Knee Society Pain Scores Research Articles

Can patients help with long-term total knee arthroplasty surveillance? Comparison of the American Knee Society Score self-report and surgeon assessment

To compare patient self-report of knee flexion, extension, range of motion (ROM) and American Knee Society (AKS) Pain, Knee and Functional scores with a clinician assessment. A total of 239 consecutive total knee arthroplasty (TKA) patients (290 knees) were mailed surveys with an AKS questionnaire and lateral knee photographs that showed knee ROM in 10 degrees increments to compare their operated knee(s) ROM. Patients were subsequently seen in clinic and their ROM, AKS Pain, Knee and Functional scores were measured. Patient- and physician-reported measures were compared using independent sample t-test and correlated using Spearman's correlation coefficient. A priori rules for comparisons were based on previously published reports. A total of 286 knees had both survey and clinic data available and constituted the analytic set. Patient-reported and physician-assessed extension, flexion and ROM were: 3 +/- 4.8 degrees vs 1.4 +/- 4.3 degrees (P < 0.001), 111.4 +/- 14.6 degrees vs 110 +/- 12.8 degrees (P = 0.04) and 108.6 +/- 16.8 vs 108.6 +/- 14.3 degrees (P = 0.98). There was a moderate correlation between patient and physician assessments (extension = 0.31; flexion = 0.44; ROM = 0.42; P < or = 0.001 for all). Patient-reported and physician-assessed AKS Pain, Knee and Functional scores were: 35.8 +/- 15.6 vs 43.9 +/- 11.1 (P < 0.001), 79.8 +/- 20 vs 88.9 +/- 13.3 (P < 0.001) and 57.7 +/- 23.1 vs 65.7 +/- 26.4 (P < 0.001), respectively. Patient- and physician-assessed AKS Pain, Knee and Functional scores had moderate-high correlation (r = 0.49, 0.49 and 0.70; P < or = 0.001 for all). Long-term surveillance of TKA patients may be possible using a self-report AKS, but the average 8- to 10-point difference between patient- and physician-reported AKS scores (patients reporting poorer scores) represents a substantial impact on this outcome instrument. Since patient-reported responses have clear value in global assessment, further evaluation with other validated outcome instruments is warranted.

Effect of Gender and Preoperative Diagnosis on Results of Revision Total Knee Arthroplasty

Recent studies question an effect of gender on outcome of primary TKA. We questioned whether the results of revision TKA were affected by gender. We separated 67 revision TKAs by gender and preoperative diagnosis into four groups (arthrofibrosis, infection, instability, and wear and loosening). Each revision TKA was individually matched by age and gender to two primary TKAs. Postoperative Knee Society pain and function scores after revision TKA were lower than for primary TKA for both females and males. However, postoperative Knee Society pain and function scores were similar in males and females. Postoperative pain and function scores were lower for all revision groups compared with primary TKA, except for pain and function scores after revision for instability. Postoperative pain and function scores were higher for instability and wear or loosening than for arthrofibrosis. Our data suggest the results of revision TKA are affected by preoperative diagnosis but not gender. Level III, retrospective matched cohort study. See Guidelines for Authors for a complete description of levels of evidence.

Outcome of Unicompartmental Knee Arthroplasty in Patients Receiving Worker's Compensation

Nineteen patients with a worker's compensation board (WCB) claim treated by unicompartmental knee arthroplasty for medial compartment osteoarthritis were compared to 20 patients who had no WCB claim. In WCB patients, the mean Knee Society Score (KSS) improved from 47.4 to 76.9; the mean Knee Society function score, from 43.8 to 75; and the mean Knee society pain score, from 6.9 to 29.4. In non-WCB patients, the mean KSS improved from 43.3 to 90.7; the mean Knee Society function score, from 44.7 to 90; and the mean Knee Society pain score, from 3.6 to 41.7. The difference in improvement of KSS between the two groups was significant ( P = .008). The postoperative KSS in the non-WCB patients was significantly higher than that of the WCB group ( P = .007). There was no difference between the incidences of conversion to total knee arthroplasty.

Triathlon Total Knee Arthroplasty –4-Year Outcomes with a High-Performance Implant

The 4-year outcomes of a prospective study of patients undergoing Triathlon total knee arthroplasty (TKA) are presented. There were 2035 consecutive cemented TKAs performed on 1688 patients. Mean follow-up was 21 months, including 713 knees with a follow-up of > or =2 years. In a subgroup of 239 patients, the coverage of the patella cut surface by the patella component was analyzed. To our knowledge, this is the first article to study this issue. Mean Knee Society pain scores improved from 48 to 96, function improved from 63 to 85, and range of motion improved from a mean of -5 degrees to 104 degrees to a mean of -2 degrees to 126 degrees. Coverage of the patella by the prosthesis was full from medial to lateral in 88% and full from proximal to distal in 91% of knees. The implant system has performed well within the follow-up period, with no implant- or design-related failures.

Midterm Results with the PFC Sigma Total Knee Arthroplasty System

We prospectively studied 207 consecutive patients (284 knees) undergoing total knee arthroplasty (June 1996 to December 1997) with a cemented tricompartmental Sigma PFC (DePuy Orthopaedics, Warsaw, Ind) total knee arthroplasty via a standard procedure (median follow-up, 87 months). Cruciate-retaining (272 knees, 96%) and cruciate-substituting (12, 4%) implants were used. There was one revision secondary to a ligament disruption after a fall. No implants were radiographically loose or at risk for loosening. Radiolucencies (none >2 mm or progressive) were shown on anteroposterior (7% of medial tibias) and lateral (17% of posterior femora) radiographs. Knee Society pain scores improved significantly (preoperative median, 20 points; postoperative median, 50 points [ P < .001]). The PFC Sigma Knee system has excellent midterm durability.

The Effect of Stuffing the Patellofemoral Compartment on the Outcome of Total Knee Arthroplasty

The effect of so-called stuffing of the patellofemoral compartment at the time of total knee arthroplasty (that is, increasing the anterior patellar displacement, the anteroposterior femoral size, or the combined anteroposterior patellofemoral size) has not been well studied. The purpose of the present study was to evaluate the effect of stuffing the patellofemoral compartment on the outcome of primary total knee arthroplasty. A retrospective review of 1100 primary total knee arthroplasties that had been performed in 1997 and 1998 was conducted. Eight hundred and thirty arthroplasties (75.5%) met the diagnostic and minimum two-year follow-up criteria for inclusion in this report. Radiographic measurements were made to determine preoperative and postoperative anterior patellar displacement, anteroposterior femoral size, combined anteroposterior patellofemoral size, anterior femoral offset, and posterior femoral offset. Regression analysis was performed to determine the effects of changes in these variables on the range of motion, the Knee Society Knee Score, the Knee Society Function Score, the Knee Society Pain Score, and the rate of lateral retinacular release. Preoperative to postoperative changes in anterior patellar displacement, anteroposterior femoral size, combined anteroposterior patellofemoral size, anterior femoral offset, and posterior femoral offset had no clinically meaningful effect on the range of motion of the knee or on any of the Knee Society scores. Increases in anterior patellar displacement were associated with a lower probability of the need for a lateral retinacular release. Increases in measured anteroposterior femoral size were associated with a higher probability of the need for lateral release. Even when combined, however, these relationships explained only 10.1% of the observed variance in the need for lateral retinacular release. Moreover, analyses indicated that patient gender, large as opposed to medium patellar size, and absolute femoral component size influenced the likelihood of lateral release more than did anterior patellar displacement and measured anteroposterior femoral size. Our findings do not support the widely held belief that stuffing of the patellofemoral joint results in adverse outcomes after total knee arthroplasty. Furthermore, the need for lateral release appears to be multifactorial and likely involves a more complex set of factors. Thus, without evidence of other identifiable causes of failure, we do not recommend revision for the treatment of pain of an overstuffed knee joint.

The Effect of Stuffing the Patellofemoral Compartment on the Outcome of Total Knee Arthroplasty

Background: The effect of so-called stuffing of the patellofemoral compartment at the time of total knee arthroplasty (that is, increasing the anterior patellar displacement, the anteroposterior femoral size, or the combined anteroposterior patellofemoral size) has not been well studied. The purpose of the present study was to evaluate the effect of stuffing the patellofemoral compartment on the outcome of primary total knee arthroplasty. Methods: A retrospective review of 1100 primary total knee arthroplasties that had been performed in 1997 and 1998 was conducted. Eight hundred and thirty arthroplasties (75.5%) met the diagnostic and minimum two-year follow-up criteria for inclusion in this report. Radiographic measurements were made to determine preoperative and postoperative anterior patellar displacement, anteroposterior femoral size, combined anteroposterior patellofemoral size, anterior femoral offset, and posterior femoral offset. Regression analysis was performed to determine the effects of changes in these variables on the range of motion, the Knee Society Knee Score, the Knee Society Function Score, the Knee Society Pain Score, and the rate of lateral retinacular release. Results: Preoperative to postoperative changes in anterior patellar displacement, anteroposterior femoral size, combined anteroposterior patellofemoral size, anterior femoral offset, and posterior femoral offset had no clinically meaningful effect on the range of motion of the knee or on any of the Knee Society scores. Increases in anterior patellar displacement were associated with a lower probability of the need for a lateral retinacular release. Increases in measured anteroposterior femoral size were associated with a higher probability of the need for lateral release. Even when combined, however, these relationships explained only 10.1% of the observed variance in the need for lateral retinacular release. Moreover, analyses indicated that patient gender, large as opposed to medium patellar size, and absolute femoral component size influenced the likelihood of lateral release more than did anterior patellar displacement and measured anteroposterior femoral size. Conclusions: Our findings do not support the widely held belief that stuffing of the patellofemoral joint results in adverse outcomes after total knee arthroplasty. Furthermore, the need for lateral release appears to be multifactorial and likely involves a more complex set of factors. Thus, without evidence of other identifiable causes of failure, we do not recommend revision for the treatment of pain of an overstuffed knee joint. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Surgical Treatment of Flexion Contractures After Total Knee Arthroplasty

The goal of knee arthroplasty is to relieve pain and normalize range of motion while providing stability through the gait cycle. Postoperative, significant (>15°) flexion contractures can cause persistent pain and altered gait mechanics. This study evaluated the efficacy of revision surgery for painful flexion contractures. Of the 14 patients included in the study, 10 had complete resolution of their flexion contracture. There was significant improvement in extension ( P < .0001), flexion ( P=.002), and total arc of motion ( P < .0001). Knee Society (KSS) pain scores improved significantly ( P < .001), whereas KSS function scores did not significantly improve ( P = .66). Revision surgery for symptomatic flexion contractures can improve range of motion and diminish pain. The best form of treatment is avoidance through careful flexion and extension gap balancing during primary surgery.

Manipulation After Total Knee Arthroplasty

Following total knee arthroplasty, some patients who fail to achieve >90 degrees of flexion in the early perioperative period may be considered candidates for manipulation of the knee under anesthesia. The purpose of this study was to assess the outcomes of manipulation following total knee arthroplasty. One hundred and thirteen knees in ninety patients underwent manipulation for postoperative flexion of < or =90 degrees at a mean of ten weeks after surgery. Flexion was measured with a goniometer prior to total knee arthroplasty, at the conclusion of the operative procedure, before manipulation, immediately after manipulation, at six months, and at one, three, and five years postoperatively. Eighty-one (90%) of the ninety patients achieved improvement of ultimate knee flexion following manipulation. The average flexion was 102 degrees prior to total knee arthroplasty, 111 degrees following skin closure, and 70 degrees before manipulation. The average improvement in flexion from the measurement made before manipulation to that recorded at the five-year follow-up was 35 degrees (p < 0.0001, paired t test). There was no significant difference in the mean improvement in flexion when patients who had manipulation within twelve weeks postoperatively were compared with those who had manipulation more than twelve weeks postoperatively. Patients who eventually underwent manipulation had significantly lower preoperative Knee Society pain scores (more pain) than those who had not had manipulation (p = 0.0027). Manipulation generally increases ultimate flexion following total knee arthroplasty. Patients with severe preoperative pain are more likely to require manipulation.

Manipulation After Total Knee Arthroplasty

Background: Following total knee arthroplasty, some patients who fail to achieve >90° of flexion in the early perioperative period may be considered candidates for manipulation of the knee under anesthesia. The purpose of this study was to assess the outcomes of manipulation following total knee arthroplasty. Methods: One hundred and thirteen knees in ninety patients underwent manipulation for postoperative flexion of ≤90° at a mean of ten weeks after surgery. Flexion was measured with a goniometer prior to total knee arthroplasty, at the conclusion of the operative procedure, before manipulation, immediately after manipulation, at six months, and at one, three, and five years postoperatively. Results: Eighty-one (90%) of the ninety patients achieved improvement of ultimate knee flexion following manipulation. The average flexion was 102° prior to total knee arthroplasty, 111° following skin closure, and 70° before manipulation. The average improvement in flexion from the measurement made before manipulation to that recorded at the five-year follow-up was 35° (p < 0.0001, paired t test). There was no significant difference in the mean improvement in flexion when patients who had manipulation within twelve weeks postoperatively were compared with those who had manipulation more than twelve weeks postoperatively. Patients who eventually underwent manipulation had significantly lower preoperative Knee Society pain scores (more pain) than those who had not had manipulation (p = 0.0027). Conclusions: Manipulation generally increases ultimate flexion following total knee arthroplasty. Patients with severe preoperative pain are more likely to require manipulation. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Mobile-Bearing Versus Fixed-Bearing Total Knee Arthroplasty: Results With a Cruciate-Retaining Knee System

This retrospective study compared 2- to 5-year results of fixed-bearing (n = 115) and mobile-bearing (n = 147) total knee arthroplasty. Knee Society score (KSS), passive range of motion (ROM), functional ROM, and radiographs were reviewed. Fixed-bearing: (50 male, 65 female), averages: age, 63 (42-71); follow-up, 4 years (2-5); body mass index, 32 (26-39); postoperative KSS pain, 96 (85-100); function, 79 (60-100). Average PROM, 117° (90°-125°); average functional ROM, 98° (40°-120°). X-rays: 15 (13%) with incomplete radiolucent lines (11 nonprogressive, 4 progressive). Mobile-bearing: (80 female, 67 male), averages: age, 61 years (45-78); follow-up, 3.2 years (2-5); body mass index, 31 (23-38); postoperative KSS pain, 93 (86-100); function, 76 (70-100). Average PROM, 120° (85°-130°); functional ROM, 100° (50°-120°). X-rays: 18 (12.2%) radiolucencies, all nonprogressive. No revisions in either group. No significant difference in PROM (P = .076), functional ROM (P = .456), KSS (P = .581), or nonprogressive radiolucencies (P = .495). Fixed-bearing had a higher number of progressive radiolucencies (P = .023).

Cementless Fixation in Revision Total Knee Arthroplasty

A surgical approach to revision total knee arthroplasty that includes minimal bone resection, minimal soft-tissue stripping, cementless fixation of the femoral and tibial components, and morselized allografting of defects was used and evaluated in 105 patients (110 knees) with severe bone loss. The patients were followed for 60 to 127 months postoperatively. Fixation included a tightly-fit fluted titanium stem in the femoral and tibial canals and rim contact on the peripheral rim of the tibia. One tibia loosened and one knee failed because of infection. Ligamentous stability and pain relief were consistent through the followup period. At 10 years the mean valgus laxity was 4 degrees +/- 2.5 degrees, and the mean varus laxity was 5.2 degrees +/- 3.3 degrees. Mean Knee Society pain score was 47 +/- 2.1. Pain was mild in 28 knees, moderate in eight knees, and severe in two knees. Evidence of bone healing occurred in the bone defects that could be seen on radiographs. Increase in radiodensity always was found at postoperative intervals greater than one year. An approach to revision total knee arthroplasty that maintains bone and soft tissue about the knee establishes an effective and durable construct. Therapeutic study, level II (prospective study). See Guidelines for Authors for a complete description of levels of evidence.

Midterm Results of Primary Total Knee Arthroplasty Using a Dished Polyethylene Insert with a Recessed or Resected Posterior Cruciate Ligament

Use of a dished polyethylene insert in 114 total knee arthroplasties, all with the posterior cruciate ligament resected or recessed, was retrospectively studied. Patients were evaluated at a mean follow-up of 8.3 years. Mean range of motion increased from 92° to 111°. Mean Knee Society pain and function scores increased from 35.2 and 39.7 to 91.3 and 74.7, respectively. WOMAC scores improved significantly in each category evaluated, including pain, stiffness, and physical function. Kaplan-Meier survivorship was 95% at 10 years (95% confidence interval, 82%-99%). The use of a dished polyethylene insert in primary total knee arthroplasty provides good to excellent midterm results regardless of whether the posterior cruciate ligament is recessed or sacrificed.

Distal Femoral Allograft Reconstruction for Massive Osteolytic Bone Loss in Revision Total Knee Arthroplasty

Massive osteolytic bone loss in revision total knee arthroplasty has been an uncommon challenge. From 2001 to 2002, 11 knees in 10 patients underwent revision of failed modular PFC (Johnson and Johnson Orthopaedics, Raynham, Mass) total knee arthroplasties with distal femoral allografts and long-stemmed revision implants for massive osteolytic induced femoral bone loss. The mean follow-up was 42 months (range, 36-48 months). Radiographic graft incorporation was demonstrated in all 11 knees with no cases of loosening. The Knee Society Pain Scores improved by an average of 25.4 points, and the function scores improved by an average of 23.3 points. The outcomes of distal femoral allografts in the reconstruction of massive osteolytic bone loss associated with failed modular PFC (Johnson and Johnson Orthopaedics) total knee arthroplasties are favorable.

Flexion Instability Without Dislocation after Posterior Stabilized Total Knees

Flexion instability after cruciate-retaining total knee arthroplasty has been well documented. We identified an analogous patient group with symptomatic flexion instability without dislocation after primary posterior stabilized total knee arthroplasty. We sought to determine the typical symptoms and exam findings that lead to the diagnosis, to assess the reliability of revision total knee arthroplasty as a treatment, and to assess the technical difficulties encountered during revision total knee arthroplasty. Between 1995 and 2001, 10 patients had revision of a well-fixed posterior stabilized total knee arthroplasty for isolated symptomatic flexion instability. The typical constellation of symptoms and physical findings included a sense of instability without giving way, recurrent knee effusions, multiple areas of soft tissue tenderness about the knee, and substantial anterior tibial translation at 90 degrees of flexion. The revision operation focused on balancing the flexion and extension gaps while taking care to fill the enlarged flexion gap. Revision total knee arthroplasty was reliable in alleviating pain (mean Knee Society Pain scores improved from 68 points preoperatively to 89 points postoperatively), improving stability (nine of 10 patients had < 5 mm anterior tibial translation postoperatively) and improving patient satisfaction (nine of 10 patients were satisfied). We had no particular technical difficulties with the revision total knee arthroplasty procedures and had reliably achieved well-balanced flexion and extension gaps. Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Stiffness After Total Knee Arthroplasty

Stiffness is an uncommon but disabling problem after total knee arthroplasty. The prevalence of stiffness after knee replacement has not been well defined in the literature. In addition, the outcomes of revision surgery for a stiff knee following arthroplasty have not been evaluated in a large series of patients, to our knowledge. The purposes of this study were to define the prevalence of stiffness after primary total knee arthroplasty and to evaluate the efficacy of revision surgery for treatment of the stiffness. We defined a stiff knee as one having a flexion contracture of 15 degrees and/or <75 degrees of flexion. Two separate groups were evaluated. First, the results of 1000 consecutive primary total knee replacements were reviewed to determine the prevalence of stiffness. Second, the results of fifty-six revisions performed because of stiffness, sometimes associated with pain or component loosening, after primary total knee arthroplasty were evaluated. The prevalence of stiffness was 1.3%, at an average of thirty-two months postoperatively. The patients with a stiff knee had had significantly less preoperative extension and flexion than did those without a stiff knee (p < 0.0001). There were no significant differences in age, gender, implant design, diagnosis, or the need for lateral release between the patients with and without stiffness. The second cohort, of knees revised because of stiffness, were followed for an average of forty-three months. The mean Knee Society score improved from 38.5 points preoperatively to 86.7 points at the time of follow-up; the mean Knee Society function score, from 40.0 to 58.4 points; and the mean Knee Society pain score, from 15.0 to 46.9 points. The mean flexion contracture decreased from 11.3 degrees to 3.2 degrees , the mean flexion improved from 65.8 degrees to 85.4 degrees , and the mean arc of motion improved from 54.6 degrees to 82.2 degrees . The arc of motion improved in 93% of the knees, and flexion increased in 80%. Extension improved in 63%, and it remained unchanged in 30%. The prevalence of stiffness in our series of 1000 primary knee arthroplasties was 1.3%. Revision surgery was a satisfactory treatment option for stiffness, as the Knee Society scores improved, the flexion contractures diminished, and 93% of the knees had an increased arc of motion. However, the results suggest that the benefits are modest.

Revision total knee arthroplasty with the Total Condylar III system in inflammatory arthritis

We report a consecutive series of 16 revision total knee arthroplasties using the Total Condylar III system in 14 patients with inflammatory arthritis which were performed between 1994 and 2000. There were 11 women and three men with a mean age of 59 years (36 to 78). The patients were followed up for 74 months (44 to 122). The mean pre-operative Knee Society score of 37 points (0 to 77) improved to 88 (61 to 100) at follow-up (t-test, p < 0.001) indicating very good overall results. The mean range of flexion improved from 62 degrees (0 degrees to 120 degrees) to 98 degrees (0 degrees to 145 degrees) (t-test, p < 0.05) allowing the patients to stand from a sitting position. The mean Knee Society pain score improved from 22 (10 to 45) to 44 (20 to 50) (t-test, p < 0.05). No knee had definite loosening, although five showed asymptomatic radiolucent lines. Complications were seen in three cases, comprising patellar pain, patellar fracture and infection. These results suggest that the Total Condylar III system can be used successfully in revision total knee arthroplasty in inflammatory arthritis.

A Study of Effectiveness of Knee Arthroscopy After Knee Arthroplasty

The purpose of this study was to investigate the outcome of arthroscopy in painful knee arthroplasty without evidence of infection, fracture, wear, and component loosening or malposition that had been refractory to conservative treatment. In addition, a literature review of 498 cases (MEDLINE 1966 to 2002) was performed. Case series. From 1997 to 2000, 27 patients (20 women, 7 men) had undergone arthroscopies because of poor results following total knee arthroplasty. Before the operation, the patients had suffered symptoms for an average of 11 months (range, 3 to 41 months). The average onset of symptoms after knee arthroplasty was 26 months (range, 3 to 59 months). The average patient age was 70 years (range, 42 to 81 years) and the average follow-up was 34 months (range, 24 to 52 months). At the initial operation, 19 patients had received total condylar surface replacement and 8 had received hemireplacement. Patients were evaluated using the Knee Society rating system. A review of the literature was performed by initial identification of the articles from a MEDLINE database followed by the use of cross references. All of the patients were available for follow-up. Eighteen of the 27 procedures resulted in an improvement in the patient's knee score. The average Knee Society ratings increased from 71 points before arthroscopy to 85 at follow-up for the knee score. The average functional scores were 69 and 83 points, respectively. The Knee Society pain score improved from 32 to 41 points. Nine patients underwent a subsequent open revision after arthroscopic diagnosis or treatment. Operative diagnoses included arthrofibrosis, impinging hypertrophic synovitis, impinging posterior cruciate ligament stump, prosthesis loosening or wear, symptomatic pseudomeniscus, an infrapatellar spur, and meniscal rupture. There was 1 infection as a complication associated with the arthroscopic procedure. Arthroscopic treatment of painful knee arthroplasty provides reliable expectations for improvement in function, decrease in pain, and improvement in knee scores for most patients. Level IV, Case Series.

Total Knee Arthroplasty for Salvage of Failed Internal Fixation or Nonunion of the Distal Femur

Seventeen patients with a mean age of 66 years had total knee arthroplasty (TKA) performed to salvage failed internal fixation or nonunion of the distal femur. Two patients died at less than 2 years, both of whom were unrevised. The remaining 15 were followed for a mean of 5 years. Three arthroplasties failed, 1 by infection and 2 by mechanical failure. The 5-year survivorship free of revision for aseptic failure was 91% (72%-100%). There were 5 intraoperative complications (29%) and 5 postoperative complications (29%). The mean Knee Society pain score improved from 2 (range, 0-10) to 89 (range, 63-97), and the mean functional score improved from 2 (range, 0-25) to 45 (range, 10-90). TKA provided reliable pain relief and functional improvement for the great majority of patients. Functional scores and prosthesis survivorship, however, were inferior to those reported for primary TKA. The surgeries were difficult, and intraoperative and postoperative complications were common.

Functional Results After Revision of Well-Fixed Components for Stiffness After Primary Total Knee Arthroplasty

Between 1990 and 2001, 16 well-fixed, aseptic, primary total knee arthroplasties were revised in 15 patients for a diagnosis of stiffness. Patients were followed for a mean of 42 months (range, 2-6 years). Of 15 patients, 10 (66%) were satisfied with the results of the procedure. The mean Knee Society pain score improved from 28 to 65 points, and the mean functional score improved from 45 to 58 points. The mean arc of motion improved from 40° preoperatively to 73° postoperatively. Recurrent stiffness required additional intervention in 4 knees (3 patients, 25%). The results of revision of a well-fixed, stiff, primary total knee arthroplasty were mixed in our hands and provided only modest improvements in pain, function, and arc of motion.