Total Knee Replacement for the Stiff Knee

Abstract

Total knee replacement (TKR) in patients with stiff knees presents a major challenge. In knee stiffness due to flexion contracture, priority should be given to the recovery of knee extension. The surgical procedure used should ensure full post-operative extension. In contrast, in cases with limitation of flexion, no specific technique needs be used, other than that for wide joint exposure. The extensor apparatus should be carefully preserved and the tibial tubercles osteotomized, as generally recommended. Under these conditions, TKR provides an average flexion gain of 30°. In any case, whatever the gain in the range of motion, the improvement of pain and functional scores is substantial. However, the surgeon should establish a clear contract with the patient, citing the symptoms most likely to be relieved by TKR while indicating possible drawbacks. Unfortunately, the full functional range of flexion, i.e. greater than 110°, can rarely be restored. Such flexion gains would require extensive release of the quadriceps that would only be possible in the absence of any infection or multiple scars resulting from trauma or prior surgery. Post-traumatic arthritis and haemophilia are major risk factors for knee stiffness. Nevertheless, in terms of mid-term survival, the result of TKR in stiff knees is similar to that in mobile knees.