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Atul F. Kamath,John G. Horneff,Angela Forsyth,Valdet Nikci,Charles L. Nelson 대한정형외과학회 2012 Clinics in Orthopedic Surgery Vol.4 No.2
Background: Hemophiliacs have extrinsic tightness from quadriceps and fl exion contractures. We sought to examine the effectof a focused physical therapy regimen geared to hemophilic total knee arthroplasty. Methods: Twenty-four knees undergoing intensive hemophiliac-specifi c physical therapy after total knee arthroplasty, at an averageage of 46 years, were followed to an average 50 months. Results: For all patients, fl exion contracture improved from −10.5 degrees preoperatively to −5.1 degrees at fi nal follow-up (p =0.02). Knees with preoperative fl exion less than 90 degrees were compared to knees with preoperative fl exion greater than 90degrees. Patients with preoperative fl exion less than 90 degrees experienced improved fl exion (p = 0.02), along with improved arcrange of motion (ROM) and decreased fl exion contracture. For those patients with specifi c twelve-month and fi nal follow-up datapoints, there was a signifi cant gain in fl exion between twelve months and fi nal follow-up (p = 0.02). Conclusions: Hemophiliacs with the poorest fl exion benefi ted most from focused quadriceps stretching to a more functionallength, with gains not usually seen in the osteoarthritic population. This data may challenge traditional views that ROM gains arenot expected beyond 12-18 months.