Predictive Risk Factors for Stiff Knees in Total Knee Arthroplasty

Gandhi, Rajiv; Beer, Justin de; Leone, James; Petruccelli, Danielle; Winemaker, Mitchell; Adili, Anthony

doi:10.1016/j.arth.2005.06.004

Cited by 165 publications

(101 citation statements)

References 29 publications

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“…No difference in mean postoperative knee flexion indicated that the resection of the fat pad did not cause stiffness after TKA as reported in the literature [6].…”

Section: Discussionsupporting

confidence: 65%

“…Removal of the fat pad enhances exposure, especially in MIS TKS, but there is some evidence that its removal may result in complications such as patellar baja [7], limited knee ROM [6], anterior knee pain [16], avascular necrosis, and fracture of the patella [8,11,17]. The evidence is inconclusive, however, about whether removal of the fat pad indeed causes problems; a recent systematic review found mixed results on the topic of pain, patella baja, and function and indicated that the literature was quite limited and called for Fig.…”

Section: Discussionmentioning

confidence: 99%

“…However, removal of the fat pad may cause patella baja, reduction of flexion, and persistent pain [6]. The infrapatellar fat pad contains transverse infrapatellar arteries, which supply the inferior pole of the patella [20].…”

Section: Introductionmentioning

confidence: 99%

“…Excision of the fat pad decreases the vascularity of the patella and may result in patellar avascular necrosis and fracture [8,12,17]. Scarring of the fat pad may cause patellar infera and limit ROM after TKA [6]. The fat pad acts as a cushion between the patellar tendon and anterior tibial plateau [5].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Infrapatellar Fat Pad Excision on Complications After Minimally Invasive TKA: A Randomized Controlled Trial

Pinsornsak

Naratrikun

Chumchuen

2013

Clin Orthop Relat Res

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Background The infrapatellar fat pad is one of the structures that obscures exposure in minimally invasive total knee arthroplasty (MIS TKA). Most MIS TKA surgeons (and many surgeons who use other approaches as well) excise the fat pad for better exposure of the knee. There is still controversy about the result of fat pad excision on patella baja, pain, and function. Questions/purposes In the setting of a randomized controlled trial, we sought to determine whether infrapatellar fat pad excision during MIS TKA causes (1) patellar tendon shortening (as measured by patella baja); (2) increased anterior knee pain; (3) decreases in the Knee Society Score or functional subscore; or (4) more patella-related complications.Methods We randomized 90 patients undergoing MIS TKA at one institution into two groups. In one group, 45 patients underwent MIS TKA with complete infrapatellar fat pad excision and in the other group, 45 patients received MIS TKA without infrapatellar fat pad excision. The patella was selectively resurfaced in these patients; there was no difference between the groups in terms of the percentage of patients whose patellae were resurfaced. We measured patellar tendon shortening, knee flexion, anterior knee pain, Knee Society Score (KSS), functional subscore, and patellar complications at preoperative and postoperative periods of 6 weeks, 3 months, 6 months, and 1 year; complete followup data were available on 86% of patients (77 of 90) who were enrolled.

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“…No difference in mean postoperative knee flexion indicated that the resection of the fat pad did not cause stiffness after TKA as reported in the literature [6].…”

Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Effect of Infrapatellar Fat Pad Excision on Complications After Minimally Invasive TKA: A Randomized Controlled Trial

Pinsornsak

Naratrikun

Chumchuen

2013

Clin Orthop Relat Res

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“…Among the early complications of surgery, stiffness remains a serious concern. In an analysis of seven studies reporting the results of 16,299 primary TKAs, manipulation under anaesthesia (MUA) was required in 4.5% of patients [5,12,16,19,30,36,40]. Postoperative range of motion (ROM) is influenced by preoperative, intraoperative, and postoperative factors [7].…”

Section: Introductionmentioning

confidence: 99%

Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts

Malik

Salas²,

Ari

et al. 2009

International Orthopaedics (SICOT)

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It is debatable whether high-flexion (HF) total knee arthroplasty (TKA) designs will improve postoperative flexion and function or will diminish the need for manipulation under anaesthesia (MUA). We retrospectively analysed range of motion (ROM), flexion, Knee Society Score (KSS), and rate of MUA in a consecutive group of patients who underwent TKA with a conventional posterior stabilised (PS) insert or an HF insert using identical surgical technique, implant design, and postoperative care. Fifty TKAs with a standard PS insert were matched for patient's age, gender, preoperative ROM, and KSS with 50 TKA performed with an HF insert. The patient's ROM and KSS were evaluated at six weeks, four months, and one year postoperatively. The outcome variables (flexion, ROM, KSS, and manipulation rate) in both groups were compared using the generalised estimating equations method. A second analysis of patients with preoperative flexion ≥120°was performed. The ROM, flexion, and patient-reported KSS was similar in both groups at each time period. The rate of MUA was also similar. Patients with a preoperative ROM of at least 120°showed similar results. Our study found that one year after surgery, patients who underwent TKA with a PS or an HF insert achieved similar flexion, ROM, and function.

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Limited evidence for the usage of renin–angiotensin–aldosterone pathway blockers to prevent arthrofibrosis after total knee arthroplasty. A systematic review of clinical evidence

Anzillotti,

Gomoll,

Conte

et al. 2024

J. exp. orthop.

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PurposeDespite advances in surgical techniques and rehabilitation protocols, arthrofibrosis following total knee arthroplasty (TKA) still has poor outcomes. In the last decade, attention has been focused on the pathogenesis and cascade of events leading to the development of fibrosis. Currently, one of the most promising approaches consists in the indirect antagonisation of transforming growth factor beta 1 (TGF‐beta 1) through the downregulation of the renin–angiotensin–aldosterone system (RAAS). This systematic review aims to analyse the available evidence regarding the use of angiotensin receptor blockers (ARBs)/angiotensin‐converting‐enzyme inhibitors (ACEi) in order to prevent post‐operative knee arthrofibrosis following TKA.MethodsExtensive research on the PubMed, Cochrane, and Google Scholar databases was performed on 8 July 2024, using keywords related to ARBs, ACE inhibitors and arthrofibrosis. Inclusion criteria included: (1) clinical trials of any level of evidence; (2) written in English; (3) studies conducted on humans; and (4) evaluating the antifibrotic effects of ACE inhibitors or ARBs administered for TKA surgeries. Exclusion criteria were articles written in other languages; preclinical studies; expert opinions; reviews and trials evaluating the effects of ACEi/ARBs not related to their antifibrotic effect after TKA.ResultsA total of six studies met the inclusion criteria and were analysed. All studies were retrospective and involved a total of 158,310 patients. Time of administration varied among the studies as well as the dosage, which fell within the range for cardiological use. Four out of six studies focused exclusively on losartan. Three studies reported a clear, significant correlation between the use of ARBs and/or ACEi and a reduced likelihood of developing arthrofibrosis.ConclusionsThe RAAS antagonism could have potential for stiffness prevention after TKA. However, given the side effects and the limited evidence available, the use of ACEi/sartans for the sole purpose of avoiding arthrofibrosis after TKA is not currently recommended.Level of EvidenceLevel III.

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Predictive Risk Factors for Stiff Knees in Total Knee Arthroplasty

Cited by 165 publications

References 29 publications

The Effect of Infrapatellar Fat Pad Excision on Complications After Minimally Invasive TKA: A Randomized Controlled Trial

The Effect of Infrapatellar Fat Pad Excision on Complications After Minimally Invasive TKA: A Randomized Controlled Trial

Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts

Limited evidence for the usage of renin–angiotensin–aldosterone pathway blockers to prevent arthrofibrosis after total knee arthroplasty. A systematic review of clinical evidence

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