Range of motion after total knee replacement: a review from the East

Abstract

Total knee arthroplasty is now an accepted mode of treatment for advanced arthritis of the knee, the main benefits of a total knee replacement (TKR) being pain relief, joint stability and improved range of motion (ROM). In many Asian countries citizens enjoy ‘floor life’: kneeling, squatting and sitting cross-legged are mandatory activities of daily living and religious acts. These sitting postures require more than 130 of knee flexion, the loss of which would be neither appreciated nor accepted. Although the 110–115 average passive knee flexion obtained after total knee arthroplasty is sufficient for Western patients, it is not adequate for other cultures.1 It is good to note that some Western surgeons and manufacturers have recently recognized the importance of extensive knee flexion. The currently accepted postoperative range of motion after knee replacement is unsuitable for billions of people, perhaps half the world’s population. Clinical studies of TKR have shown that the average ROM after surgery is around 100 (usually between 80 and 120 flexion), depending on such factors as the patient population, type of prosthesis used, postoperative management, preoperative ROM, soft tissue status before surgery, surgical technique and the postoperative rehabilitation. Although these factors influence the postoperative