The stiff total knee arthroplasty: evaluation and management

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Rehabilitation Medicine

Background:

• Arthrofibrosis is a frequent complication following total knee arthroplasty (TKA).
• Current treatments include physical therapy, injections, and manipulation under anesthesia (MUA).
• Limited data exists on the prevalence and MUA outcomes specifically for posterior stabilized (PS) TKA.

Purpose of the Study:

• To determine the prevalence of arthrofibrosis in posterior stabilized TKA patients.
• To evaluate the efficacy of manipulation under anesthesia (MUA) in treating TKA arthrofibrosis.
• To compare the long-term outcomes of TKA patients who underwent MUA with the general TKA population.

Main Methods:

• Retrospective analysis of consecutive posterior stabilized total knee arthroplasty cases.
• Definition of arthrofibrosis: knee flexion <90 degrees.
• Assessment of knee flexion before and after manipulation under anesthesia (MUA).

Main Results:

• Approximately 11% of patients met the criteria for arthrofibrosis.
• MUA significantly improved average knee flexion from 67 degrees pre-manipulation to 111 degrees post-manipulation.
• Patients undergoing MUA achieved outcomes statistically similar to the overall TKA cohort at 1-year follow-up (mean flexion 114 degrees).

Conclusions:

• Arthrofibrosis occurs in approximately 11% of posterior stabilized TKAs.
• Manipulation under anesthesia is an effective treatment for restoring knee flexion after TKA.
• MUA provides comparable long-term functional outcomes to the general TKA population.