Abstract
Arthrofibrosis is a relatively common complication after total knee arthroplasty that negatively affects function and quality of life. Static progressive stretching is a technique that has shown promising results in the treatment of contractures of the elbow, ankle, wrist and knee. This study evaluated a static progressive stretching device as a treatment method for patients who had refractory knee stiffness after total knee arthroplasty. Twenty-five patients who had knee stiffness and no improvement with conventional physical therapy modalities were treated with the device. After a median of 7 weeks (range, 3–16 weeks), the median increase in range of motion was 25° (range, 8–82°). The median gain in knee active flexion was 19° (range, 5–80°). Ninety-two percent of patients were satisfied with the results. The authors believe static progressive stretching devices may be an effective method for increasing the ranges of motion and satisfaction levels of patients who develop arthrofibrosis after total knee arthroplasty.
Similar content being viewed by others
References
Boldt JG, Munzinger UK, Zanetti M, Hodler J (2004) Arthrofibrosis associated with total knee arthroplasty: gray-scale and power Doppler sonographic findings. AJR Am J Roentgenol 182:337–340
Bonutti PM, McGrath MS, Ulrich SD, McKenzie SA, Seyler TM, Mont MA (2008) Static progressive stretch for the treatment of knee stiffness. Knee 15:272–276
Bonutti PM, Windau JE, Ables BA, Miller BG (1994) Static progressive stretch to reestablish elbow range of motion. Clin Orthop Relat Res 303:128–134
Brassard MF, Insall JN, Scuderi GR (2001) Complications of total knee arthroplasty. In: Complications of total knee arthroplasty. Insall JN, Scott WN (eds) Surgery of the knee. Churchill Livingstone, Philadelphia, pp 1801–1844
Esler CN, Lock K, Harper WM, Gregg PJ (1999) Manipulation of total knee replacements. Is the flexion gained retained? J Bone Joint Surg Br 81:27–29
Fernandez-Palazzi F, Battistella LR (1999) Non-operative treatment of flexion contracture of the knee in haemophilia. Haemophilia 5(Suppl 1):20–24
Finger E, Willis FB (2008) Dynamic splinting for knee flexion contracture following total knee arthroplasty: a case report. Cases J 1:421
Gollwitzer H, Burgkart R, Diehl P, Gradinger R, Buhren V (2006) Therapy of arthrofibrosis after total knee arthroplasty. Orthopade 35:143–152
Jansen CM, Windau JE, Bonutti PM, Brillhart MV (1996) Treatment of a knee contracture using a knee orthosis incorporating stress-relaxation techniques. Phys Ther 76:182–186
Kim J, Nelson CL, Lotke PA (2004) Stiffness after total knee arthroplasty. Prevalence of the complication and outcomes of revision. J Bone Joint Surg Am 86:1479–1484
Magit D, Wolff A, Sutton K, Medvecky MJ (2007) Arthrofibrosis of the knee. J Am Acad Orthop Surg 15:682–694
Maloney WJ (2002) The stiff total knee arthroplasty: evaluation and management. J Arthroplasty 17:71–73
McGrath MS, Mont MA, Siddiqui JA, Baker E, Bhave A (2009) Evaluation of a custom device for the treatment of flexion contractures after total knee arthroplasty. Clin Orthop Relat Res 467:1485–1492
McGrath MS, Ulrich SD, Bonutti PM, Marker DR, Johanssen HR, Mont MA (2009) Static progressive splinting for restoration of rotational motion of the forearm. J Hand Ther 22:3–8
McGrath MS, Ulrich SD, Bonutti PM, Smith JM, Seyler TM, Mont MA (2008) Evaluation of static progressive stretch for the treatment of wrist stiffness. J Hand Surg Am 33:1498–1504
Mohammed R, Syed S, Ahmed N (2009) Manipulation under anaesthesia for stiffness following knee arthroplasty. Ann R Coll Surg Engl 91:220–223
Phillips WE, Audet M (1990) Use of serial casting in the management of knee joint contractures in an adolescent with cerebral palsy. Phys Ther 70:521–523
Ranawat CS, Ranawat AS, Mehta A (2003) Total knee arthroplasty rehabilitation protocol: what makes the difference? J Arthroplasty 18:27–30
Scranton PE Jr (2001) Management of knee pain and stiffness after total knee arthroplasty. J Arthroplasty 16:428–435
Seyler TM, Marker DR, Bhave A, Plate JF, Marulanda GA, Bonutti PM, Delanois RE, Mont MA (2007) Functional problems and arthrofibrosis following total knee arthroplasty. J Bone Joint Surg Am 89(Suppl 3):59–69
Steffen TM, Mollinger LA (1995) Low-load, prolonged stretch in the treatment of knee flexion contractures in nursing home residents. Phys Ther 75:886–895
Wang JH, Zhao JZ, He YH (2006) A new treatment strategy for severe arthrofibrosis of the knee. A review of twenty-two cases. J Bone Joint Surg Am 88:1245–1250
Wang JH, Zhao JZ, He YH (2007) A new treatment strategy for severe arthrofibrosis of the knee. Surgical technique. J Bone Joint Surg Am 89(Suppl 2 Pt.1):93–102
Westberry DE, Davids JR, Jacobs JM, Pugh LI, Tanner SL (2006) Effectiveness of serial stretch casting for resistant or recurrent knee flexion contractures following hamstring lengthening in children with cerebral palsy. J Pediatr Orthop 26:109–114
Yercan HS, Sugun TS, Bussiere C, Ait Si Selmi T, Davies A, Neyret P (2006) Stiffness after total knee arthroplasty: prevalence, management and outcomes. Knee 13:111–117
Acknowledgments
We would like to thank Gina Zerrusen for her help in the preparation of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Additional information
Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained.
Level of Evidence: Therapeutic Level IV.
Rights and permissions
About this article
Cite this article
Bonutti, P.M., Marulanda, G.A., McGrath, M.S. et al. Static progressive stretch improves range of motion in arthrofibrosis following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 18, 194–199 (2010). https://doi.org/10.1007/s00167-009-0947-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-009-0947-1