Revision surgery for the stiff total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Arthroplasty Research
• Biomedical Engineering

Background:

• Stiffness after total knee arthroplasty (TKA) is a challenging complication.
• Revision surgery for TKA stiffness, excluding infection and loosening, is less commonly reported.
• Limited data exists on the outcomes of revision TKA specifically for stiffness.

Purpose of the Study:

• To evaluate the outcomes of revision total knee arthroplasty (TKA) performed for knee stiffness.
• To assess improvements in range of motion (ROM) and patient-reported outcomes following revision surgery for stiffness.
• To introduce and evaluate a novel surgical technique for severe cases of TKA stiffness.

Main Methods:

• Retrospective analysis of 48 revision TKA cases for stiffness, performed by a single surgeon.
• Stiffness defined as <70° flexion arc or >15° flexion contracture.
• Collected data on ROM changes and Western Ontario and McMasters Osteoarthritis index (WOMAC) scores.

Main Results:

• Mean improvement in arc of movement was 45.0°.
• Mean flexion improved significantly (p < 0.05), and mean flexion contracture decreased significantly (p < 0.05).
• Improved WOMAC scores for pain, stiffness, and function were observed. A novel 'sloppy' revision technique was described for extreme stiffness.

Conclusions:

• Revision surgery for TKA stiffness, when sepsis and loosening are excluded, can lead to significant improvements in ROM and functional outcomes.
• The 'sloppy' revision technique offers a potential solution for managing extreme stiffness.
• Optimal outcomes are associated with revision surgery performed within two years of the primary TKA.