How to Treat the Stiff Total Knee Arthroplasty?: A Systematic Review
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Multiple modalities have been used to treat the stiff TKA, including manipulation under anesthesia (MUA), arthroscopy, and open arthrolysis.
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?
We performed a PubMed search of English language articles from 1966 to 2008 and identified 20 articles, mostly Level IV studies.
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.
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.
- Babis GC, Trousdale RT, Pagnano MW, Morrey BF. Poor outcomes of isolated tibial insert exchange and arthrolysis for the management of stiffness following total knee arthroplasty. J Bone Joint Surg Am. 2001;83:1534–1536.
- Bae DK, Lee HK, Cho JH. Arthroscopy of symptomatic total knee replacements. Arthroscopy. 1995;11:664–671.
- Bong MR, Di Cesare PE. Stiffness after total knee arthroplasty. J Am Acad Orthop Surg. 2004;12:164–171.
- Campbell ED Jr. Arthroscopy in total knee replacements. Arthroscopy. 1987;3:31–35. CrossRef
- Cuckler JM. The stiff knee: evaluation and management. Orthopedics. 2002;25:969–970.
- Daluga D, Lombardi AV Jr, Mallory TH, Vaughn BK. Knee manipulation following total knee arthroplasty: analysis of prognostic variables. J Arthroplasty. 1991;6:119–128.
- Dennis DA. The stiff total knee arthroplasty: causes and cures. Orthopedics. 2001;24:901–902.
- Diduch DR, Scuderi GR, Scott WN, Insall JN, Kelly MA. The efficacy of arthroscopy following total knee replacement. Arthroscopy. 1997;13:166–171.
- Esler CN, Lock K, Harper WM, Gregg PJ. Manipulation of total knee replacements: is the flexion gained retained? J Bone Joint Surg Br. 1999;81:27–29. CrossRef
- Fox JL, Poss R. The role of manipulation following total knee replacement. J Bone Joint Surg Am. 1981;63:357–362.
- Jerosch J, Aldawoudy A. Arthroscopic treatment of patients with moderate arthrofibrosis after total knee replacement. Knee Surg Sports Traumatol Arthrosc. 2007;15:71–77. CrossRef
- Johanson NA. The stiff total knee replacement: causes, treatment, and prevention. Instr Course Lect. 1997;46:191–195.
- Johnson DR, Friedman RJ, McGinty JB, Mason JL, St Mary EW. The role of arthroscopy in the problem total knee replacement. Arthroscopy. 1990;6:30–32. CrossRef
- Keating EM, Ritter MA, Harty LD, Haas G, Meding JB, Faris PM, Berend ME. Manipulation after total knee arthroplasty. J Bone Joint Surg Am. 2007;89:282–286. CrossRef
- Laubenthal KN, Smidt GL, Kettelkamp DB. A quantitative analysis of knee motion during activities of daily living. Phys Ther. 1972;52:34–43.
- Maloney WJ. The stiff total knee arthroplasty: evaluation and management. J Arthroplasty. 2002;17(4 suppl 1):71–73. CrossRef
- Mariani PP, Santori N, Rovere P, Della Rocca C, Adriani E. Histological and structural study of the adhesive tissue in knee arthrofibrosis: a clinical-pathological correlation. Arthroscopy. 1997;13:313–318. CrossRef
- Meade MO, Richardson WS. Selecting and appraising studies for a systematic review. In: Mulrow C, Cook D, eds. Systematic Reviews: Synthesis of Best Evidence for Health Care Decisions. Philadelphia, PA: American College of Physicians; 1998:81–90.
- Mont MA, Seyler TM, Marulanda GA, Delanois RE, Bhave A. Surgical treatment and customized rehabilitation for stiff knee arthroplasties. Clin Orthop Relat Res. 2006;446:193–200. CrossRef
- Pariente GM, Lombardi AV Jr, Berend KR, Mallory TH, Adams JB. Manipulation with prolonged epidural analgesia for treatment of TKA complicated by arthrofibrosis. Surg Technol Int. 2006;15:221–224.
- Parisien JS. The role of arthroscopy in the treatment of postoperative fibromatosis of the knee joint. Clin Orthop Relat Res. 1988;229:185–192.
- Perry J, Antonelli D, Ford W. Analysis of knee-joint forces during flexed-knee stance. J Bone Joint Surg Am. 1975;57:961–967.
- Scott WN, Clarke HD. The stiff knee: causes and cures. Orthopedics. 2000;23:987–988.
- Scranton PE Jr. Management of knee pain and stiffness after total knee arthroplasty. J Arthroplasty. 2001;16:428–435. CrossRef
- Scuderi GR. The stiff total knee arthroplasty: causality and solution. J Arthroplasty. 2005;20:23–26. CrossRef
- Sprague NF III, O’Conner RL, Fox JM. Arthroscopic treatment of postoperative knee fibroarthrosis. Clin Orthop Relat Res. 1982;166:165–172.
- Stamos VP, Bono JV. Management of the stiff total knee arthroplasty. In: Bono JV, Scott RD, eds. Revision Total Knee Arthroplasty. New York, NY: Springer; 2005:251–257. CrossRef
- Teng HP, Lu YC, Hsu CJ, Wong CY. Arthroscopy following total knee arthroplasty. Orthopedics. 2002;25:422–424.
- Wasilewski SA, Frankl U. Arthroscopy of the painful dysfunctional total knee replacement. Arthroscopy. 1989;5:294–306. CrossRef
- Williams RJ III, Westrich GH, Siegel J, Windsor RE. Arthroscopic release of the posterior cruciate ligament for stiff total knee arthroplasty. Clin Orthop Relat Res. 1996;331:185–191. CrossRef
- Wright JG, Swiontkowski MF, Heckman JD. Introducing levels of evidence to the journal. J Bone Joint Surg Am. 2003;85:1–3. CrossRef
- Wright RW, Brand RA, Dunn W, Spindler KP. How to write a systematic review. Clin Orthop Relat Res. 2007;455:23–29. CrossRef
- Yercan HS, Sugun TS, Bussiere C, Ait Si Selmi T, Davies A, Neyret P. Stiffness after total knee arthroplasty: prevalence, management and outcomes. Knee. 2006;13:111–117. CrossRef
- How to Treat the Stiff Total Knee Arthroplasty?: A Systematic Review
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