Abstract
Introduction
A stiff total knee arthroplasty (TKA) is an uncommon but disabling problem because it causes pain and limited function. Revision surgery has been reported as a satisfactory treatment option for stiffness with modest benefits. The aim of this study was to evaluate the results of revision surgery for the treatment of stiffness after TKA.
Methods
We defined stiffness as 15 degrees or more of flexion contracture or less than 75º of flexion or a range of motion of 90º or less presenting with a chief complain of limited range of motion and pain. We evaluated the results of forty-two revisions performed by one of four orthopedic surgeons due to stiffness after TKA. Patients with history of infection or isolated polyethylene insert exchange were excluded.
Results
Patients were followed for an average of forty-seven months. The mean Knee Society score improved from 43.9 points preoperatively to 72.0 points at the time of follow-up and the mean Knee Society function score from 48.7 to 70.1 respectively. Pain improved in 73% of the patients and four patients (9.5%) presented severe pain at latest follow up. The mean flexion contracture decreased from 9.7º to 2.3º, the mean flexion improved from 81.5º to 94.3º, and the mean range of motion improved from 72º to 92º. The range of motion improved in 80% of the knees and flexion increased in 64.3%. Extension improved in 88% and it remained unchanged in 5%.
Conclusion
Revision surgery appears to be a reasonable option for patients presenting with pain and stiffness after TKA. However, the benefits may be modest as the outcomes do not approach those achieved with a primary TKA. Although the flexion contractures were significantly improved and 80% of the knees presented an increase range of motion, the final range of motion was only 92º.
