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Updated: May 7 2023

TKA Stiffness

Images
https://upload.orthobullets.com/topic/12309/images/2d10ada9-a225-4b2e-a0bd-6aa03002b84c_patella_baja..jpg
  • summary
    • TKA Stiffness is a common complication following TKA that results in poor postoperative functional outcomes.
    • Diagnosis is made clinically in a patient with a TKA who has flexion < 90 degrees or a flexion contracture of 10-15 degrees.
    • Treatment is manipulation under anesthesia for flexion < 90 degrees within first 12 weeks of surgery.  Arthroscopic lysis of adhesions is indicated for flexion < 90 degrees after 12 weeks. 
  • Epidemiology
    • Incidence
      • 1.3%-12%
    • Risk factors
      • preoperative factors
        • poor preoperative ROM
          • most important factor
        • patella baja
        • younger age (< 55)
        • smoking
        • increased medical comorbidities
        • low pain tolerance
        • prior surgery
      • technical factors
        • overstuffing patellofemoral joint
        • malrotation
        • tight flexion and/or extension gaps
        • joint line elevation
        • excessive tightening of extensor mechanism during closure
          • closure in flexion (as opposed to extension) may limit this complication
        • tight PCL in cruciate-retaining prosthesis
      • postoperative factors
        • delayed rehabilitation
        • infection
        • HO
        • hamstring spasms
        • usually resolves within 6 months
  • Presentation
    • Symptoms
      • difficulty kneeling
    • Physical exam
      • check preoperative ROM from records
      • flexion contracture 10-15 degrees
      • flexion < 90 degrees
  • Imaging
    • Radiographs
      • rule out prosthesis malposition or alignment
    • CT scan
      • rule out prosthesis malposition or alignment
  • Studies
    • Serum labs
      • ESR/CRP
        • must rule-out infection
  • Treatment
    • Nonoperative
      • manipulation under anesthesia
        • indications
          • flexion <90 degrees within first 12 weeks of operation (timing is controversial)
            • over aggressive manipulation
              • fracture
              • extensor mechanism disruption
        • contraindications
          • stiffness >3 months postoperatively
          • manipulation associated with greater risk and lower benefit
    • Operative
      • arthroscopic lysis of adhesions with manipulation under anesthesia
        • indications
          • persistent late stiffness
      • revision total knee arthroplasty
        • indications
          • identifiable technical cause for stiffness
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