The effect of losartan on range of motion and rates of manipulation in total knee arthroplasty: a retrospective matched cohort study
Introduction Arthrofibrosis remains a common cause of patient dissatisfaction and reoperation after total knee arthroplasty (TKA). Losartan is an angiotensin receptor blocker (ARB) with inhibitory effects on transforming growth factor beta, previously implicated in tissue repair induced fibrosis, an...
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Published in | Archives of orthopaedic and trauma surgery Vol. 143; no. 7; pp. 4043 - 4048 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.07.2023
Springer Nature B.V |
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Abstract | Introduction
Arthrofibrosis remains a common cause of patient dissatisfaction and reoperation after total knee arthroplasty (TKA). Losartan is an angiotensin receptor blocker (ARB) with inhibitory effects on transforming growth factor beta, previously implicated in tissue repair induced fibrosis, and has been studied to prevent stiffness following hip arthroscopy. This study aimed to evaluate pre- and postoperative range of motion (ROM) and the incidence of manipulation under anesthesia (MUA) following primary TKA in patients taking Losartan preoperatively for hypertension.
Materials and methods
A retrospective review of 170 patients from 2012 to 2020 who underwent a primary, elective TKA and were prescribed Losartan at least three months prior to surgery. All patients who were prescribed Losartan and had a preoperative and postoperative ROM in their chart were included and were matched to a control group of patients who underwent TKA and had no Losartan prescription. ROM, MUA, readmissions, reoperations, and revisions were assessed using chi-square and independent sample
t
tests.
Results
Seventy-nine patients met the inclusion criteria. Preoperative ROM was similar between patients on Losartan and the control group (103.59° ± 16.14° vs. 104.59° ± 21.59°, respectively;
p
= 0.745). Postoperative ROM and ΔROM were greater for patients prescribed Losartan (114.29° ± 12.32° vs. 112.76° ± 11.65°;
p
= 0.429 and 10.57° ± 14.95° vs. 8.17° ± 21.68°;
p
= 0.422), though this difference did not reach statistical significance. There was no difference in readmission, rate of manipulation for stiffness, or all-cause revision rates.
Conclusion
In this study, we found that the use of Losartan did not significantly improve postoperative ROM, reduce MUA or decrease revision rates. Further prospective studies using Losartan are required to elucidate the potential effects on ROM and incidence of arthrofibrosis requiring MUA.
Level III evidence
Retrospective cohort study. |
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AbstractList | Arthrofibrosis remains a common cause of patient dissatisfaction and reoperation after total knee arthroplasty (TKA). Losartan is an angiotensin receptor blocker (ARB) with inhibitory effects on transforming growth factor beta, previously implicated in tissue repair induced fibrosis, and has been studied to prevent stiffness following hip arthroscopy. This study aimed to evaluate pre- and postoperative range of motion (ROM) and the incidence of manipulation under anesthesia (MUA) following primary TKA in patients taking Losartan preoperatively for hypertension.
A retrospective review of 170 patients from 2012 to 2020 who underwent a primary, elective TKA and were prescribed Losartan at least three months prior to surgery. All patients who were prescribed Losartan and had a preoperative and postoperative ROM in their chart were included and were matched to a control group of patients who underwent TKA and had no Losartan prescription. ROM, MUA, readmissions, reoperations, and revisions were assessed using chi-square and independent sample t tests.
Seventy-nine patients met the inclusion criteria. Preoperative ROM was similar between patients on Losartan and the control group (103.59° ± 16.14° vs. 104.59° ± 21.59°, respectively; p = 0.745). Postoperative ROM and ΔROM were greater for patients prescribed Losartan (114.29° ± 12.32° vs. 112.76° ± 11.65°; p = 0.429 and 10.57° ± 14.95° vs. 8.17° ± 21.68°; p = 0.422), though this difference did not reach statistical significance. There was no difference in readmission, rate of manipulation for stiffness, or all-cause revision rates.
In this study, we found that the use of Losartan did not significantly improve postoperative ROM, reduce MUA or decrease revision rates. Further prospective studies using Losartan are required to elucidate the potential effects on ROM and incidence of arthrofibrosis requiring MUA.
Retrospective cohort study. IntroductionArthrofibrosis remains a common cause of patient dissatisfaction and reoperation after total knee arthroplasty (TKA). Losartan is an angiotensin receptor blocker (ARB) with inhibitory effects on transforming growth factor beta, previously implicated in tissue repair induced fibrosis, and has been studied to prevent stiffness following hip arthroscopy. This study aimed to evaluate pre- and postoperative range of motion (ROM) and the incidence of manipulation under anesthesia (MUA) following primary TKA in patients taking Losartan preoperatively for hypertension.Materials and methodsA retrospective review of 170 patients from 2012 to 2020 who underwent a primary, elective TKA and were prescribed Losartan at least three months prior to surgery. All patients who were prescribed Losartan and had a preoperative and postoperative ROM in their chart were included and were matched to a control group of patients who underwent TKA and had no Losartan prescription. ROM, MUA, readmissions, reoperations, and revisions were assessed using chi-square and independent sample t tests.ResultsSeventy-nine patients met the inclusion criteria. Preoperative ROM was similar between patients on Losartan and the control group (103.59° ± 16.14° vs. 104.59° ± 21.59°, respectively; p = 0.745). Postoperative ROM and ΔROM were greater for patients prescribed Losartan (114.29° ± 12.32° vs. 112.76° ± 11.65°; p = 0.429 and 10.57° ± 14.95° vs. 8.17° ± 21.68°; p = 0.422), though this difference did not reach statistical significance. There was no difference in readmission, rate of manipulation for stiffness, or all-cause revision rates.ConclusionIn this study, we found that the use of Losartan did not significantly improve postoperative ROM, reduce MUA or decrease revision rates. Further prospective studies using Losartan are required to elucidate the potential effects on ROM and incidence of arthrofibrosis requiring MUA.Level III evidenceRetrospective cohort study. Introduction Arthrofibrosis remains a common cause of patient dissatisfaction and reoperation after total knee arthroplasty (TKA). Losartan is an angiotensin receptor blocker (ARB) with inhibitory effects on transforming growth factor beta, previously implicated in tissue repair induced fibrosis, and has been studied to prevent stiffness following hip arthroscopy. This study aimed to evaluate pre- and postoperative range of motion (ROM) and the incidence of manipulation under anesthesia (MUA) following primary TKA in patients taking Losartan preoperatively for hypertension. Materials and methods A retrospective review of 170 patients from 2012 to 2020 who underwent a primary, elective TKA and were prescribed Losartan at least three months prior to surgery. All patients who were prescribed Losartan and had a preoperative and postoperative ROM in their chart were included and were matched to a control group of patients who underwent TKA and had no Losartan prescription. ROM, MUA, readmissions, reoperations, and revisions were assessed using chi-square and independent sample t tests. Results Seventy-nine patients met the inclusion criteria. Preoperative ROM was similar between patients on Losartan and the control group (103.59° ± 16.14° vs. 104.59° ± 21.59°, respectively; p = 0.745). Postoperative ROM and ΔROM were greater for patients prescribed Losartan (114.29° ± 12.32° vs. 112.76° ± 11.65°; p = 0.429 and 10.57° ± 14.95° vs. 8.17° ± 21.68°; p = 0.422), though this difference did not reach statistical significance. There was no difference in readmission, rate of manipulation for stiffness, or all-cause revision rates. Conclusion In this study, we found that the use of Losartan did not significantly improve postoperative ROM, reduce MUA or decrease revision rates. Further prospective studies using Losartan are required to elucidate the potential effects on ROM and incidence of arthrofibrosis requiring MUA. Level III evidence Retrospective cohort study. |
Author | Schwarzkopf, Ran Arraut, Jerry Lygrisse, Katherine A. Rozell, Joshua C. Fiedler, Benjamin Singh, Vivek |
Author_xml | – sequence: 1 givenname: Jerry orcidid: 0000-0001-7023-7458 surname: Arraut fullname: Arraut, Jerry organization: Department of Orthopedic Surgery, NYU Langone Health – sequence: 2 givenname: Katherine A. surname: Lygrisse fullname: Lygrisse, Katherine A. organization: Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Huntington Hospital – sequence: 3 givenname: Vivek surname: Singh fullname: Singh, Vivek organization: Department of Orthopedic Surgery, NYU Langone Health – sequence: 4 givenname: Benjamin surname: Fiedler fullname: Fiedler, Benjamin organization: Department of Orthopedic Surgery, NYU Langone Health – sequence: 5 givenname: Ran surname: Schwarzkopf fullname: Schwarzkopf, Ran organization: Department of Orthopedic Surgery, NYU Langone Health – sequence: 6 givenname: Joshua C. surname: Rozell fullname: Rozell, Joshua C. email: Joshua.Rozell@nyulangone.org organization: Department of Orthopedic Surgery, NYU Langone Health |
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CitedBy_id | crossref_primary_10_1016_j_arth_2023_10_015 crossref_primary_10_1016_j_otsr_2024_103851 crossref_primary_10_1016_j_asmr_2023_05_005 crossref_primary_10_1080_03008207_2024_2358351 crossref_primary_10_1016_j_jseint_2023_06_008 crossref_primary_10_1016_j_jse_2024_02_035 |
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Keywords | Total knee arthroplasty Range of motion Manipulation under anesthesia Losartan Arthrofibrosis |
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Arthrofibrosis remains a common cause of patient dissatisfaction and reoperation after total knee arthroplasty (TKA). Losartan is an angiotensin... Arthrofibrosis remains a common cause of patient dissatisfaction and reoperation after total knee arthroplasty (TKA). Losartan is an angiotensin receptor... IntroductionArthrofibrosis remains a common cause of patient dissatisfaction and reoperation after total knee arthroplasty (TKA). Losartan is an angiotensin... |
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SubjectTerms | Angiotensin Receptor Antagonists Angiotensin-Converting Enzyme Inhibitors Arthroplasty, Replacement, Knee Cohort analysis Cohort Studies Humans Joint Diseases - surgery Joint replacement surgery Knee Joint - surgery Losartan - therapeutic use Medicine Medicine & Public Health Orthopaedic Surgery Orthopedics Prospective Studies Range of motion Range of Motion, Articular Retrospective Studies Treatment Outcome |
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Title | The effect of losartan on range of motion and rates of manipulation in total knee arthroplasty: a retrospective matched cohort study |
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