Functional mobility in patients after unilateral total knee replacement and its influencing factors

Abstract

Objective To investigate the functional mobility of the knee joint after unilateral total knee replacement (TKA), and explore the factors affecting the difference of mobility. Methods A retrospective analysis was performed on 110 patients who received unilateral TKA for the first time from January to December 2019 in the orthopedics department of a Grade A hospital in Chongqing by telephone follow-up. Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index was adopted to evaluate the knee joint function. And the general information of patients and their knee functional activities were subsequently analyzed. Results Standing and walking were the easiest and most satisfying activities for the patients after TKA, but 83% of them still had problems in going up and down stairs or slopes, and 41.8% were expected to be able to squat or use a squat toilet. Among them, 88.2% continued to exercise after discharge to train muscle strength and joint mobility, and only 13.4% had added special training for knee joint function. There were no differences between the patients taking exercise at home and at special rehabilitation centers. The results of rank sum test showed that age, pain, postoperative months, post-discharge exercise, functional training, and home environment had significantly different effects on WOMAC function score (P < 0.05). And stepwise multiple linear regression model indicated that pain (B=13.924, P=0.000) was positively correlated with WOMAC functional score, while persistent exercise (B=-19.889, P=0.002) and functional training (B=-14.671, P=0.011) after discharge were negatively correlated with the score, in an order of strong influencing significance of post-discharge exercise, functional training, and pain. For the patients having post-discharge exercise, functional training was negatively correlated with the WOMAC function score (B=-10.694, P=0.044), whose effect was only second to pain. Conclusion TKA surgery can improve the knee function of patients with knee osteoarthritis, however, pain is still the main factor affecting postoperative functional mobility. Keeping exercise after discharge combined with functional training in addition is helpful to further improve the knee functional joint mobility.

Keywords

• knee replacement
• functional exercise
• functional training
• functional mobility