Decreased flexion contracture after total knee arthroplasty using Botulinum toxin A: a randomized controlled trial

Smith, Eric B.; Shafi, Karim; Greis, Ari C.; Maltenfort, Mitchell; Chen, Antonia F.

doi:10.1007/s00167-016-4277-9

Cited by 17 publications

(17 citation statements)

References 18 publications

(32 reference statements)

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“…2). Its prevalence was significantly (p = 0.033) lower in studies with >24 months of follow-up 1,4,12,[16][17][18]20,28,30,31,36,38,39,44,54 (3%, I 2 = 96%) than in those with £24 months of followup 19,29,[32][33][34][35]37,40,41,43,[45][46][47][48][49][50][51]53 (4%, I 2 = 85%) (Fig. 3).…”

Section: Discussionmentioning

confidence: 99%

“…Eighteen (51%) of the studies 4,12,[16][17][18]20,[28][29][30][31][32][33][34][35][36][37][38][39] (31,195 knees) contained sufficient data to allow analysis of age as a risk factor for developing acquired idiopathic stiffness following pTKA. This complication developed in 1,069 knees (3.4%) in patients with a mean age of 64.3 years (range among studies, 57 to 71 years).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…This complication developed in 1,069 knees (3.4%) in patients with a mean age of 64.3 years (range among studies, 57 to 71 years). Patient sex was reported in 17 studies 4,12,[17][18][19][20]28,29,31,32,[34][35][36][37][38][39][40] (49%) with a total of 16,720 patients (27,736 knees), 10,473 (63%) of whom were female and 6,247 (37%) of whom were male. Acquired idiopathic stiffness developed in 980 (6%) of these patients, 658 (67%) of whom were female and 322 (33%) of whom were male.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Of the 35 studies included in our review, 2 used the clinical term "arthrofibrosis," 20,41 29 used "stiffness," 1,12,[16][17][18][19][20][28][29][30][31][32][33][34][35][38][39][40][41][42][43][44][45][46][47][48][49][50][51] and 11 used "flexion contracture." 4,16,20,[36][37][38][50][51][52][53][54] Five studies used a combination of the aforementioned clinical terminology as inclusion criteria 16,20,38,41,51 . For 12 studies 12,18,19,28,29,…”

Section: Clinical Definitionsmentioning

confidence: 99%

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Acquired Idiopathic Stiffness After Total Knee Arthroplasty

Tibbo

Limberg

Salib

et al. 2019

The Journal of Bone and Joint Surgery

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Background: Stiffness is a common reason for suboptimal clinical outcomes after primary total knee arthroplasty (pTKA).There is a lack of consensus regarding its definition, which is often conflated with its histopathologic subcategory-i.e., arthrofibrosis. There is value in refining the definition of acquired idiopathic stiffness in an effort to select for patients with arthrofibrosis. We conducted a systematic review and meta-analysis to establish a consensus definition of acquired idiopathic stiffness, determine its prevalence after pTKA, and identify potential risk factors for its development.Methods: MEDLINE, Embase, Cochrane Controlled Register of Trials (CENTRAL), and Scopus databases were searched from 2002 to 2017. Studies that included patients with stiffness after pTKA were screened with strict inclusion and exclusion criteria to isolate the subset of patients with acquired idiopathic stiffness unrelated to known extrinsic or surgical causes. Three authors independently assessed study eligibility and risk of bias and collected data. Outcomes of interest were then analyzed according to age, sex, and body mass index (BMI).Results: In the 35 included studies (48,873 pTKAs), the mean patient age was 66 years. In 63% of the studies, stiffness was defined as a range of motion of <90°or a flexion contracture of >5°at 6 to 12 weeks postoperatively. The prevalence of acquired idiopathic stiffness after pTKA was 4%, and this did not differ according to age (4%, I 2 = 95%, among patients <65 years old and 5%, I 2 = 96%, among those ‡65 years old; p = 0.238). The prevalence of acquired idiopathic stiffness was significantly lower in males (1%, I 2 = 85%) than females (3%, I 2 = 95%) (p < 0.0001) as well as in patients with a BMI of <30 kg/m 2 (2%, I 2 = 94%) compared with those with a BMI of ‡30 kg/m 2 (5%, I 2 = 97%) (p = 0.027).Conclusions: Contemporary literature supports the following definition for acquired idiopathic stiffness: a range of motion of <90°persisting for >12 weeks after pTKA in patients in the absence of complicating factors including preexisting stiffness. The mean prevalence of acquired idiopathic stiffness after pTKA was 4%; females and obese patients were at increased risk.Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Stiffness is a common reason for failure of primary total knee arthroplasty (pTKA), contributing to up to 58% of reoperations or repeat interventions (such as manipulation under anesthesia) and >25% of 90-day hospital readmissions in some series [1][2][3] . Patients who develop this complication have poor functional outcomes and increased rates of knee pain, and their symptoms often are refractory to nonoperative and even oper-ative management 4,5 . The incidence of TKA increased from 31.2 per 100,000 person-years from 1971 to 1976 to 220.9 per 100,000 person-years from 2005 to 2008 6 . This trend, compounded by an increasing prevalence of obesity and a decreasing mean age of patients undergoing pTKA, wil...

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Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Clinical Definitionsmentioning

confidence: 99%

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Acquired Idiopathic Stiffness After Total Knee Arthroplasty

Tibbo

Limberg

Salib

et al. 2019

The Journal of Bone and Joint Surgery

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“…Table 1 and threshold values for the components and total WOMAC score (Table 3) were all entered into the model using "enter" methodology (Nagelkerke R 2 = 0.17) Surgeons should be aware that a proportion of patients will have increased symptoms of stiffness after TKA and that they have a worse functional outcome and a lower rate of post-operative satisfaction. Patients at risk may benefit from increased early physiotherapy or other treatment modalities [20] to prevent an increase in their symptoms of stiffness after TKA.…”

Section: Discussionmentioning

confidence: 99%

Increased symptoms of stiffness 1 year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction

Clement

Bardgett

Weir

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Purpose Symptoms of stiffness after total knee arthroplasty (TKA) cause significant morbidity, but there is limited data to facilitate identification of those most at risk after surgery. Stratifying risk can aid earlier directed treatment options. Methods A retrospective cohort consisting of 2589 patients undergoing a primary TKA was identified from an established arthroplasty database. Patient demographics, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and short form (SF) 12 scores were collected pre-operatively and 1 year post-operatively. In addition, patient satisfaction was assessed for 1 year. Patients with a worse WOMAC stiffness score in 1 year were defined as the "increased" stiffness group and the other cohort as the non-stiffness group. Results At 1 year after surgery 129 (5%) patients had a significant increase in their stiffness symptoms (20%, 95% confidence interval (CI) 17.9-22.0, p < 0.001), and had significantly (all p < 0.001) less of an improvement in their pain, function and total WOMAC scores, and SF-12 scores compared to the non-stiffness group (n = 2460). Patient satisfaction was significantly lower (odds ratio (OR) 0.178, CI 0.121 to 0.262, p < 0.001) for the increased stiffness group. Logistic regression analysis identified male gender (OR 1.66, p = 0.02), lung disease (OR 2.06, p = 0.002), diabetes (OR 1.82, p = 0.02), back pain (OR 1.81, p = 0.005), and a pre-operative stiffness score of 44 or more (OR 5.79, p < 0.001) were significantly predictive of increased stiffness. Conclusion Patients with increased symptoms of stiffness after TKA have a worse functional outcome and a lower rate of patient satisfaction, and patients at risk of being in this group should be informed pre-operatively. Level of evidence Retrospective prognostic study, Level III.

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