Severity of post - operative knee stiffness and associated factors after surgical fixation of knee osseous injuries among adults at Mulago National Referral Hospital

Abstract

Background: Knee stiffness following surgical fixation of knee osseous injuries is a common and potential complication of surgery and rehabilitation with a global incidence of 4% to 38%. Even with the currently recommended surgical fixation techniques of these injuries, it was noted that patients develop varying degrees of stiffness. Main objective: To establish the severity of post – operative knee stiffness and associated factors after surgical fixation of knee osseous injuries among adults at Mulago national referral hospital. Methods: A period cross sectional study was done between September 2024 and January 2025, among adults with knee osseous injuries managed by surgical fixation. A total of 115 participants were enrolled into the study and consecutive sampling was used to recruit the participants. Descriptive statistics was done and then Bivariate and multivariate ordinal logistic regression model analyses were conducted, with STATA version 15 to identify the factors associated with severity of POKS. Results: 90 (78.3%) out 115 patients had varying severity of POKS. 25.2% had extreme POKS, 28.7% had severe POKS, 19.1% had moderate POKS and 5.2% had mild POKS. 15 patients had extension limitation, 39 patients had flexion limitation and 36 patients had combined extension and flexion limitation. After controlling for other factors, non-adherence to physiotherapy (cOR = 0.28, 95% CI 0.16 – 0.49), cigarette use (cOR = 3.49, 95% CI 1.29 – 10.92) and surgical fixation done greater than 2 weeks post-injury (cOR = 1.35, 95% CI 1.02 – 7.76) were significantly associated with the severity of POKS, with P – values less than 0.05. Conclusion: In this study, most participants presented with the extreme and severe forms of severity of POKS. The independent predictors of POKS severity included non-adherence to physiotherapy, surgical fixation performed more than 2 weeks post-injury, and cigarette use.