Abstract
PurposeManagement of the severely stiff total knee arthroplasty (TKA) is challenging, with the outcome of revision arthroplasty being inferior compared to the outcome for other indications. The aim of this study was to analyse the outcome after revision TKA with hinged-type implants for severely stiff TKA [range of motion (ROM) ≤ 70°] at 2 years.MethodsA cohort of 38 patients with a hinged-type revision TKA (Waldemar Link or RT-Plus) and preoperative ROM ≤ 70° were selected from a prospectively collected database. ROM, visual analogue scale (VAS) for pain and satisfaction and Knee Society Score (KSS) were obtained preoperatively and at 3 months, 1 year and 2 years. Pre- and postoperative outcome were compared at 2 years.ResultsThere was a significant increase in ROM and KSS. VAS pain scores did not differ significantly. The median ROM at 2 years was 90° (range 50°–125°) with a median gain of 45° (range 5°–105°). Median VAS pain was 28.5 (range 0–96) points and median VAS satisfaction was 72 (range 0–100) points at 2 years. Twelve patients suffered a complication. Recurrent stiff knee was the most frequently reported complication (n = 5).ConclusionsHinged-type revision TKA following a severely stiff TKA renders a significant, although moderate, clinical improvement at 2 years.Level of evidenceRetrospective case series. Level IV.
Highlights
Stiffness following total knee arthroplasty (TKA) is a challenging problem in orthopaedic surgery
When looking at revision TKA, it has been shown that patients who were revised for severely stiff TKA have the worst outcome directly postoperatively and remain worse at 2 years with respect to range of motion (ROM), pain and satisfaction score, and Knee Society Score (KSS) when compared to other indications [1]
Management of a severely stiff TKA consists of physiotherapy, manipulation under anaesthesia (MUA), arthroscopic debridement or open debridement [5,6,7,8,9,10]
Summary
Stiffness following total knee arthroplasty (TKA) is a challenging problem in orthopaedic surgery. When looking at revision TKA, it has been shown that patients who were revised for severely stiff TKA have the worst outcome directly postoperatively and remain worse at 2 years with respect to range of motion (ROM), pain and satisfaction score, and Knee Society Score (KSS) when compared to other indications (revision for septic loosening, aseptic loosening, component malposition or instability) [1]. Analysis of the outcome and treatment of severely stiff TKAs has proven. Revision arthroplasty is most commonly reserved for the correction of technical errors in the severely stiff TKA, such as malrotation, malpositioning and instability [8, 9, 11]. According to Cohen et al, revision TKA, being a viable option for some patients, still does not offer a solution for all patients suffering from a
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