Stiffness after Total Knee Arthroplasty

Abstract

Stiffness after total knee arthroplasty (TKA) adversely affects outcome and impacts patient function. Various risk factors for stiffness after TKA have been identified, including reduced preoperative knee range of motion, history of prior knee surgery, etiology of arthritis, incorrect positioning or oversizing of components, and incorrect gap balancing. Mechanical and associated causes, such as infection, arthrofibrosis, complex regional pain syndrome, and heterotopic ossification, secondary gain issues have also been identified. Management of stiffness following TKA can be challenging. The condition needs to be assessed and treated in a staged manner. A nonsurgical approach is the first step. Manipulation under anesthesia may be considered within the first 3 months after the index TKA, if physical therapy fails to improve the range of motion. Beyond this point, consideration should be given to surgical intervention such as lysis of adhesions, either arthroscopically or by open arthrotomy. If the cause of stiffness is deemed to be surgical error, such as component malpositioning, revision arthroplasty is indicated. The purpose of this article is to evaluate the various aspects of management of stiffness after TKA.

A mini-invasive technique for severe arthrofibrosis of the knee: A technical note

“…Intraarticular fibrosis could be treated with physical therapy, manipulation under anesthesia, arthroscopic debridement and open debridement [1]. Some authors suggested a protocol for treatment according to the time lapse after the initial surgery, recommending manipulation under general anaesthesia for 8 weeks post-operatively, arthroscopiclysis from 8 weeks to 6 months and open surgery if more than 6 months [16].…”

“…The treatments for arthrofibrosis include physiotherapy, aggressive pain management, manipulation under anesthesia, arthroscopic release, and open sugical release [1]. The arthroscopic approach is a less invasive approach that has been advocated for both focal, discrete lesions as well as for more global arthrofibrosis [2].…”

Improved clinical outcomes after revision arthroplasty with a hinged implant for severely stiff total knee arthroplasty

“…Revision arthroplasty is most commonly reserved for the correction of technical errors in the severely stiff TKA, such as malrotation, malpositioning and instability [8, 9, 11]. …”

Sulfasalazine Resolves Joint Stiffness in a Rabbit Model of Arthrofibrosis

“…Joint capsule contracture and the formation of intra‐articular fibrotic lesions can result in severe limitations in joint mobility . Fibrosis often develops after joint trauma or major surgical procedures such as total knee arthroplasty (TKA) and anterior cruciate ligament (ACL) reconstruction .…”