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Official Journal of the Italian Society of Orthopaedics and Traumatology

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  • Open Access

A comparison of two rehabilitation protocols after total knee arthroplasty: does flexion affect mobility and blood loss?

  • 1Email author,
  • 2,
  • 1,
  • 1 and
  • 1
Journal of Orthopaedics and TraumatologyOfficial Journal of the Italian Society of Orthopaedics and Traumatology20078:154

  • Received: 28 August 2006
  • Accepted: 16 January 2007
  • Published:


We report a prospective trial comparing the effectveness of a post-operative flexion regime versus a standard extension regime on the early outcome and on the post-operative blood loss of total knee arthroplasty. Fourty-eight knees were divided to two different post-operative rehabilitation regimes: a flexion regime and an extension regime. The two groups were well matched with respect to age, gender, operation side and pre-op diagnosis All patients were implanted with a NexGen cemented total knee prosthesis and all operations were performed by the same surgeon. Patients were assessed pre-operatively, at the time of discharge, at 6 weeks and at 12 weeks, and were evaluated by means of the Knee Society Score (KSS) and the WOMAC score, the Clarkson criteria for range of motion and muscolar strength measurement, and the Verbal Numeric Scale (VNS) for the pain. Futhermore, postoperative blood loss was assessed by comparing the volume of blood in the drain at the time of their removal and measuring the difference in preoperative and postoperative blood haemoglobin (Hb) in the 2 groups. Patients subjected to the flexion regime had a better KSS and Womac score after 12 weeks and had less post-operative blood loss, requiring fewer blood transfusions. No differences were found between the two groups in terms of pain and muscolar strength. We believe a flexion regime after a total knee arthroplasty is a valid option of rehabilitation treatment and does not result in an increase in wound problems.

Key words

  • Knee arthroplasty
  • Blood loss
  • Postoperative flexion