Outcomes of Liner Exchange Versus Component Revision for the Treatment of Stiffness Following Primary Total Knee Arthroplasty

Abstract

BackgroundThis study aimed to compare outcomes of revision total knee arthroplasty (rTKA) with liner exchange (LE) versus component revision (CRev) for stiffness post-TKA. MethodsWe retrospectively identified all rTKA performed for stiffness after primary TKA using our institutional database (2003 to 2021). Cases with infection, loosening, or < two years follow-up were excluded. There were 129 rTKA included, 91 in the LE, and 38 in the CRev cohorts. The mean follow-up was 8.5 years (range, two to 21). The LE and CRev cohorts had similar baseline demographics (P > 0.05), previous manipulation (P = 0.45), time from primary TKA (P = 0.14), and pre-rTKA arc of motion (AOM) (P = 0.08). The primary outcomes were the achievement of a successful range of movement (ROM), defined as flexion ≥ 90⁰ with an extension deficit of ≤ 10⁰, and AOM improvement. Kaplan-Meier analysis was used to compare survival free from re-revision between cohorts. ResultsFor the entire cohort, 69% achieved a successful ROM, and the mean AOM improved (P < 0.001). Achievement of successful ROM was comparable between LE (72%) and CRev (62%) cohorts (P = 0.29). The mean gain in AOM was similar between LE (24.9⁰) and CRev (25.4⁰) cohorts (P = 0.45). Preoperative extension deficit was associated with poorer outcomes (P = 0.006). The 10-year re-revision-free survival was similar between the LE (86.2%) and CRev (81.1%) cohorts (P = 0.55). Survival from re-revision for stiffness at 10-years was also similar (P = 0.6). The CRev group had increased surgical times (P < 0.0001), blood loss (P < 0.0001), and length of stay (P = 0.01). ConclusionsLE resulted in similar achievement of a successful ROM and re-revision-free survival compared with CRev. In properly selected patients, LE is a reasonable option for the treatment of stiffness after TKA.