Conduite à tenir devant une raideur après prothèse totale du genou

Abstract

A stiff total knee arthroplasty can be caused by a preexisting knee stiffness, technical errors, poor control of pain, postoperative complications and perhaps personal predisposition to postoperative arthrofibrosis and ossifications. Understanding of the mechanism of the stiffness is the first step. However, origin of the stiffness may remain unknown. Revisions for stiffness represent more than 10% of total knee arthroplasties revisions. Treatment options are closed manipulation, surgical or more recently arthroscopic arthrolysis and prosthetic exchange. Manipulation may be performed until 6weeks or two months after healing of the wound and, for this reason, clinical examination one month after the procedure is needed. Arthroscopic arthrolysis requires an experienced surgeon. It provides the best results in stiffness treated between 2 and 6months or a little bit more. After this delay, surgical arthrolysis or prosthetic exchange is indicated. Technical errors are identified by preoperative investigations. CT scan is needed to determine the rotation of both femoral and tibial components. Technical errors require prosthetic exchange unless patella alone is concerned, which is rare. In fact, patellar complications are frequently due to rotational tibial or femoral malpositions. It is difficult to identify some technical errors, such as unbalanced flexion and extension gaps before the revision and, for this reason, it is necessary to be able to perform a prosthetic exchange in any case. All these techniques require an early intensive and prolonged postoperative rehabilitation. Whichever the technique, patients may be disappointed by the result and for this reason careful information is mandatory. Poor results are more frequent when stiffness is unexplained.