The stiff total knee arthroplasty: Evaluation and management

Maloney, William J.

doi:10.1054/arth.2002.32450

Cited by 107 publications

(83 citation statements)

References 9 publications

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“…Given the fact that functionality is also one of the goals of joint replacement, recovering functional ROM is an important factor in evaluating MUA outcomes after primary TKA. Currently, there is no consensus of the definition for successful MUA, as patient satisfaction may vary according to pre-operative ROM, activity requirement or regional life style [15,16]. NonWestern populations, who perform frequent squatting, kneeling or sitting cross-legged activities, clearly demand a greater ROM [16].…”

Section: Discussionmentioning

confidence: 99%

“…Specifically in regard to procedure indication and timing, several studies [4,11,14,17] suggested 90 days as time criteria between TKA and MUA; however, other studies suggested early MUA as being that performed within three weeks [10,18], 30 days [19], eight weeks [9] and 75 days [8] following TKA. In our study, we applied a 12-week cutoff for evaluating MUA timing, as most authors recommend a time interval < three months following initial surgery [4,9,15,19,20].…”

Section: Discussionmentioning

confidence: 99%

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How often is functional range of motion obtained by manipulation for stiff total knee arthroplasty?

Choi

Siliski

Malchau

et al. 2014

International Orthopaedics (SICOT)

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Purpose To evaluate how often manipulation under anesthesia (MUA) can achieve functional flexion ≥ 90 degrees and identify predictor for successful outcome of MUA for stiff total knee arthroplasty (TKA). Methods Demographic data, range of motion, and surgical and anesthetic information of 143 MUAs were retrospectively analyzed from 2000 to 2011.Results One-hundred thirty-six out of 143 patients (95 %) improved mean range of motion (ROM) from pre-MUA 62±17°to final ROM 101±21°(p<0.001). Flexion ≥ 90 degrees was achieved in 74% (106/143) of patients. Regional anesthesia was identified as predictor of successful MUA outcome (p=0.007, OR: 8.5, 95 % CI: 1.2-66.7). Conclusions Although the proportion of patients regaining flexion ≥ 90 degrees following MUA was less than those patients with simple overall ROM increase, the functional flexion ≥ 90 degrees was achieved in the vast majority of patients with stiff TKA following MUA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

How often is functional range of motion obtained by manipulation for stiff total knee arthroplasty?

Choi

Siliski

Malchau

et al. 2014

International Orthopaedics (SICOT)

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show abstract

“…Among the early complications of surgery, stiffness remains a serious concern. In an analysis of seven studies reporting the results of 16,299 primary TKAs, manipulation under anaesthesia (MUA) was required in 4.5% of patients [5,12,16,19,30,36,40]. Postoperative range of motion (ROM) is influenced by preoperative, intraoperative, and postoperative factors [7].…”

Section: Introductionmentioning

confidence: 99%

Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts

Malik

Salas²,

Ari

et al. 2009

International Orthopaedics (SICOT)

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It is debatable whether high-flexion (HF) total knee arthroplasty (TKA) designs will improve postoperative flexion and function or will diminish the need for manipulation under anaesthesia (MUA). We retrospectively analysed range of motion (ROM), flexion, Knee Society Score (KSS), and rate of MUA in a consecutive group of patients who underwent TKA with a conventional posterior stabilised (PS) insert or an HF insert using identical surgical technique, implant design, and postoperative care. Fifty TKAs with a standard PS insert were matched for patient's age, gender, preoperative ROM, and KSS with 50 TKA performed with an HF insert. The patient's ROM and KSS were evaluated at six weeks, four months, and one year postoperatively. The outcome variables (flexion, ROM, KSS, and manipulation rate) in both groups were compared using the generalised estimating equations method. A second analysis of patients with preoperative flexion ≥120°was performed. The ROM, flexion, and patient-reported KSS was similar in both groups at each time period. The rate of MUA was also similar. Patients with a preoperative ROM of at least 120°showed similar results. Our study found that one year after surgery, patients who underwent TKA with a PS or an HF insert achieved similar flexion, ROM, and function.

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“…Considerable loss of range of motion of the knee may occur in 1% to 15% of patients who have undergone primary TKAs [12,17,18,23,31,34]. Additionally, the frequency of knee stiffness may be even higher in patients who have had revision TKA, especially after treatment of a periprosthetic infection [2,32].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Custom Device for the Treatment of Flexion Contractures after Total Knee Arthroplasty

McGrath

Mont

Siddiqui

et al. 2009

Clin Orthop Relat Res

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Knee flexion contractures can severely impair function after total knee arthroplasties. We evaluated the use of a custom-molded knee device to treat 47 patients who had knee flexion contractures (mean, 22°; range, 10°-40°) after primary or revision total knee arthroplasties and who had failed conventional therapeutic methods. The device was used for 30 to 45 minutes per session two to three times per day in conjunction with standard physical therapy modalities two to three times per week. Twentyseven of 29 patients who underwent primary total knee arthroplasty and 13 of 18 patients who underwent revisions achieved full extension after a mean treatment time of 9 weeks (range, 6-16 weeks). Full knee extension was maintained at a minimum followup of 18 months (mean, 24 months; range, 18-36 months). The mean Knee Society knee and functional scores improved from 50 points and 34 points to 91 points and 89 points, respectively. This protocol had comparable rates of improvement in knee extension with less treatment time when compared with other nonoperative treatments reported in the literature.

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The stiff total knee arthroplasty: Evaluation and management

Cited by 107 publications

References 9 publications

How often is functional range of motion obtained by manipulation for stiff total knee arthroplasty?

How often is functional range of motion obtained by manipulation for stiff total knee arthroplasty?

Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts

Evaluation of a Custom Device for the Treatment of Flexion Contractures after Total Knee Arthroplasty

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