Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Hirzberger, D.
Reproducibility of circumferential leg and knee joint flexion measurements and clinical course of recovery after total knee arthroplasty
[ Diplomarbeit ] Medical University of Graz; 2014. pp. 141
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- Autor*innen der Med Uni Graz:
- Donnelly Daniela
- Betreuer*innen:
- Glehr Mathias
- Sadoghi Patrick
- Altmetrics:
- Abstract:
- Background: Knee swelling after total knee arthroplasty (TKA) may lead to pain and loss of motion. In clinical practice, postsurgical swelling is recorded by means of circumferential measurements using tape measures, while the knee range of motion (ROM) may be assessed by goniometric measurements. The first objective of this study was to determine inter-observer and intra-observer reproducibility (in terms of reliability and agreement) of circumferential leg and knee flexion measurements. The second aim was to evaluate recovery of in-patients following TKA with respect to postoperative swelling, passive knee ROM and pain intensity, and to determine a possible influence of postsurgical swelling on passive ROM. Methods: For reproducibility of circumferential and goniometric measurement, two observers examined 40 legs of 20 healthy adults. Circumferential measurements were obtained at three measurement sites (mid-patella, 7 cm proximal of mid-patella, 7 cm distal of mid-patella), using four different types of tape measures (standard tape measure, circumference tape measure, Gulick I tape measure, Gulick II plus tape measure). Knee flexion was measured with a short-arm universal goniometer in two standardised knee joint positions. Agreement was quantified by calculation of the smallest detectable difference (SDD), and reliability by means of the intraclass correlation coefficient (ICC2,1). Clinical assessment was undertaken in 29 patients undergoing TKA. This included lower limb girths at the three measurement sites mentioned above, passive knee ROM, and knee pain intensity using a Numerical Rating Scale (NRS). Pearson´s correlation coefficient was computed to establish a possible relationship between circumference change and passive ROM. Results: In the circumference study, inter-tester agreement (SDD) ranged from 0.7 to 2.1 cm and intra-tester agreement from 0.9 to 1.7 cm. The circumference measurements were generally reliable (ICC2,1 > 0.93). Considering the different measurement sites, agreement was lowest at 7 cm proximal of mid-patella. Comparing the different tape measures used, the Gulick II plus tape measure showed the lowest level of agreement (SDD range, 0.8-2.1 cm). Agreement was highest for the circumference tape measure (SDD range, 0.7-1.2 cm). In knee joint flexion measurements, the level of agreement (SDD) ranged from 5.9 to 9.0° for inter-observer and 7.1 to 8.1° for intra-observer comparisons. Reliability (ICC2,1) ranged from 0.85 to 0.99. Lower limb swelling occurred in all patients after TKA surgery. The circumference change was higher above the knee (mean 5.1 cm, range, 2.3-7.6 cm) than at mid-patella (mean 3.8 cm, range, 1.9-9.8 cm) and below the knee (mean 2.8 cm, range, 1.7-7.2 cm). Maximum swelling was reached on the third to fourth postoperative day. Passive ROM increased continuously after TKA. On sixth postoperative day, the mean passive ROM was 79.0° (range, 55-100°). Circumference change at the three measurement positions did not show any significant correlation with passive ROM on third and sixth postoperative day (P¿0.1375). Postsurgical pain intensity reported by the patients was highest preoperatively (mean NRSmax 7.0, range 4-9), which might be explained by the patient-controlled analgesia for 72 hours postoperatively. After surgery, pain intensity decreased continuously until dismissal day (mean NRSmax 3.0, range 1-9). Conclusion: In circumferential measurements, the level of reproducibility differed substantially depending on the measuring position and tape measure used. With the circumference tape measure, differences in girth exceeding 1.2 cm can be considered a real change above measurement error. Measuring knee flexion with a short-arm universal goniometer, differences of less than 9° cannot be distinguished from measurement error. After TKA, swelling in the knee region was observed in all patients, but did not seem to influence passive ROM after TKA surgery.