Stiffness a Complication of Total Knee Arthroplasty and Its Management

Title: Stiffness a Complication of Total Knee Arthroplasty and Its Management

Authors: Shiekh Ajaz, Mohammad Ashraf Khan, Mufti Mahmood, Basit Ahmad, Sajad Jehan, Sawjid Habib

DOI: http://dx.doi.org/10.18535/jmscr/v4i9.80

Abstract

References

Corresponding Author

Abstract

Introduction

Total knee replacement is a highly successful procedure with a success rate of survivorship of 10 to 15 years exceeding 90%^[1,2]. However despite advances in the surgical technique and rehabilitation post-operative stiffness continues to be relatively common complication^[3-5]Stiffness is defined as an inadequate range of motion (ROM) that results in functional limitations in activities of daily living. Although early studies reported stiffness in >50% of patients with TKA,^[6]the true incidence appears to be 8% to 12%^[3,7,8]. The incidence of complete fibrous ankylosis after TKA is about 0.1%. Biomechanical studies and gait analysis have shown that patients require 67° of knee flexion during the swing phase of gait, 83° to ascend stairs, 90° to 100° to descend stairs, 93° to rise from a standard chair, and up to 105° to rise from a low chair^[9,10]. There are no universally accepted criteria for diagnosis of stiffness, nor does consensus exist on appropriate timing of intervention. Thorough understanding of the multiple etiologies and available management options can help prevent stiffness in most patients and improve outcomes.

References

1. Stern SH, Insall JN: Posterior stabilized prosthesis: Results after follow-up of nine to twelve=years. J Bone Joint SurgAm 1992;74:980986.

2. Ritter MA, Herbst SA, Keating EM, FarisPM, MedingJB: Long-term survival analysis of a posterior cruciate-retaining total condylar total knee arthroplasty. ClinOrthop1994;309:136145.

3. Scranton PE Jr: Management of knee pain and stiffness after total knee arthroplasty. J Arthroplasty 2001;16:428-435.

4. Esler CN, Lock K, Harper WM, Gregg PJ: Manipulation of total knee replacements: Is the flexion gained retained? J Bone Joint Surg Br 1999;81:27-29.

5. Fox JL, Poss R: The role of manipulation following total knee replacement. J Bone Joint Surg Am 1981;63:357-362.

6. Shoji H, Yoshino S, Komagamine M: Improved range of motion with the Y/S total knee arthroplasty system. ClinOrthop 1987;218:150-163

7. Daluga D, Lombardi AVJr, Mallory TH, Vaughn BK: Knee manipulation following total knee arthroplasty: Analysis of prognostic variables. J Arthroplasty 1991;6:119-128.

8. Mauerhan DR, Mokris JG, Ly A, Kiebzak GM: Relationship between length of stay and manipulation rate after total knee arthroplasty. J Arthroplasty 1998;13:896-900.

9. Kettelkamp D: Gait characteristics of the knee: Normal, abnormal, and postrec-onstruction, in American Academy of Orthopaedic Surgeons Symposium on Reconstructive Surgery of the Knee. St. Louis, MO: CV Mosby, 1978, pp 47-57.

10. Laubenthal KN, Smidt GL, Kettelkamp DB: Aquantitative analysis of knee motion during activities of daily living. PhysTher 1972;52:34-43

11. Weinrauch, N Myers, et al: Comparison of early postoperative rehabilitation outcome following total knee arthroplasty using different surgical approaches and instrumentation. Journal of Orthopaedic Surgery 2006;14(1):47-52

12. Parsley BS, Engh GA, Dwyer KA: Preoperative flexion: Does it influence postoperative flexion after posteriorc-ruciate- retaining total knee arthroplasty? ClinOrthop 1992;275:204-210.

13. Katz MM, Hungerford DS, KrackowKA, Lennox DW: Results of total knee arthroplasty after failed proximal tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 1987;69:225-233

14. Shoji H, Solomonow M, Yoshino S, D’Ambrosia R, Dabezies E: Factors affecting postoperative flexion in total knee arthroplasty. Orthopedics 1990;13: 643-649.

15. Tanzer M, Miller J: The natural history of flexion contracture in total knee arthroplasty: A prospective study. ClinOrthop 1989;248:129-134.

16. Adam C, Eckstein F, Milz S, Schulte E, Becker C, Putz R: The distribution of cartilage thickness in the knee-joints of old-aged individuals–measurement by A-mode ultrasound. ClinBiomech (Bristol, Avon) 1998;13:1-10.

17. Figgie HE III, Goldberg VM, Heiple KG, Moller HS III, Gordon NH: The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am1986;68:1035-1040.

18. Masri BA, Laskin RS, Windsor RE, Haas SB: Knee closure in total knee replacement: A randomized prospecti-vetrial. ClinOrthop 1996;331:81-86

19. Matthew R. Bong, MD, and Paul E. Di Cesare, MDJ Am AcadOrthopSurg 2004; 12:164-171

20. Sprague NF III, O’Connor RL, Fox JM: Arthroscopic treatment of postoperative kneefibroarthrosis. Clin Orthop 1982;166: 165-172

21. Del Pizzo W, Fox JM, Friedman MJ, Snyder SJ, Ferkel RD: Operative arthroscopyfor the treatment of arthrofibrosis of the knee. Contemporar Orthopaedics1985;10:67-72

22. Sprague NF III: Motion-limiting arthrofibrosis of the knee: The role of arthroscopic management. Clin Sports Med 1987;6:537-549.

23. Campbell ED Jr: Arthroscopy in total knee replacements. Arthroscopy 1987;3: 31-35

24. Bocell JR, Thorpe CD, Tullos HS: Arthroscopic treatment of symptomatic total knee arthroplasty. Clin Orthop 1991;271:125-134

25. Diduch DR, Scuderi GR, Scott WN, Insall JN, Kelly MA: The efficacy of arthroscopy following total knee replacement. Arthroscopy 1997;13:166-171

26. BaeDK, Lee HK, Cho JH: Arthroscopy of symptomatic total knee replacements. Arthroscopy 1995;11:664-671.

Abstract

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Call For Paper Volume 12 Issue 10 November 2024

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