 primary TKAs performed in the province of Ontario. Our data confirmed that approximately one in five (19%) primary TKA patients were not satisfied with the outcome. Satisfaction with pain relief varied from 72-86% and with function from 70-84% for specific activities of daily living. The strongest predictors of patient dissatisfaction after primary TKA were expectations not met (10.7x greater risk), a low 1-year WOMAC (2.5x greater risk), preoperative pain at rest (2.4x greater risk) and a postoperative complication requiring hospital readmission (1.9x greater risk). Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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            The total condylar knee prosthesis. A report of two hundred and twenty cases.

            The total condylar knee prosthesis is a non-hinged surface replacement which can be used for almost all knee deformities. This report discusses the first consecutive 220 arthroplasties in 183 patients. Follow-up time was three to five years. Before operation eighty-six knees had more than 10 degrees of fixed varus deformity and thirty-one knees had more than 10 degrees of fixed valgus deformity. All patients were assessed using The Hospital for Special Surgery scoring system. Of the total of 220 knees, 137 (62%) were rated excellent; sixty-one (28%), good; ten (4.5%), fair; and twelve (5.5%), poor. Of 139 osteoarthritic knees, 93% were rated excellent or good. Complications included three deep infections and four cases of posterior subluxation. The over-all reoperation rate was 3.6%.
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              Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis.

              Range of motion is a crucial measure of the outcome of total knee arthroplasty. The purpose of this study was to determine which factors are predictive of the postoperative range of motion. We retrospectively studied 3066 patients (4727 knees) who had a primary total knee arthroplasty with the same type of implant at the same center between 1983 and 1998. Statistical clustering analysis paired with log-linear regression was used to determine groupings along continuous variables. Regression tree analysis was used to characterize the combinations of variables influencing the postoperative range of motion. The variables considered were preoperative and intraoperative flexion and extension, preoperative alignment, age, gender, and soft-tissue releases. Preoperative flexion was the strongest predictor of the postoperative flexion regardless of preoperative alignment. Other factors that were significantly related to reduced flexion were intraoperative flexion (p < 0.0001), gender (p < 0.0001), preoperative tibiofemoral alignment (p = 0.0005), age (p < 0.0001), and posterior capsular release (p < 0.0001). The removal of posterior osteophytes was related to the greatest increase in postoperative flexion in the group of patients with a varus tibiofemoral alignment preoperatively. The principal predictive factor of the postoperative range of motion was the preoperative range of motion. Removal of posterior osteophytes and release of the deep medial collateral ligament, the semimembranosus tendon, and the pes anserinus tendon in patients with large preoperative varus alignment and the attainment of a good intraoperative range of motion improved the likelihood that a good postoperative range of motion would be achieved.

                Author and article information

                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                30 November 2021
                : 17
                : 1249-1256
                [1 ]Medical School of Chinese PLA , Beijing, 100853, People’s Republic of China
                [2 ]Department of Orthopedics, The First Medical Center of PLA General Hospital , Beijing, 100048, People’s Republic of China
                [3 ]Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation , Beijing, 100853, People’s Republic of China
                Author notes
                Correspondence: Yonggang Zhou Department of Orthopedics, PLA General Hospital , Fuxing Road, Haidian District, Beijing, People’s Republic of China Tel +8613801287599 Email ygzhou301@163.com
                Author information
                © 2021 Li et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                : 12 October 2021
                : 18 November 2021
                Page count
                Figures: 0, Tables: 6, References: 40, Pages: 8
                Funded by: did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors;
                This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
                Original Research

                squatting ability,joint line elevation,preoperative rom,total knee arthroplasty
                squatting ability, joint line elevation, preoperative rom, total knee arthroplasty


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