抄録
The purpose of this study was to evaluate the effectiveness of epidural anesthesia on the flexion angle after total knee arthroplasty (TKA). Thirty-seven TKAs with Advance system (Wright medical) performed on 32 patients were reviewed. There were 30 knees with osteoarthritis, six with rheumatoid arthritis, and one osteonecrosis. The average age at surgery was 74.9 years. Eighteen knees were categorized as group E, and introduced epidural anesthesia. Epidural one-shot injection was given prior to the range of motion (ROM) exercise for two weeks after surgery. NSAIDs were used for the other 19 knees, instead of epidural anesthesia, and categorized as group N. The flexion angle, flexion angle ratio (% : flexion after surgery × 100/flexion before surgery), and the Japanese Orthopaedic Association (JOA) score of each group was evaluated. Mann-Whitney analysis was used to assess the statistical significance (p<0.05 ).
The flexion angle and the JOA score of each group were similar, and no significant difference was recognized before or after surgery. The flexion angle ratio of group E was 96.5 ± 21.6 % at two weeks and 104.1 ± 31.8 % at three months after surgery. Those of group N were 84.8 ± 17.0 % and 94.4 ± 13.3% retrospectively. Group E tended to show better ratio, however no significant difference was identified.
Epidural anesthesia is considered to be a good method for managing pain during ROM exercise after TKA. However, the anesthetic effects were not clearly seen at the affected side in some cases. This should be one of the reasons why there was no significant difference.
