The stiff total knee arthroplasty: causes, treatment modalities and results

Rodríguez-Merchán, E. Carlos

doi:10.1302/2058-5241.4.180105

Cited by 26 publications

(19 citation statements)

References 49 publications

(103 reference statements)

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“…In general, postoperative stiffness following TKAs can be challenging to manage given the variety of etiologies, including infections, idiopathic arthrofibrosis, component malpositioning, and sizing was well as kinesiophobia [33,34]. If an underlying cause cannot be definitively isolated, the efficacy of treatment options may be limited.…”

Section: Discussionmentioning

confidence: 99%

Heterotopic Ossification Negatively Influences Range of Motion After Revision Total Knee Arthroplasty

Gkiatas

Xiang

Nocon

et al. 2021

The Journal of Arthroplasty

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Background: The incidence of heterotopic ossification (HO) after total knee arthroplasty (TKA) varies and is of unclear clinical significance. This study aimed to identify the incidence of HO in patients undergoing revision TKA for either stiffness or aseptic loosening/instability and determine if the presence of HO is associated with inferior absolute range of motion (ROM) and ROM gains. Methods: Eighty-seven patients were prospectively enrolled and separated into 2 cohorts to evaluate ROM after revision TKA (2017-2019). Group 1 (N ¼ 40) patients were revised for stiffness, while group 2 (N ¼ 47) patients were revised for either aseptic loosening or instability. Goniometer-measured ROM values were obtained preoperatively and at 6 weeks, 6 months, and 1 year postoperatively. Statistical analysis included a Fisher's exact test to assess for an association between preoperative HO and final ROM at 1 year after revision TKA. Results: HO was identified on preoperative radiographs in 17 patients (20%). There was a significantly higher rate of preoperative HO in patients revised for stiffness compared to patients revised for instability or loosening (30% vs 11%; P ¼ .03). Five cases of HO qualitatively identified as most clinically severe were associated with lower ROM at each time point compared to the remainder of HO cases in this study cohort (P < .02). Conclusion:The presence of HO is greater in patients undergoing revision TKA for stiffness. Additionally, HO severity appears to have a major effect on preoperative and postoperative ROM trajectory. This information should help guide patient expectations and highlight the need for a comprehensive, standardized classification system for HO.

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Section: Discussionmentioning

confidence: 99%

Heterotopic Ossification Negatively Influences Range of Motion After Revision Total Knee Arthroplasty

Gkiatas

Xiang

Nocon

et al. 2021

The Journal of Arthroplasty

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“…Reduced preoperative knee mobility has previously been shown to be associated with decreased functional outcomes following TKA [ 24 ]. However, there are limited data on the effect of optimizing preoperative knee mobility in the sagittal plane prior to TKA [ 25 ]. This study supports the importance of evaluating patients for the presence of factors (including LSS) that may contribute to decreased preoperative AOM.…”

Section: Discussionmentioning

confidence: 99%

Severity and location of lumbar spine stenosis affects the outcome of total knee arthroplasty

et al. 2021

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Background Recent studies have noted that patients with pre-existing lumbar spinal stenosis (LSS) have lower functional outcomes after total knee arthroplasty (TKA). Given that LSS manifests heterogeneously in location and severity, its influence on knee replacement merits a radiographically targeted analysis. We hypothesize that patients with more severe LSS will have diminished knee mobility before and after TKA. Methods This retrospective case series assessed all TKAs performed at our institution for primary osteoarthritis from 2017–2020. Preoperative lumbar magnetic resonance image (MRI) with no prior lumbar spine surgery was necessary for inclusion. Stenosis severity was demonstrated by (1) anterior–posterior (AP) diameter of the thecal sac and (2) morphological grade. TKA outcomes in 103 cases (94 patients) were assessed by measuring preoperative and postoperative arc of motion (AOM), postoperative flexion contracture, and need for manipulation under anesthesia. Results Patients with mild stenosis did significantly better in terms of postoperative knee AOM. As AP diameter decreased at levels L1–2, L2–3, L3–4, and L4–5, there was a significant reduction in preoperative-AOM (p < 0.001 for each), with a 16 degree decrease when using patients’ most stenotic level (p < 0.001). The same was noted with respect to increased morphological grade (p < 0.001), with a 5 degree decrease for patients’ most stenotic level (p < 0.001). Conclusion Severe LSS, which is readily demonstrated by a reduction in the AP diameter of the thecal sac or increased morphological grade on MRI, correlated with a significant reduction in preoperative AOM that was not improved after TKA. Persistent postoperative reductions in AOM may contribute to reduced patient satisfaction and recovery. Level of evidence: Level 4

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“…Castrodod et al verified that high intensity and high velocity exercise were beneficial [ 8 ]. On one hand, post-TKA rehabilitation was encouraged to begin sooner rather than later [ 9 ], but on the other hand, early high intensity training would induce intense pain and consequent kinesiophobia [ 10 ]. It is critical to find a method which can both increase the training intensity early after surgery and improve the knee joint function without causing side effects.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of motor imagery for improving functional performance after total knee arthroplasty: a systematic review with meta-analysis

Jubao

Yang

et al. 2022

J Orthop Surg Res

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Background The aim of this study was to appraise the effects of motor imagery on the functional performance improvement among total knee arthroplasty patients systematically. We hypothesized a relatively greater recovery in the motor imagery group. Methods Medline (Ovid), Embase and Cochrane Controlled Register of Trials (CENTRAL) were searched from inception to October 1st, 2021. We included randomized controlled trials evaluating the effects of motor imagery on the functional recovery among total knee arthroplasty patients. Measurements included range of motion, strength intensity, Visual Analogue Scale, Time Up and Go Test, Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, all of which were evaluated before and after intervention. Mean differences (MD) or standard mean differences (SMD) and 95% confidence intervals (CI) were calculated. The Cochrane risk of bias tool was used to assess the risk of bias. Results Six studies with 168 patients were included for the meta-analysis. The SMD of strength intensity was increased (SMD = 0.90, 95% CI = [0.47]–[1.32], P < 0.001). The SMD of Visual Analogue Scale was reduced (SMD = − 0.91; 95% CI = [− 1.29]–[− 0.52], P < 0.001). The SMD of Time Up and Go Test was reduced (SMD = − 0.56, 95% CI = [− 0.94]–[− 0.19], P = 0.003). The MD of Oxford Knee Score was slightly increased (MD = 0.79-point, 95% CI = [− 0.31]–[1.88], P = 0.159). The outcomes of range of motion, Western Ontario and McMaster Universities Osteoarthritis Index were described according to the original data. Conclusion Compared with control therapy, motor imagery in the intervention group achieved an effective treatment for strength enhancement, pain reduction and physical activities improvement. More large-scale, prospective researches are needed in the future. Trial registration: The PROSPERO trial registration number is CRD42021250996.

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The stiff total knee arthroplasty: causes, treatment modalities and results

Cited by 26 publications

References 49 publications

Heterotopic Ossification Negatively Influences Range of Motion After Revision Total Knee Arthroplasty

Heterotopic Ossification Negatively Influences Range of Motion After Revision Total Knee Arthroplasty

Severity and location of lumbar spine stenosis affects the outcome of total knee arthroplasty

Effectiveness of motor imagery for improving functional performance after total knee arthroplasty: a systematic review with meta-analysis

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