Causes of stiffness after total knee arthroplasty: a systematic review

Zaffagnini, Stefano; Paolo, Stefano Di; Meena, Amit; Alesi, Domenico; Zinno, Raffaele; Barone, Giuseppe; Pizza, Nicola; Bragonzoni, Laura

doi:10.1007/s00264-021-05023-3

Cited by 16 publications

(15 citation statements)

References 38 publications

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“…Stiffness or arthrofibrosis is one of the most common complications associated with joint arthroplasty surgery [ 40 ]. Arthrofibrosis may occur due to several factors, including those on the part of the surgeon and patient [ 40 , 41 ]. MUA is a therapeutic procedure to treat stiffness or arthrofibrosis [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Sensor-guided gap balance versus manual gap balance in primary total knee arthroplasty: a meta-analysis

Sun

Zhao

Lee³

et al. 2022

J Orthop Surg Res

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Background Despite Vast improvements in technology and surgical technique in total knee arthroplasty (TKA), approximately 15–25% TKAs, have suboptimal subjective clinical outcomes. Our study sought to evaluate if sensor-guided balancing improves postoperative clinical outcomes compared to a conventional gap balancing technique. Methods We searched Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in March 2022 to identify studies involving sensor-guided balancing versus conventional gap balancing technique in TKA. Finally, we identified 2147 knees assessed in nine studies. Results Compared with manual gap balancing, Sensor-guided gap balancing resulted in less rate of Manipulation under anesthesia (MUA) (P = 0.02), however more rate of intraoperative additional procedures (P = 0.0003). There were no significant differences in terms of KSS (P = 0.21), KSS Function score (P = 0.36), OKS (P = 0.61), KOOS (P = 0.78), operative time (P = 0.17), Mechanical axis (P = 0.69) and rate of reoperation between two groups. Conclusion Compared with conventional manual gap balancing techniques, sensors have more balancing procedures being performed. However, it did result in a reduction in the rate of MUA. More extensive, high-quality RCTs are required to verify our findings further.

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Section: Discussionmentioning

confidence: 99%

Sensor-guided gap balance versus manual gap balance in primary total knee arthroplasty: a meta-analysis

Sun

Zhao

Lee³

et al. 2022

J Orthop Surg Res

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“…Knee stiffness, defined as limited range-of-motion that affects daily activities, occurs in 1–16% patients after TKA 8 – 11 . Knee stiffness results from the interplay between patient-intrinsic predisposing (pre-operative) risk factors and intra-operative and post-operative factors 12 . However, the disease- and surgery-specific signatures dysregulated in patients who develop stiffness after TKA are not well understood.…”

Section: Introductionmentioning

confidence: 99%

Association of circulating gene expression signatures with stiffness following total knee arthroplasty for osteoarthritis: a pilot study

Kirksey

Lessard²,

Khan³

et al. 2022

Sci Rep

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A subset of patients undergoing total knee arthroplasty (TKA) for knee osteoarthritis develop debilitating knee stiffness (reduced range of motion) for poorly understood reasons. Dysregulated inflammatory and immune responses to surgery correlate with reduced surgical outcomes, but the dysregulated gene signatures in patients with stiffness after TKA are poorly defined. As a consequence, we are limited in our ability to identify patients at risk of developing poor surgical outcomes and develop preventative approaches. In this pilot study we aimed to identify perioperative blood gene signatures in patients undergoing TKA for knee osteoarthritis and its association with early surgical outcomes, specifically knee range of motion. To do this, we integrated clinical outcomes collected at 6 weeks after surgery with transcriptomics analyses in blood samples collected immediately before surgery and at 24 h after surgery. We found that patients with stiffness at 6 weeks after surgery have a more variable and attenuated circulating gene expression response immediately after surgery. Our results suggest that patients with stiffness following TKA may have distinct gene expression signatures detectable in peripheral blood in the immediate postoperative period.

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“…However, it is well known that these patients have significant muscular atrophy and weakness in the affected limb that can persist for months after surgery [24], with mobility deficits remaining for many years [13,14]. Exercise programs beyond the initial post-operative rehabilitation period have been shown to reduce pain and joint stiffness, improve physical function and lessen the chance of accidental falls after surgery [25][26][27][28][29][30]. These programs have generally used strengthening exercises and functional tasks such as stair climbing to improve muscular strength and power, walking speed, and mobility.…”

Section: Introductionmentioning

confidence: 99%

“…In conclusion, although there is a large consensus on the importance of physical function improvement to prevent or mitigate disability in persons who underwent THR/TKR in the long term, there is no best practice specifically designed to these persons. Therefore, taking into account previously published experiences [25][26][27][28][29][30] and experts' opinion [31][32][33], we designed an exercise protocol aimed at improving quality of life (QoL) after THR and TKR for primary osteoarthritis. This goal is intended to be achieved by improving a variety of factors which influence QoL, including muscle strength, joint mobility, gait and balance function, and pain [13,14,[24][25][26][27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, taking into account previously published experiences [25][26][27][28][29][30] and experts' opinion [31][32][33], we designed an exercise protocol aimed at improving quality of life (QoL) after THR and TKR for primary osteoarthritis. This goal is intended to be achieved by improving a variety of factors which influence QoL, including muscle strength, joint mobility, gait and balance function, and pain [13,14,[24][25][26][27][28][29][30]. This paper presents the protocol of a single-blinded randomized trial aimed at evaluating the efficacy and safety of this exercise program.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Efficacy and Safety of an Exercise Program for Persons with Total Hip or Total Knee Replacement: Study Protocol for a Randomized Controlled Trial

Barone

Zinno

Pinelli

et al. 2021

IJERPH

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Total hip replacement (THR) and total knee replacement (TKR) are among the most common elective surgical procedures. There is a large consensus on the importance of physical activity promotion for an active lifestyle in persons who underwent THR or TKR to prevent or mitigate disability and improve the quality of life (QoL) in the long term. However, there is no best practice in exercise and physical activity specifically designed for these persons. The present protocol aims to evaluate the efficacy and safety of an exercise program (6 month duration) designed for improving quality of life in people who had undergone THR or TKR. This paper describes a randomized controlled trial protocol that involves persons with THR or TKR. The participant will be randomly assigned to an intervention group or a control group. The intervention group will perform post-rehabilitation supervised training; the control group will be requested to follow the usual care. The primary outcome is QoL, measured with the Short-Form Health Survey (SF-36); Secondary outcomes are clinical, functional and lifestyle measures that may influence QoL. The results of this study could provide evidence for clinicians, exercise trainers, and policymakers toward a strategy that ensures safe and effective exercise physical activity after surgery.

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Causes of stiffness after total knee arthroplasty: a systematic review

Cited by 16 publications

References 38 publications

Sensor-guided gap balance versus manual gap balance in primary total knee arthroplasty: a meta-analysis

Sensor-guided gap balance versus manual gap balance in primary total knee arthroplasty: a meta-analysis

Association of circulating gene expression signatures with stiffness following total knee arthroplasty for osteoarthritis: a pilot study

Evaluation of the Efficacy and Safety of an Exercise Program for Persons with Total Hip or Total Knee Replacement: Study Protocol for a Randomized Controlled Trial

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