The stiff total knee arthroplasty: Evaluation and management,☆☆

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Abstract

Arthrofibrosis after total knee arthroplasty is a relatively common complication. A variety of modalities have been employed to treat this problem, including physical therapy, injections, and manipulations. We examined a group of consecutive posterior stabilized total knee arthroplasties to determine the prevalence of arthrofibrosis, as defined by flexion <90°, and the effect of manipulation under anesthesia on outcome. Approximately 11% of the patients met the criteria for arthrofibrosis. Manipulation under anesthesia was successful in improving flexion from an average of 67° premanipulation to 111° postmanipulation. The group that required manipulation did as well statistically as the group as a whole, which had a mean flexion of 114° at 1 year. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Preoperative evaluation

One of the most important factors in evaluating a patient with a stiff knee after TKA is understanding where the patient started in terms of range of motion before surgery. Multiple studies have documented that preoperative flexion is the most important variable in determining the patient's postoperative flexion 2, 3, 4, 5, 6. It is important for the operating surgeon to record the patient's preoperative flexion. There is a paradox as it relates to range of motion preoperatively and

Management

When the cause of the postoperative stiffness has been determined, one can focus on management. When a patient develops a stiff knee >6 to 8 weeks after surgery, it is unusual for range to improve significantly with physical therapy, continuous passive motion, or other modalities. For the patient who has arthrofibrosis, manipulation under anesthesia is a good option. Arthrofibrosis is defined as periarticular fibrosis that limits range of motion by forming bands of scar tissue between the

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Cited by (0)

No benefits or funds were received in support of this study.

☆☆

Reprint requests: William J. Maloney, MD, Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid, Campus Box 8233, St. Louis, MO 63110. E-mail: [email protected]

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