Results of total knee arthroplasty for painless, stiff knees

Abstract

Background: Stiff knees, like completely ankylosed or arthrodesed knees, can be painless. Total knee arthroplasty (TKA) for these painless, stiff knees is technically demanding. However, it can correct the alignment and advance the range of motion to improve quality of life. So, we reviewed the preoperative and postoperative results of functional and pain scores, range of motion (ROM) and complications in painless, stiff knees treated by TKA.

Methods: Fifteen painless, stiff knees underwent TKA from January 1998 to January 2017. The mean follow-up period was 15.4 (2.4-22.2) years. All the knees were completely ankylosed or arthrodesed. Clinical outcome and complications were evaluated using medical record review, serial plan radiography, ROM assessment, Knee Society score (KSS), Knee Society function score (FS), and a visual analog scale for pain (VAS).

Results: All patients were satisfied with their operated knees. Mean KSS and FS scores were improved from 36 and 50.9 to 76.9 and 67.2, respectively (P < 0.001 and P = 0.01). The mean ROM increased from 0º preoperatively to 77.6º (15-130) at the final follow-up (P < 0.001). The mean VAS had worsened from 0 preoperatively to 0.2 postoperatively, however it was not significant (P = 0.1). Major postoperative complications were reported in five of the knees (33.3%).

Conclusions: The results of TKA for painless, stiff knees were satisfactory with improved ROM and quality of life. Although some patients had mild pain and complications postoperatively, they were satisfied with the result. However, our study recommends that surgeons should consider the high rate of complications in the completely ankylosed or arthrodesed knees.

Level of evidence: A retrospective case series, Level IV.

Keywords: Ankylosis; Knee; Stiff; Total knee arthroplasty.

Fig. 1

A 44-year-old female patient who had bilateral knee pain due to rheumatoid arthritis. The right knee showed 15º range of motion (ROM) (range; 30–45º) and the left knee was spontaneously ankylosed in 40º of flexion. In the right knee, a PS type (Nexgen LPS) prosthesis was used, and in the left knee, a valgus-varus constrained (VVC) type (Nexgen LCCK) prosthesis was used. The right-knee arc of motion improved from 15 to 85º (range; 0–85º) and the left-knee arc of motion improved from 0 to 85º (range; 0–85º). No complications were noticed during the 16-year follow-up. The left knee (complete ankylosis) was included in this study

Fig. 2

A 31-year-old male patient who had a history of arthrodesis due to tuberculosis infection of the left knee at the age of 17 years. His right knee was ankylosed in 15º of flexion. Take down and total knee arthroplasty (TKA) with a valgus-varus constrained (VVC) prosthesis (Nexgen LCCK) were performed. At 51 months after the key operation, the polyethylene insert was dislocated with breakage of the locking screws after sea-swimming. After exchanging the polyethylene insert with a posterior-stabilized (PS) type, no further complications occurred, with an arc of motion of 0–130º. (Left 2 images, preoperative anteroposterior and lateral views; middle 2 images, postoperative 4 years; right 2 images, postoperative 14 years anteroposterior and lateral views)

Fig. 3

A 60-year-old female patient who had a history of arthrodesis due to severe trauma of the right knee at the age of 50 years, had an ankylosed knee in the 10º flexion position. The right knee was operated on with a valgus-varus constrained (VVC) type (Nexgen LCCK) prosthesis. A tibial tuberosity avulsion fracture occurred in the operation, which was fixed using the tension-band wiring technique. The postoperative arc motion was improved from 0 to 65 (range; 15–80º) with 15º of extension lag. In the 16-year follow-up, polyethylene wear and a fracture of the medial femoral condyle were noticed. A revision was performed with the same type of implant and an internal fixation of the fracture fragment