Photographic Evidence on Total Knee Arthroplasty Outcomes

October 29, 2025 updated by: Nicholas Brown, Loyola University

The Impact of Photographic Evidence on Postoperative Range of Motion Following Total Knee Arthroplasty: A Randomized Control Trial

Historically, total knee arthroplasty (TKA) has been performed to restore knee range of motion and relieve pain, with postoperative rehabilitation focused on helping patients regain mobility and function. This study evaluates whether providing patients with photographic evidence of their knee range of motion immediately after surgery can enhance short-term recovery.

Patients will be randomly assigned to one of two groups: one group will receive printed photographs showing their knee in full flexion immediately after surgery, while the other group will not receive photographs. Outcomes assessed at six weeks postoperatively will include knee range of motion, physical therapy progress metrics, length of hospital stay, and patient-reported outcomes.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Participants include patients 18 years or older presenting to the investigators' institutions who are scheduled to undergo a primary total knee arthroplasty (TKA). Exclusion criteria include revision TKA, prior surgery or fracture involving the operative knee, preoperative knee flexion contracture greater than 10 degrees, patients with comorbidities, and those unable or unwilling to provide informed consent.

If, after evaluation, the patient remains eligible, the surgeon will introduce the study. If the patient expresses interest, a member of the study team will approach the patient to explain the study in detail. The voluntary nature of participation will be emphasized, and the prospective participant will be encouraged to ask questions and discuss participation with others. Once all questions have been addressed, the participant will be presented with the informed consent document (ICD). The study team member will step out of the room to allow time for review. If desired, the participant may take a paper copy of the ICD to discuss with family or others before signing. Once all questions have been answered to the participant's satisfaction, the ICD will be signed, preferably in the clinic. If the participant elects to take the ICD home, a follow-up time will be arranged, typically during preoperative clearance or on the day of surgery to review and sign the document.

After informed consent is obtained, preoperative baseline data including range of motion and patient-reported outcome measures will be collected. Participants will then be randomized in a 1:1 fashion to either receive or not receive photographic evidence of their postoperative knee range of motion. Randomization will be performed using stratified randomization lists generated and maintained by the Biostatistics Core at Loyola University Clinical Research Office to ensure equal allocation across sites.

During surgery, photographs of the operated knee in full flexion and full extension will be taken. Participants randomized to the intervention group will receive printed copies of the photographs and instructions to share them with their physical therapist. The control group will not receive any photographs. All participants will receive standard perioperative management, surgical technique, and rehabilitation protocols.

The primary outcome is knee flexion at six weeks postoperatively, measured using a goniometer by a blinded assessor. Secondary outcomes include knee extension, physical therapy progress metrics (total duration of therapy, time to achieve 110 degrees of flexion, and number of therapy sessions), distance walked on postoperative day one, length of hospital stay, and patient-reported outcomes via the Knee Injury and Osteoarthritis Outcome Score (KOOS) survey.

A sample size of 52 patients (26 per group) was calculated to provide 80% power to detect a 10-degree difference in knee flexion at six weeks, assuming a standard deviation of 12 degrees and a two-sided alpha level of 0.05.

Both groups will undergo standard postoperative follow-up at two weeks, six weeks, and as per routine care thereafter. Data collection at each time point will include range of motion assessments, physical therapy metrics, and KOOS surveys.

The investigators hypothesize that providing photographic evidence of postoperative knee range of motion will enhance patient motivation and engagement in rehabilitation, resulting in improved early range of motion and functional recovery compared to standard rehabilitation alone.

Participation in this study carries minimal risk. All procedures, surgical techniques, and follow-up care are consistent with the standard of care for patients undergoing TKA. The primary risk to participants is potential loss of confidentiality, which is rare. There are no additional surgical risks associated with participation. Subject safety will be monitored during routine postoperative visits, and participants will have access to the study team for any questions or concerns.

Study Type

Interventional

Enrollment (Actual)

59

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Illinois
      • Maywood, Illinois, United States, 60153
        • Loyola University Medical Center
      • Melrose Park, Illinois, United States, 60160
        • Gottlieb Memorial Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adults aged 18 years or older
  • Scheduled to undergo primary unilateral total knee arthroplasty (TKA) at one of the investigators' participating institutions
  • Able to understand study procedures and comply with follow-up requirements
  • Able to read and complete questionnaires in English
  • Willing and able to provide informed consent prior to participation

Exclusion Criteria:

  • Undergoing revision TKA
  • History of prior surgery or fracture involving the operative knee
  • Preoperative knee flexion contracture >10 degrees
  • Patients with non-elective or trauma-related indications for knee replacement
  • Inability or unwillingness to provide informed consent

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Photographic Evidence Group
Participants in this group will receive printed photographs of their operated knee in full flexion and full extension immediately following total knee arthroplasty (TKA). The photographs will be taken in the operating room after dressings are applied. Patients will be instructed to keep one copy for personal use and to provide another copy to their physical therapist. The goal of this intervention is to determine whether visual feedback of postoperative range of motion enhances motivation, engagement in rehabilitation, and early recovery.
Behavioral: Photographic Evidence of Postoperative Knee Range of Motion
The intervention consists of providing patients with photographic evidence of their knee range of motion (ROM) immediately following total knee arthroplasty (TKA). After the procedure, while still in the operating room and after sterile dressings are applied, two photographs are taken of the operated knee, one in maximum flexion and one in full extension.
Active Comparator: Control Group
Participants in this group will undergo total knee arthroplasty (TKA) and receive standard postoperative management and rehabilitation without photographs of their knee range of motion. They will participate in the same physical therapy and follow-up schedule as the intervention group.
Behavioral: Standard Postoperative Care
Participants will receive routine postoperative management and physical therapy following TKA. No photographic evidence of knee range of motion will be provided.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Knee Flexion at Six Weeks Postoperatively
Time Frame: 6 weeks after total knee arthroplasty
Knee flexion will be measured in degrees using a goniometer by a blinded assessor at the 6-week postoperative visit. The outcome compares the degree of maximum flexion between participants who received photographic evidence of their postoperative range of motion and those who did not.
6 weeks after total knee arthroplasty

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Knee Extension at Six Weeks Postoperatively
Time Frame: 6 weeks after total knee arthroplasty
Knee extension will be measured in degrees using a goniometer by a blinded assessor at the 6-week postoperative visit.
6 weeks after total knee arthroplasty
Total Duration of Physical Therapy
Time Frame: Up to 6 weeks after surgery
Total duration of physical therapy from initiation to completion, measured in weeks, as documented in the medical record.
Up to 6 weeks after surgery
Length of Hospital Stay
Time Frame: From the date of surgery until the date of hospital discharge, assessed for up to 6 weeks postoperatively.
Length of stay (LOS) will be measured as the number of days from the date of surgery to the date of hospital discharge.
From the date of surgery until the date of hospital discharge, assessed for up to 6 weeks postoperatively.
Total Number of Physical Therapy Sessions
Time Frame: Up to 6 weeks after surgery
Total number of in-person physical therapy sessions completed during the postoperative period, as documented in the medical record.
Up to 6 weeks after surgery
Time to Achieve 110° of Knee Flexion (Weeks)
Time Frame: Up to 6 weeks after surgery
Number of weeks from surgery until the patient achieves 110° of knee flexion during physical therapy, as documented in the medical record.
Up to 6 weeks after surgery
Time to Achieve 110° of Knee Flexion (Sessions)
Time Frame: Up to 6 weeks after surgery
Number of physical therapy sessions required for the patient to achieve 110° of knee flexion, as recorded in the physical therapy documentation.
Up to 6 weeks after surgery
Distance Walked on Postoperative Day One
Time Frame: Postoperative day 1
Distance walked during the first postoperative physical therapy session, measured in feet, as documented in the physical therapy record.
Postoperative day 1
Patient-Reported Outcome Measures (KOOS Survey)
Time Frame: 6 weeks after surgery

Patient-reported outcomes will be measured using the Knee Injury and Osteoarthritis Outcome Score (KOOS) survey, a validated instrument assessing five subscales: Pain, Symptoms, Activities of Daily Living (ADL), Sports and Recreation Function, and Knee-Related Quality of Life (QOL).

Each subscale is scored from 0 to 100, where 0 represents extreme knee problems and 100 represents no knee problems.
6 weeks after surgery

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Loyola University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2020

Primary Completion (Actual)

December 31, 2021

Study Completion (Actual)

December 31, 2021

Study Registration Dates

First Submitted

October 27, 2025

First Submitted That Met QC Criteria

October 29, 2025

First Posted (Estimated)

October 31, 2025

Study Record Updates

Last Update Posted (Estimated)

October 31, 2025

Last Update Submitted That Met QC Criteria

October 29, 2025

Last Verified

October 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • LU213164

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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