Jordan S Cohen1, Alex Gu2, Nicole S Lopez3, Mindy S Park1, Keith A Fehring4, Peter K Sculco5. 1. Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC. 2. Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY. 3. Department of Medicine, Medical College of Georgia, Augusta, GA. 4. Department of Orthopedic Surgery, OrthoCarolina, Charlotte, NC. 5. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
Abstract
BACKGROUND: Knee stiffness following total knee arthroplasty (TKA) may cause pain and reduced functionality, contributing to unsatisfactory surgical outcomes. Revision surgery remains a possible treatment for refractory postoperative stiffness. However, the efficacy of the procedure has not been systematically evaluated. METHODS: A systematic review of the literature was performed to identify studies that reported on outcomes for patients who underwent revision surgery for postoperative stiffness after TKA. RESULTS: Ten studies (including 485 knees) were reviewed. The most common etiologies of stiffness requiring revision TKA were component malposition, malalignment, overstuffing, aseptic loosening, arthrofibrosis, patella baja, and heterotopic ossification. Of 9 studies reviewing range of motion outcomes after revision TKA, 7 studies documented significant improvement and 2 found trends toward improvement. Seven of 8 studies documenting Knee Society knee scores and 7 of 9 studies documenting functional scores found improvement after revision TKA. All studies reporting on pain found improvement at final follow-up after revision TKA. CONCLUSION: Revision TKA results in increased range of motion, improved functionality, and reduced pain in most patients who require surgery for stiffness. The present literature is inadequate to predict which patients will achieve adequate outcomes from revision TKA based on the specific etiology of their stiffness, although identification of the etiology may help in surgical planning. Surgeons performing revision TKA should counsel patients on the risks and benefits of undergoing revision surgery, with the understanding that outcomes for well-selected patients are generally favorable.
BACKGROUND:Knee stiffness following total knee arthroplasty (TKA) may cause pain and reduced functionality, contributing to unsatisfactory surgical outcomes. Revision surgery remains a possible treatment for refractory postoperative stiffness. However, the efficacy of the procedure has not been systematically evaluated. METHODS: A systematic review of the literature was performed to identify studies that reported on outcomes for patients who underwent revision surgery for postoperative stiffness after TKA. RESULTS: Ten studies (including 485 knees) were reviewed. The most common etiologies of stiffness requiring revision TKA were component malposition, malalignment, overstuffing, aseptic loosening, arthrofibrosis, patella baja, and heterotopic ossification. Of 9 studies reviewing range of motion outcomes after revision TKA, 7 studies documented significant improvement and 2 found trends toward improvement. Seven of 8 studies documenting Knee Society knee scores and 7 of 9 studies documenting functional scores found improvement after revision TKA. All studies reporting on pain found improvement at final follow-up after revision TKA. CONCLUSION: Revision TKA results in increased range of motion, improved functionality, and reduced pain in most patients who require surgery for stiffness. The present literature is inadequate to predict which patients will achieve adequate outcomes from revision TKA based on the specific etiology of their stiffness, although identification of the etiology may help in surgical planning. Surgeons performing revision TKA should counsel patients on the risks and benefits of undergoing revision surgery, with the understanding that outcomes for well-selected patients are generally favorable.
Authors: Eytan M Debbi; Kyle Alpaugh; Daniel A Driscoll; T David Tarity; Ioannis Gkiatas; Peter K Sculco Journal: JBJS Essent Surg Tech Date: 2021-12-22
Authors: Paul J H van Rensch; Petra J C Heesterbeek; Gerjon Hannink; Gijs G van Hellemondt; Ate B Wymenga Journal: Knee Surg Sports Traumatol Arthrosc Date: 2018-10-26 Impact factor: 4.342