Stiffness a Complication of Total Knee Arthroplasty and Its Management

Abstract

Introduction Total knee replacement is a highly successful procedure with a success rate of survivorship of 10 to 15 years exceeding 90% [1,2] . However despite advances in the surgical technique and rehabilitation post-operative stiffness continues to be relatively common complication [3-5] Stiffness is defined as an inadequate range of motion (ROM) that results in functional limitations in activities of daily living. Although early studies reported stiffness in >50% of patients with TKA, [6] the true incidence appears to be 8% to 12% [3,7,8] . The incidence of complete fibrous ankylosis after TKA is about 0.1%. Biomechanical studies and gait analysis have shown that patients require 67° of knee flexion during the swing phase of gait, 83° to ascend stairs, 90° to 100° to descend stairs, 93° to rise from a standard chair, and up to 105° to rise from a low chair [9,10] . There are no universally accepted criteria for diagnosis of stiffness, nor does consensus exist on appropriate timing of intervention. Thorough understanding of the multiple etiologies and available management options can help prevent stiffness in most patients and improve outcomes.