Buterin A, Vuckovic M, Spanja Prpic S, Zaharija V, Nonkovic M, Prpic T. Comparison of functional recovery of the knee following total knee arthroplasty in patients with and without ankle symptoms. World J Orthop 2025; 16(5): 106004 [DOI: 10.5312/wjo.v16.i5.106004]
Corresponding Author of This Article
Antea Buterin, Department of Orthopaedics and Traumatology, Special Hospital for Orthopaedics Biograd na Moru, Zadarska 62, Biograd na Moru 23210, Croatia. antea.buterin@yahoo.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. May 18, 2025; 16(5): 106004 Published online May 18, 2025. doi: 10.5312/wjo.v16.i5.106004
Comparison of functional recovery of the knee following total knee arthroplasty in patients with and without ankle symptoms
Antea Buterin, Mirela Vuckovic, Sandra Spanja Prpic, Vedrana Zaharija, Martin Nonkovic, Tomislav Prpic
Antea Buterin, Martin Nonkovic, Department of Orthopaedics and Traumatology, Special Hospital for Orthopaedics Biograd na Moru, Biograd na Moru 23210, Croatia
Mirela Vuckovic, Sandra Spanja Prpic, Vedrana Zaharija, Department of Physiotherapy, Faculty of Health Studies, University of Rijeka, Rijeka 51000, Croatia
Sandra Spanja Prpic, Vedrana Zaharija, Tomislav Prpic, Department of Orthopaedics, University Hospital for Orthopaedics and Traumatology Lovran, University of Rijeka, Lovran 51415, Croatia
Tomislav Prpic, Department of Clinical Sciences, Faculty of Health Studies, University of Rijeka, Rijeka 51000, Croatia
Author contributions: Buterin A, Vuckovic M and Prpic T conceived and designed the research study; Buterin A, Vuckovic M, Spanja Prpic S and Zaharija V performed the research; Buterin A, Vuckovic M, Nonkovic M and Prpic T wrote and edited the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The study was conducted in accordance with the ethical standards of the institutional research committee (No. 02-272/2019) and with the 1964 Helsinki Declaration and its later amendments.
Clinical trial registration statement: The study was registered at Clinicaltrials.gov (NCT05751954) prior to patient inclusion.
Informed consent statement: Informed consent was obtained from all patients.
Conflict-of-interest statement: The authors declare no conflict-of-interests.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The datasets generated and analysed during the current study are not publicly available due to institutional policy, but are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Antea Buterin, Department of Orthopaedics and Traumatology, Special Hospital for Orthopaedics Biograd na Moru, Zadarska 62, Biograd na Moru 23210, Croatia. antea.buterin@yahoo.com
Received: February 13, 2025 Revised: March 31, 2025 Accepted: April 11, 2025 Published online: May 18, 2025 Processing time: 92 Days and 18.3 Hours
Abstract
BACKGROUND
Total knee arthroplasty (TKA) aims to restore motion and alleviate pain, enabling patients to return to daily activities. Despite advances in implants, surgery, and perioperative care, patient dissatisfaction rates remain significant.
AIM
To determine whether ankle symptoms are associated with inferior results of functional recovery of the knee following TKA.
METHODS
This prospective study included all patients with advanced knee osteoarthritis who underwent a primary unilateral TKA between August 2019 and December 2019 with data documented by the treating surgeon and outpatient physical therapists. Patients were categorized based on ankle symptoms using the American Orthopaedic Foot and Ankle Society (AOFAS) score: (1) Group 1 (AOFAS ≤ 85, n = 30); and (2) Group 2 (AOFAS > 85, n = 49). Active range of motion (ROM), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the visual analogue scale (VAS) were compared between two groups.
RESULTS
Postoperative KOOS, ROM, and VAS significantly improved in both groups (P < 0.001). However, at three months, KOOS (P = 0.02) and extension motion (P = 0.01) improvements were significantly greater in group 2.
CONCLUSION
These findings suggest that preoperative ankle symptoms may negatively impact early knee functional recovery, particularly in KOOS scores and extension motion.
Core Tip: Preoperative ankle symptoms may negatively impact early functional recovery following total knee arthroplasty (TKA). This study found that patients with ankle symptoms had significantly lower Knee Injury and Osteoarthritis Outcome Scores and reduced knee extension three months postoperatively compared to those without ankle symptoms. These findings highlight the importance of assessing and addressing ankle pathology before TKA to optimize postoperative outcomes. A comprehensive approach considering the biomechanical interplay between the knee and ankle may improve functional recovery and patient satisfaction after TKA.
