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Is There a Threshold for Stiffness Complaints Following TKA on the WOMAC Stiffness Subscale?

2016; SAGE Publishing; Volume: 12; Issue: 2 Linguagem: Inglês

10.1007/s11420-016-9489-5

1556-3324

Hassan Ghomrawi, Carol A. Mancuso, Alejandro González Della Valle, Christina Herrero, Geoffrey H. Westrich,

Knee injuries and reconstruction techniques

Background Stiffness complaints after total knee arthroplasty (TKA) are frequent, yet poorly understood and can be challenging for surgeons to address. The WOMAC stiffness subscale is a widely used measure of stiffness and can serve as a simple screening tool for complaints. Questions/Purposes We aimed to identify a threshold for stiffness complaints on the WOMAC stiffness subscale and investigate its overlap with range of motion (ROM) in TKA patients. Methods TKA patients were enrolled preoperatively and followed for 6 months. At follow-up, patients reported their ROM, completed the WOMAC stiffness subscale (range 1–8 with 8 continuous stiffness) and indicated whether they experienced more stiffness than expected. To identify a threshold for complaints, we compared patients’ WOMAC stiffness scores to when they experienced more stiffness than expected, visually, and statistically. We also mapped ROM limitations at 6 months to WOMAC stiffness scores. Finally, we determined if baseline characteristics were associated with stiffness complaints. Results Two hundred and forty-six TKA patients were enrolled preoperatively with 82% follow-up rate at 6 months. Our results showed that patients with a WOMAC stiffness score = 3+ were significantly more likely to experience more stiffness than expected. Patients reporting full ROM (54%) reported a wide range of WOMAC stiffness subscale scores (1–6). Baseline WOMAC pain and function scores were the only factors associated with stiffness complaints. Conclusions ROM is a poor surrogate of patient-reported stiffness, and the patients’ perception of “stiffness” is clearly more complex than just ROM. We identified a WOMAC threshold that could potentially easily serve this purpose.