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Classification-Based Management of Stiff/Ankylosed Knees

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Abstract

Introduction

Stiff knees are defined as those with an arc of motion < 50°. They pose a considerable surgical challenge to the operating surgeon. Based on our experience to deal with these complex cases, we have developed a working classification that outlines a flowchart to manage the stiff/ankylosed knees.

Materials and Methods

It was a retrospective study conducted in our department. Out of 570 TKA performed in last 5 years, 57 had stiffness and four had bony ankyloses (total 61 knees). Patients were classified based on the fibrous or bony ankylosis and preoperative ROM.

Results

Patients were followed for an average 2.4 years (1.8–5.5 years). KSS pain scores improved from an av. 32 preop (18–64) to av. 76 postoperatively (61–90). The KSS function scores improved from a preoperative value of 36 (16–56) to an av. 78 (52–90) postoperatively. ROM improved from an average of 35.6° (0°–44°) preoperatively to an average of 95.6° (ROM 73°–118°) postoperatively. Extension lag was an av. 8° (3°–12°) and was seen in 13 patients postoperatively. Residual fixed flexion deformity was an av. 7° (3°–14°) and seen in 17 patients. The stiff knees (type 1 and type 2) fared better than ankylosed knees (type 3) in all aspects. Complication rate was high (24%) in our series.

Conclusion

Our classification of stiff/ankylosed knees guides the surgeon to decide upon which approach to take, which implants to keep handy and has a predictive and prognostic value.

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Authors and Affiliations

  1. Asian Institute of Medical Sciences, Badkal Flyover Road, Sec 21A, Faridabad, Delhi NCR, India

    Mrinal Sharma, Saurabh Sharma & Akshay Raj Upadhyaya

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  1. Mrinal Sharma
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  2. Saurabh Sharma
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Correspondence to Mrinal Sharma.

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The corresponding author on behalf of all the authors declares that they have no conflict of interest to declare and no source of funding has been received for this study.

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This article does not contain any studies with human or animal subjects performed by the any of the authors.

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The authors would like to state that all patients were operated after informed consent and the study was done after approval of the internal review board.

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Sharma, M., Sharma, S. & Upadhyaya, A.R. Classification-Based Management of Stiff/Ankylosed Knees. JOIO 55, 1158–1174 (2021). https://doi.org/10.1007/s43465-021-00457-8

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  • DOI: https://doi.org/10.1007/s43465-021-00457-8

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