The effect of preoperative and postoperative hamstring stretches on knee range of motion (ROM), Knee Extension Angle (KEA) and fixed flexion deformity after total knee arthroplasty

In individuals with hamstring tightness and varus and/or flexion deformity undergoing total knee arthroplasty how does additional preoperative and postoperative hamstring stretching compared with standard postoperative physical therapy effect knee range of motion, knee extension angle, fixed flexion deformity, gait mechanics and patient outcomes.

Status

Terminated

Phases

Unknown

Study type

Interventional

Source

ANZCTR

Registry ID

ACTRN12612001291875

Enrollment

Registered

2012-12-13

Start date

2013-02-21

Completion date

2016-04-13

Last updated

2021-09-27

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

Hamstring tightness and insertional tendonopathy is a common condition that frequently coexists with osteoarthritis about the knee. Total knee arthroplasty (TKA) is the definitive treatment of advanced symptomatic knee ostoearthritis but does nothing to treat hamstring tightness and insertional tendonopathy which can then interfere with the recovery from TKA by causing pain and altering gait mechanics. Little data exists on the coexistence of these two conditions however. The author proposes a prospective randomized blinded trial to assess the effect of hamstring stretching on knee extension angle,gait, fixed flexion deformity and symptoms in the osteoarthritic knee and to assess the effect of hamstring stretching the same parameters after TKA. Patients presenting to participating orthopaedic surgeons for treatment of knee osteoarthritis with flexion, varus or flexion and varus deformity >= 10 degrees and scheduled for TKA will be eligible for enrollment in the study. Clinical assessment of the knee, gait analysis and validated outcomes scores to be assessed at time zero, after four weeks of stretching and six weeks after TKA. Final examination and scoring at 6 months post op. Symptoms to be assessed using standardized assessment forms (Euroqual, WOMAC, Oxford Knee Score, Knee Society Knee Score, KOOS). Unilateral TKA participants will be randomly allocated to either a control (CTKA) or treatment (TTKA). Bilateral TKA patients will also be randomly allocated to either a control (CTKA) or treatment (TTKA).The TTKA treatment groups will undergo a stretching program 4 weeks before and 6 weeks after TKA surgery. The Participants will be instructed in performing a hamstring stretch by a physiotherapist. Participants will be required to perform a 2 x 2 mins progressive hamstring stretches twice daily (total of 8 min hamstring stretch on each leg). Instruction video to be provided to each patient on portable USB drive. Reminder text messages twice weekly to be sent. Gait lab technician and clinical assessor and inpatient physiotherapist to be blinded.

Interventions

Preoperative and postoperative hamstring stretches. Two, 2 min stretches twice daily for 4 weeks prior to total knee arthroplasty and for 6 weeks after total knee arthroplasty. Participants will be all be instructed in this exercise by a senior musculoskeletal physiotherapist at commencement in a one on one session and will recieve and instructional video on a DVD or USB drive. Participants will receive an exercise log and reminder text messages twice weekly. Accompanied by otherwise routine postoperative rehabilitation protocol after surgery (quadriceps and extension control, flexion range of motion, gait patterning, oedema control, deep venous thrombosis (DVT) prevention) to be done twice daily for 15 minutes immediately following the hamstring exercise.

Study design

Allocation

Randomised controlled trial

Intervention model

Parallel

Primary purpose

Treatment

Masking

Blinded (masking used)

Eligibility

Sex/Gender

All

Age

45 Years to 85 Years

Healthy volunteers

Inclusion criteria

1. A diagnosis of advanced symptomatic knee osteoarthritis with varus, flexion or flexion and varus deformities >=10 degrees in any one plane in individuals fit for and requiring total knee arthroplasty (TKA). 2. Hamstring tightness (Knee Extension Angle (KEA) >40o .with or without symptomatic pes anserinus bursitis (PAB). 3. The ability and willingness to engage a preoperative and postoperative hamstring stretching program.

Exclusion criteria

1. A leg length discrepancy is greater or equal to three cm. 2. Ipsilateral hip / ankle ankylosis or arthrodesis. 3. Ipsilateral fixed flexion deformities of the hip or ankle on the same limb.

Outcome results