Stiffness after total knee arthroplasty: prevalence, management and outcomes

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Stiffness is a potential complication following total knee arthroplasty (TKA).
• Understanding the prevalence and effective treatment of post-TKA stiffness is crucial for patient outcomes.

Purpose of the Study:

• To determine the prevalence of stiffness after posterior-stabilized TKA.
• To evaluate the effectiveness of manipulation and secondary surgery for treating TKA stiffness.

Main Methods:

• Retrospective review of 1188 posterior-stabilized TKAs performed between 1987 and 2003.
• Analysis of patients treated for stiffness via manipulation (n=46) or secondary surgery (n=10).
• Assessment of range of motion and pain scores pre- and post-intervention.

Main Results:

• Stiffness prevalence was 5.3% at a mean 31-month follow-up.
• Manipulation improved mean range of motion from 67 to 117 degrees, maintained at follow-up.
• Early manipulation yielded better results than delayed manipulation (p=0.021).
• Secondary surgery achieved a mean gain of 49 degrees in motion.
• Patellar problems (loosening, clunk syndrome) were noted in 40% of secondary surgery cases.

Conclusions:

• Early manipulation is superior to delayed manipulation for improving range of motion after TKA.
• Patellar evaluation is essential in stiff TKAs, as patellar issues can be prognostic for revision surgery.
• Arthroscopic release may be suitable for moderately stiff knees, while open arthrolysis primarily addresses pain.