Changes in Korean Knee Score and Range of Motion after the Implementation of Structured Nursing Exercise Programs for Patients underwent Total Knee Arthroplasty: A Retrospective Study

슬관절 전치환술 환자를 위한 구조화된 운동교육 프로그램 후 한국형 슬관절 점수와 슬관절 운동범위 변화: 후향적 조사연구

  • Park, Yu Ra (Keimyung University Dongsan Medical Center) ;
  • Park, Wanju (College of Nursing.Research Institute of Nursing Science, Kyungpook National University)
  • 박유라 (계명대학교 동산의료원 정형외과) ;
  • 박완주 (경북대학교 간호대학.간호과학연구소)
  • Received : 2018.03.26
  • Accepted : 2018.07.03
  • Published : 2018.08.31


Purpose: The purpose of this study was to examine the factors affecting changes in Korean Knee Score (KKS) and ranges of motion (ROM) of the knee after the structured exercise programs for the patients with total knee arthroplasty. Methods: This was a retrospective study using electronic medical records from January 2015 to February 2017, and the subject of this study was a total of 124 out of 434 patients underwent total knee replacement operation. They took part in a structured step-by-step exercise program conducted by orthopedic nurses, and then were evaluated for KKS and Knee ROM for 12 weeks after operation. Results: Post-intervention scores increased significantly in the KKS subdomains including pain and symptoms (t=-22.31, p<.001), function (t=-20.68, p<.001), evaluation of floor life (t=-14.18, p<.001), socioemotional function (t=-28.94, p<.001) over time. As for the change in the ROM, knee extension (t=9.23, p<.001) and knee flexion (t=4.04, p<.001) showed a statistically significant changes over time. Conclusion: This study illuminated the factors affecting the changes in pain and symptom, physical function, evaluation of floor life, socioemotional function and range of motion after structured exercise training programs for knee arthritis patients.


  1. Baek, S. H., & Kim, S. Y. (2013). Pharmacologic treatment of osteoarthritis. Journal of the Korean Medical Association, 56(12), 1123-1131.
  2. Cho, W. S., Ahn, H. S., Kim, M. Y., Seol, E. S., Lee, S. W., & Choi, J. W. (2006). Pain after total knee arthroplasty. Journal of the Korean Orthopaedic Association, 41(1), 129-133.
  3. Cho, W. S., Byun, S. E., Yoon, Y. S., & Sun, J. H. (2013). The effect of a lumbar spinal lesion on the clinical results of total knee arthroplasty. Journal of Korean Orthopedic Association, 48(1), 1-8.
  4. Cho, W. S., Kim, M. Y., & Youm, Y. S. (2015). Knee joint arthroplasty (3rd ed.). Seoul: Young Chang Press.
  5. Choi, H. K., Kim, N. S., & Kim, H. S. (2009). Effects of water exercise program on physical fitness, pain and quality of life in patients with osteoarthritis. Journal of Muscle and Joint Health, 16(1), 55-65.
  6. Choi, Y. J., & Ra, H. J. (2016). Patient satisfaction after total knee arthroplasty. Knee Surgery & Related Research, 28(1), 1-15.
  7. Fisher, D. A., Dierckman, B., Watts, M. R., & Davis, K. (2007). Looks good but feels bad: Factors that contribute to poor results after total knee arthroplasty. Journal of Arthroplasty, 22(6), 33-42.
  8. Ha, J. K., Kim, J. G., Lee, M. C., & Wang, J. H. (2012). What symptoms are more important for korean patients in knee osteoarthritis? Development and validation of the Korean knee score. Knee Surgery Related Research, 24(3), 151-157.
  9. Ha, Y. J. (2017). A convergence study on the effects of satisfaction of nurses using the electronic medical record system on job stress. Journal of the Korea Convergence Society, 8(5), 69-78.
  10. Ju, Y. J., & Kim, H. K. (2012). Factors influencing depression among patients with chronic degenerative arthritis after total knee arthroplasty. Journal of Muscle and Joint Health, 19(2), 161-172.
  11. Kang, M. K. (2010). Impact of 12-week complex exercise on degenerative knee joint pain, physical function and physical fitness in elderly women. Unpublished master's thesis, Kookmin University, Seoul.
  12. Kim, O. Y. (2007). The effects of cold therapy on postoperative pain and range of motion of elderly with osteoarthritis after total knee replacement arthroplasty. Unpublished master's thesis, Chung-Ang University, Seoul.
  13. Kim, Y. J., Yoon, M. N., & Han, S. S. (2011). Effects of thera-band resistance training including isometric exercise in total knee replacement patients. Korean Journal of Health Promotion, 11(2), 82-90.
  14. Lau, R. L., Gandhi, R., Mahomed, S., & Mahomed, N. (2012). Patient satisfaction after total knee and hip arthroplasty. Clinics in Geriatric Medicine, 28(3), 349-365.
  15. Lee, D. C., Son, Y. J., & He, J. H. (2003). Results of posterior cruciate retaining and cruciate substituting total knee arthroplasty (3 to 8 years follow up). Knee Surgery & Related Research, 15(1), 48-54.
  16. Lee, J., & Park, K. (2013). Review of rehabilitation exercise for elderly with degenerative knee osteoarthritis. Korean Journal of Growth and Development, 21, 171-183.
  17. Lee, M. K. (2005). The effects of home care exercise program on knee joint function and quality of life in patients with total replacement arthroplasty. Journal of Muscle and Joint Health, 18(2), 143-155.
  18. Maloney, W. J., & Schurman, D. J. (1992). The effects of implant design on range of motion after total knee arthroplasty: Total condylar versus posterior stabilized total condylar designs. Clinical Orthopaedics and Related Research, 278(1), 147-152.
  19. Matsuda, S., Kawahara, S., Okazaki, K., Tashiro, Y., & Iwamoto, Y. (2013). Postoperative alignment and ROM affect patient satisfaction after TKA. Clinical Orthopaedics and Related Research, 471(1), 127-133.
  20. Min, H. S., Jung, Y. H., Kim, E. S., Kim, S. H., & Choi, Y. J. (2011). Effects of muscle strengthening exercise program on pain, fatigue, physical function in elderly women with total knee arthroplasty. Journal of Muscle and Joint Health, 12(2), 203-214.
  21. Moon, I. S. (2013). Research on the quality of life of elderly patients suffering form chronic degenerative knee arthritis. Unpublished master's thesis, Kyunghee University, Seoul.
  22. Pang, W. W., Hsu, T. C., Tung, C. C., Hung, C. P., Chang, D. P., & Huang, M. H. (2000). Is total knee replacement more painful than total hip replacement? Acta Anaesthesiologica Sinica, 38(3), 143-148.
  23. Park, M. A., Hwang, S. K., & Lee, Y. J. (2016). The WOMAC index and life satisfaction after knee replacement arthroplasty. Global Health and Nursing, 6(2), 69-79.
  24. Seok, S. I., & Lee, C. K. (2013). Orthopaedics. Seoul: Newest Medical Publishing Company.
  25. Shim, E. O. (2014). A study on the effects of structures cryotherapy on pain, inflammation, range of motion and edema in patients with total knee arthroplasty. Unpublished master's thesis, Chonnam National University, Daejeon.
  26. Trudel, G., & Uhthoff, H. K. (2000). Contractures secondary to immobility: Is the restriction articular or muscular? An experimental longitudinal study in the rat knee. Archives of Physical Medicine and Rehabilitation, 81(1), 6-13.
  27. Van Manen, M. D., Nace, J., & Mont, M. A. (2012). Management of primary knee osteoarthritis and indications for total knee arthroplasty for general practitioners. Journal of the American Osteopathic Association, 112, 709-715.
  28. Wilson, S. F., & Giddens, J. F. (2013). Health assessment for nursing practice (K. Y. Lee, J. S. Park, Y. H. Lee, M. S. Hong, & E. S. Gong, Trans.). Seoul: Hyunmoonsa.
  29. Yu, J. Y., & Lee H. J. (2016). Effects of motivational intervention for patient with total knee replacement. Journal of Muscle and Joint Health, 23(3), 139-151.