Stiffness in total knee arthroplasty

Abstract

Stiffness is a relatively uncommon complication after total knee arthroplasty. It has been defined as a painful limitation in the range of movement (ROM). Its pathogenesis is still unclear even if some risk factors have been identified. Patient-related conditions may be difficult to treat. Preoperative ROM is the most important risk factor, but an association with diabetes, reflex sympathetic dystrophy, and general pathologies such as juvenile rheumatoid arthritis and ankylosing spondylitis has been demonstrated. Moreover, previous surgery may be an additional cause of an ROM limitation. Postoperative factors include infections, arthrofibrosis, heterotrophic ossifications, and incorrect rehabilitation protocol. Infections represent a challenging problem for the orthopaedic surgeon, and treatment may require long periods of antibiotics administration. However, it is widely accepted that an aggressive rehabilitation protocol is mandatory for a proper ROM recovery and to avoid the onset of arthrofibrosis and heterotrophic ossifications. Finally, surgeryrelated factors represent the most common cause of stiffness; they include errors in soft-tissue balancing, component malpositioning, and incorrect component sizing. Although closed manipulation, arthroscopic and open arthrolysis have been proposed, they may lead to unpredictable results and incomplete ROM recovery. Revision surgery must be proposed in the case of welldocumented surgical errors. These operations are technically demanding and may be associated with high risk of complications; therefore they should be accurately planned and properly performed.

Pain characteristics and self‐rated health after elective orthopaedic surgery – a cross‐sectional survey

“…Early physical therapy and exercises with the operated limb are often necessary in order to achieve rapid and optimal function (Schiavone et al . ).…”

“…Besides the need for pain control, early mobilisation is imperative to prevent complications of immobility (Mont et al 2011). Early physical therapy and exercises with the operated limb are often necessary in order to achieve rapid and optimal function (Schiavone et al 2009).…”

Fibrosis is a common outcome following total knee arthroplasty

“…Success rates for the operation are very high resulting in a substantial restoration of function and alleviation of pain and associated morbidity 3 . However, although a very high success rate is observed with TKA surgery, some 3–10% of individuals go on to develop fibrosis in the form of arthrofibrosis post-surgery 4 5 6 .…”

Treatment of post-traumatic joint contracture in a rabbit model using pulsed, high intensity laser and ultrasound

“…Post-traumatic contracture can result from either an initial injury to the joint or as a complication from surgery on the joint, such as anterior cruciate ligament (ACL) reconstruction or total knee arthroscopy (TKA) (Cosgarea et al, 1994). Currently when patients have joint contracture due to arthrofibrosis they will receive either conservative treatment or in more severe cases, surgery to release the contracture, however a complete recovery is not always attained (Enad, 2014, Hutchinson et al, 2005, Schiavone Panni et al, 2009, Schwarzkopf et al, 2013, Kucera et al, 2007, Cosgarea et al, 1994.…”