Abstract
Stiffness after total knee arthroplasty (TKA) adversely affects outcome and impacts
patient function. Various risk factors for stiffness after TKA have been identified,
including reduced preoperative knee range of motion, history of prior knee surgery,
etiology of arthritis, incorrect positioning or oversizing of components, and incorrect
gap balancing. Mechanical and associated causes, such as infection, arthrofibrosis,
complex regional pain syndrome, and heterotopic ossification, secondary gain issues
have also been identified. Management of stiffness following TKA can be challenging.
The condition needs to be assessed and treated in a staged manner. A nonsurgical approach
is the first step. Manipulation under anesthesia may be considered within the first
3 months after the index TKA, if physical therapy fails to improve the range of motion.
Beyond this point, consideration should be given to surgical intervention such as
lysis of adhesions, either arthroscopically or by open arthrotomy. If the cause of
stiffness is deemed to be surgical error, such as component malpositioning, revision
arthroplasty is indicated. The purpose of this article is to evaluate the various
aspects of management of stiffness after TKA.
Keywords
arthroplasty - replacement - knee - contracture - joint deformities - acquired - reoperation
