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. 2007 Sep;3(2):182-9.
doi: 10.1007/s11420-007-9053-4.

Etiology and surgical interventions for stiff total knee replacements

Alejandro González Della Valle  1 , Alejandro Leali, Steven Haas
Affiliations

Etiology and surgical interventions for stiff total knee replacements

Alejandro González Della Valle et al. HSS J. 2007 Sep.

Abstract

Stiffness is the most prevalent early local complication of primary total knee replacement, affecting approximately 6 to 7% of patients undergoing surgery. The definition of stiffness after total knee replacement in terms of restriction of the arc of motion has evolved in the last 2 decades as patients and physicians expect better postoperative functional outcomes. Gentle manipulation under anesthesia within 3 to 4 months of surgery improves the range of motion in most patients. However, approximately 1% of patients, including those in which the window for manipulation has passed, will require further surgical interventions, which may include arthroscopy with lysis of adhesions, open debridement with exchange of the polyethylene insert, or revision of one or more components. This review will focus on describing the etiology of the problem and the results of the different surgical interventions for stiffness after total knee replacement.

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Figures

Fig. 1
Fig. 1
Histogram demonstrating the arc of motion required for activities of daily living and definitions of stiffness according to three publications [6, 27, 39]
Fig. 2
Fig. 2
a and b: A posteriorly displaced femoral component results in a tight flexion gap and limited flexion
Fig. 3
Fig. 3
An oversized femoral component resulted in marked flexion contracture of 30° (a). Isolated downsizing of the femoral component resulted in correction of the flexion contracture (b)
Fig. 4
Fig. 4
Oversized and flexed femoral component resulted in limited flexion and extension (a,b). Normal biomechanics isolated revision of the femoral component (c)
Fig. 5
Fig. 5
Overstuffed patellofemoral joint resulted in limited flexion
Fig. 6
Fig. 6
Dense fibrous scar occupying the suprapatellar pouch and gutters was resected (a). The histology specimen shows abundant collagen fibers (b) (Courtesy of Dr. Giorgio Perino)
Fig. 7
Fig. 7
The suprapatellar pouch and gutters should be reestablished by removing all scar tissue. This will allow assessment of knee balance and removal of the components
Fig. 8
Fig. 8
In a patient with a sound biomechanical knee reconstruction, and with a combined flexion and extension deficit; the isolated revision of the femoral component increased the flexion and extension gaps
Fig. 9
Fig. 9
Isolated femoral revision is technically easy and allows access to the posterior capsule
See this image and copyright information in PMC

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