Factors affecting range of flexion after total knee arthroplasty

Many factors affect postoperative range of flexion after total knee arthroplasty (TKA). The purpose of this study was to identify the most important factors that affect range of knee flexion after TKA. Sixty-five patients (73 knees) were treated with Genesis II knee replacements. Minimum follow-up was 2 years. Patient demographics (sex, age, body mass index, previous surgery, component type, patella resurfacing, preoperative Knee Society score preoperative range of motion) and radiographic measurements (preoperative tibiofemoral varus/valgus angle, height of the joint line, length of the patellar tendon, shift and tilt angle of the patella) were analyzed statistically. Among these factors, preoperative range of flexion, positively, and preoperative varus/valgus tibiofemoral angle, negatively, affected postoperative range of flexion. The tilt angle of the patella and the tilt angle of the patellar button approached statistical significance in revealing a negative relation with postoperative range of flexion. TKAs in which the patella was not resurfaced tended to lose range of flexion, whereas TKAs in which the patella was resurfaced tended to have no loss of flexion, although the number of TKAs in which the patella was not resurfaced was small. In conclusion, preoperative range of flexion and preoperative varus/valgus tibiofemoral angle affected postoperative range of flexion. The tilt angle of the patella and tilt angle of the patellar button may be factors that affect postoperative range of flexion.