Revision total knee arthroplasty for stiffness.

Few studies have evaluated the results of revision of well-fixed components for stiffness, and some authors have recommended against this intervention based on poor reported results. Thirty-five consecutive patients underwent revision of both femoral and tibial components for stiffness. At a mean of 54.5 months (range, 25-134), the mean arc of motion improved by 44.5 degrees from a preoperative mean of 53.6 degrees to a postoperative mean of 98.1 degrees (P < .0001). The arc of motion improved by more than 30 degrees in 75% (24/32) of patients evaluated at a minimum of 2 years. Seventeen (49%) of the 35 patients required a further intervention for stiffness or sustained a complication. These results suggest that revision total knee arthroplasty for stiffness can be performed with a reasonable expectation of improvement, although the risk of complications and additional operative procedures is substantial.

[1]  T. Vail,et al.  Revision of the stiff total knee arthroplasty. , 2002, The Journal of arthroplasty.

[2]  D. Levine The Hospital for the Ruptured and Crippled, Entering the Twentieth Century, ca. 1900 to 1912 , 2007, HSS Journal.

[3]  J. Lewsey,et al.  The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. , 2007, The Journal of bone and joint surgery. British volume.

[4]  R. D'ambrosia,et al.  Factors affecting postoperative flexion in total knee arthroplasty. , 1990, Orthopedics.

[5]  G. Smidt,et al.  A quantitative analysis of knee motion during activities of daily living. , 1972, Physical therapy.

[6]  L. Whiteside,et al.  Making your next unicompartmental knee arthroplasty last: three keys to success. , 2005, The Journal of arthroplasty.

[7]  L. Dorr,et al.  Rationale of the Knee Society clinical rating system. , 1989, Clinical orthopaedics and related research.

[8]  B. Morrey,et al.  Poor Outcomes of Isolated Tibial Insert Exchange and Arthrolysis for the Management of Stiffness Following Total Knee Arthroplasty , 2001, The Journal of bone and joint surgery. American volume.

[9]  M. Ritter,et al.  Manipulation after total knee arthroplasty. , 2007, The Journal of bone and joint surgery. American volume.

[10]  A. Amari Vesicoureteral Reflux Causing Improved Visualization on the Delayed Excretory Urogram , 1971 .

[11]  Joanne B. Adams,et al.  Manipulation with prolonged epidural analgesia for treatment of TKA complicated by arthrofibrosis. , 2006, Surgical technology international.

[12]  M. Ries,et al.  Arthrofibrosis After Total Knee Arthroplasty , 2000, Clinical orthopaedics and related research.

[13]  A. Gonzalez Della Valle,et al.  Etiology and Surgical Interventions for Stiff Total Knee Replacements , 2007, HSS Journal.

[14]  P. D. Di Cesare,et al.  Stiffness After Total Knee Arthroplasty , 2004, The Journal of the American Academy of Orthopaedic Surgeons.

[15]  G. Scuderi**,et al.  The efficacy of arthroscopy following total knee replacement. , 1997, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[16]  D. Bae,et al.  Arthroscopy of symptomatic total knee replacements. , 1995, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[17]  F. C. Ewald The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. , 1989, Clinical orthopaedics and related research.

[18]  E. Salvati,et al.  Patella position in the normal knee joint. , 1971, Radiology.

[19]  D. Dennis The stiff total knee arthroplasty: causes and cures. , 2001, Orthopedics.

[20]  L. Dorr,et al.  Revision surgery for stiff total knee arthroplasty. , 1990, The Journal of arthroplasty.

[21]  P. Scranton Management of knee pain and stiffness after total knee arthroplasty. , 2001, The Journal of arthroplasty.

[22]  Paul A Lotke,et al.  Stiffness after total knee arthroplasty. Prevalence of the complication and outcomes of revision. , 2004, The Journal of bone and joint surgery. American volume.

[23]  D. Jacofsky,et al.  Functional results after revision of well-fixed components for stiffness after primary total knee arthroplasty. , 2005, The Journal of arthroplasty.

[24]  Y. K. Park,et al.  Novel methods for diagnosis and treatment of posterolateral rotatory instability of the knee. , 2007, The Journal of bone and joint surgery. American volume.

[25]  M. Ritter,et al.  Predictive range of motion after total knee replacement. , 1979, Clinical orthopaedics and related research.

[26]  R. Laskin,et al.  Stiffness after total knee arthroplasty. , 2004, The Journal of arthroplasty.