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How to Treat the Stiff Total Knee Arthroplasty?: A Systematic Review

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Multiple modalities have been used to treat the stiff TKA, including manipulation under anesthesia (MUA), arthroscopy, and open arthrolysis.

Questions/purposes

We reviewed the literature to address three questions: (1) How many degrees of ROM will a stiff TKA gain after MUA, arthroscopy, and open arthrolysis? (2) Does the timing of each procedure influence this gain in ROM? (3) What is the number of clinically important complications for each procedure?

Methods

We performed a PubMed search of English language articles from 1966 to 2008 and identified 20 articles, mostly Level IV studies.

Results

For patients who have arthrofibrosis after TKA, the gains in ROM after MUA and arthroscopy (with or without MUA) are similar. Open arthrolysis seems to have inferior gains in ROM. MUA is more successful in increasing ROM when performed early but still may be effective when performed late. Arthroscopy combined with MUA still is useful 1 year after the index TKA. The numbers of clinically important complications after MUA and arthroscopy (with or without MUA) are similar.

Conclusions

Stiffness after TKA is a common problem that can be improved with MUA and/or arthroscopic lysis of adhesions with few complications. The low quality of available literature makes it difficult to develop treatment protocols.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Amy Romanoff for help with manuscript submission.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, 10029, USA

    Sean E. Fitzsimmons MD & Michael J. Bronson MD, FACS

  2. The Mount Sinai School of Medicine, New York, NY, USA

    Edward A. Vazquez BS

Authors
  1. Sean E. Fitzsimmons MD
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  2. Edward A. Vazquez BS
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  3. Michael J. Bronson MD, FACS
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Corresponding author

Correspondence to Michael J. Bronson MD, FACS.

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Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Appendix

Appendix

Appendix 1 Demographic data
Full size table
Appendix 2 Indications for each procedure
Full size table
Appendix 3 Technique-related variables
Full size table

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Fitzsimmons, S.E., Vazquez, E.A. & Bronson, M.J. How to Treat the Stiff Total Knee Arthroplasty?: A Systematic Review. Clin Orthop Relat Res 468, 1096–1106 (2010). https://doi.org/10.1007/s11999-010-1230-y

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