Abstract
Limited motion is associated with functional impairment and lack of satisfaction after total knee arthroplasty (TKA). The development of limited motion after TKA is often multifactorial. Patient related factors that can contribute to limited motion include poor pre-operative motion, patella infera, hip flexion contracture, leg length inequality, habitual narcotic use, morbid obesity, and possible genetic factors which lead to a biologic predisposition to form scar tissue. Surgical techniques to achieve full motion include appropriate sizing and positioning of the implants, proper gap balancing and soft tissue release, removal of posterior condylar osteophytes, and adequate tibial slope. Patient education, pain management, and participation in post-operative rehabilitation are also important. If adequate motion is not achieved, then manipulation can be helpful particularly up to three months after surgery. Once scar tissue is more mature, 6 months to a year after surgery, arthroscopy to resect arthrofibrotic scar is an appropriate option. For stiffness beyond one year after surgery revision TKA can be expected to result in modest improvement in motion, but pain relief may be quite variable.
