术前活动范围作为全膝关节置换术术后预后的预测指标：确定临床相关临界值

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-05-22 DOI:10.1016/j.jor.2025.05.026

R. Radhakrishnan, A. Padki, A.X. Han, X. Liu, M.H. Liow, D.K.J. Tay, S.J. Yeo, H.N. Pang, J.Y. Chen

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引用次数: 0

摘要

背景：术前活动范围（ROM）在全膝关节置换术（TKA）术后增强恢复（ERAS）方案中的预测作用仍未得到充分探讨。目的确定临床相关的术前ROM阈值，预测基于erasas的TKA术后运动不佳。方法对339例经ERAS治疗的TKA患者进行回顾性队列分析。术前伸展活动度（ROMS）和屈曲活动度（ROME）被评估为术后活动度和功能预后的预测指标。进行相关分析、回归分析和ROC分析。结果术前ROMS截止值为30°，预测术后伸展（>10°）和屈曲（<100°）不良的特异性为100% （AUC分别为0.361和0.420）。术前ROME预测术后屈曲的准确度较高（AUC = 0.778），最佳阈值为150°，达到100%的敏感性和99.6%的特异性。然而，术前ROM参数与功能评分和患者报告的结果的相关性有限。结论术前30度ROMS可作为术后ROM限制的高度特异性预测指标，为ERAS路径的患者选择和围手术期计划提供了可操作的基准。证据水平：III级，回顾性队列研究。

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Preoperative range of motion as a predictor of postoperative outcomes in total knee arthroplasty under enhanced recovery after surgery protocols: Defining clinically relevant cut-offs

Background

The predictive role of preoperative range of motion (ROM) in total knee arthroplasty (TKA) under Enhanced Recovery After Surgery (ERAS) protocols remains underexplored.

Objective

To identify clinically relevant preoperative ROM thresholds predictive of suboptimal postoperative motion in ERAS-based TKA.

Methods

A retrospective cohort of 339 TKA patients managed under ERAS was analyzed. Preoperative ROM in extension (ROMS) and flexion (ROME) were assessed as predictors of postoperative ROM and functional outcomes. Correlation, regression, and ROC analyses were performed.

Results

A preoperative ROMS cut-off of 30° demonstrated 100 % specificity for predicting poor postoperative extension (>10°) and flexion (<100°) (AUC = 0.361 and 0.420, respectively). Preoperative ROME predicted postoperative flexion with higher accuracy (AUC = 0.778) and an optimal threshold of 150°, achieving 100 % sensitivity and 99.6 % specificity. Preoperative ROM parameters, however, showed limited correlation with functional scores and patient-reported outcomes.

Conclusion

A 30-degree preoperative ROMS serves as a highly specific predictor of postoperative ROM limitation, offering an actionable benchmark for patient selection and perioperative planning within ERAS pathways.

Level of evidence

Level III, Retrospective cohort study.

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.