Angiotensin II blockade had no effect on range of motion after total knee arthroplasty: a retrospective review

• Published in: Journal of orthopaedic surgery and research 2020-02, Vol.15 (1), p.48-48, Article 48
• Main Authors: Langston, Joseph R, Ramsey, Duncan C, Skoglund, Kathryn, Schabel, Kathryn
• Format: Article
• Language: English
• Subjects: ACE inhibitors; Age; Analysis; Angiotensin; Angiotensin II; Angiotensin-converting enzyme inhibitors; Angiotensins; ARBs; Arthritis; Arthroplasty; Arthroplasty (knee); Cardiovascular disease; Coronary vessels; Diabetes; Diabetes mellitus; Enzyme inhibitors; Enzymes; Flexion; Gender; Gene expression; Heart failure; Hypertension; Joint replacement surgery; Joint surgery; Knee; Knee replacement arthroplasty; Liver; Musculoskeletal system; Opioids; Orthopedic surgery; Orthopedics; Patients; Peptidyl-dipeptidase A; Physicians; Range of motion; Statins; Statistical analysis; Total knee arthroplasty; Variables
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-020-1555-5

Stiffness and pain from arthrofibrosis following total knee arthroplasty (TKA) is a challenging problem, and investigating methods to prevent or reduce the incidence of postoperative arthrofibrosis is critical. Studies have shown that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are efficacious at preventing fibrotic disorders in the lungs, liver, kidneys, and eyes. Our aim was to determine if ACEI or ARB use postoperatively reduces the incidence of arthrofibrosis in TKA patients. In a retrospective review, we analyzed 141 consecutive TKAs performed at a single institution by a single surgeon from December 2010 to December 2014. Range of motion (ROM) in patients already taking ACEI, ARB, or neither medication was compared. Independent variables recorded were gender, age, BMI, presence of diabetes or preoperative opioid or statin use, preoperative ROM, and use of ACEIs or ARBs. Dependent variables recorded were postoperative knee flexion, extension, and total arc of motion. The primary outcome variable was success or failure of achieving 118 total arc of motion postoperatively, based on a study that found significant compromise of function in TKA patients who failed to obtain this goal. Secondary endpoints were postoperative knee flexion, extension, and total arc of motion. The use of neither ACEIs nor ARBs showed a significant difference in attaining greater than 118° of motion postoperatively compared to controls at 6 months. Significant predictors of obtaining > 118° motion were BMI (p