Introduction Definition flexion contracture 10-15 degrees flexion < 90 degrees Incidence 1.3%-12% Risk factors preoperative factors poor preoperative ROM most important factor patella baja increased medical comorbidities low pain tolerance 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 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
Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. TKA Revision Orthobullets Team Recon - TKA Stiffness Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. TKA - Parapatellar Approach Derek Bernstein Stephen Incavo Recon - TKA Stiffness
QUESTIONS 1 of 9 1 2 3 4 5 6 7 8 9 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.173) A 60-year-old woman undergoes a total knee arthroplasty for end-stage osteoarthritis. Preoperative knee range of motion is 5 to 100 degrees. Postoperatively, she experiences reduced range of motion. She is scheduled to undergo manipulation under anesthesia. In which of the following scenarios is this procedure best indicated? Review Topic | Tested Concept QID: 4808 Type & Select Correct Answer 1 Knee range of motion 0 to 60 degrees at 2 months postoperatively 84% (3756/4467) 2 Knee range of motion 0 to 60 degrees at 8 months postoperatively 5% (203/4467) 3 Knee range of motion 30 to 120 degrees at 2 months postoperatively 8% (336/4467) 4 Knee range of motion 30 to 120 degrees at 8 months postoperatively 2% (75/4467) 5 Knee range of motion 30 to 120 degrees at 2 weeks postoperatively 2% (77/4467) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.250) A 64-year-old male underwent the procedure shown in Figures A and B 7 weeks ago. He complains of difficulty with going down stairs. He reports no pain and denies constitutional symptoms. On examination the incision is well healed and no effusion is present. He is able to perform a straight leg raise with 5/5 strength. He lacks 2 degrees of terminal extension and has 80 degrees of active flexion. The knee is stable to varus and valgus stress testing at extension and mid flexion. His C-reactive protein and erythrocyte sedimentation rate are normal. What is the next most appropriate step in management? Review Topic | Tested Concept QID: 3673 FIGURES: A B Type & Select Correct Answer 1 Manipulation under anesthesia 85% (2440/2867) 2 Cortisone injection followed by physical therapy for quadriceps strengthening 2% (69/2867) 3 Aspiration to evaluate for septic arthritis 2% (45/2867) 4 Revise femoral component by downsizing A-P diameter 6% (176/2867) 5 Revise tibial component and add 5 degrees of posterior tibial slope 4% (126/2867) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07HK.38) Which of the following statements best describes the outcome of the routine use of continuous passive motion (CPM) machines after total knee arthroplasty (TKA)? Review Topic | Tested Concept QID: 5998 Type & Select Correct Answer 1 CPM is likely to improve early range of motion and final range of motion. 5% (15/302) 2 CPM may improve early range of motion but is unlikely to improve final range of motion. 93% (281/302) 3 CPM is likely to decrease postoperative pain. 1% (3/302) 4 CPM is likely to improve extension but not flexion. 0% (1/302) 5 CPM is likely to restore quicker ambulatory ability. 0% (1/302) L 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07HK.84) A 73-year-old man has stiffness after undergoing primary posterior cruciate ligament-retaining total knee arthroplasty 18 months ago. Extensive physiotherapy, dynamic splinting, and manipulations under anesthesia have failed to result in improvement. Examination reveals range of motion from 30 degrees to 60 degrees of flexion. The components are well fixed, and the evaluation for infection is negative. In discussing the possibility of revision arthroplasty, the patient should be advised that Review Topic | Tested Concept QID: 6044 Type & Select Correct Answer 1 the success of improving range of motion to a functional range of 0 degrees to 90 degrees in the literature is between 75% to 80%. 22% (52/232) 2 the preoperative arc of motion will not influence the ultimate range of motion after formal component revision. 2% (4/232) 3 change from a posterior cruciate ligament-retaining to a posterior cruciate ligament-substituting design has a much greater chance of success. 22% (51/232) 4 manipulation under anesthesia will effectively improve range of motion if postoperative stiffness develops following revision. 1% (3/232) 5 the major postoperative focus will be to regain near full extension. 52% (120/232) L 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07HK.25) Stiffness can occur following total knee arthroplasty. What is the most appropriate management for a patient who has deteriorating arc of motion after undergoing a revision knee arthroplasty 9 months ago? Review Topic | Tested Concept QID: 5985 Type & Select Correct Answer 1 Aggressive physical therapy 19% (52/278) 2 Manipulation under anesthesia 18% (51/278) 3 Investigation for periprosthetic infection 55% (153/278) 4 Revision knee arthroplasty 4% (12/278) 5 Resection arthroplasty 1% (2/278) L 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept
All Videos (3) Podcasts (1) 2018 Orthopaedic Summit Evolving Techniques Evolving Technique Update: 51-Year-Old Tennis Player 6 Weeks After Surgery Working With His Therapist & The Knee Won’t Bend - Edward J. McPherson, MD, FACS (OSET 2018) Edward McPherson Recon - TKA Stiffness 7/25/2019 645 views (2) Login to View Community Videos Login to View Community Videos 2018 HSS Holiday Knee & Hip Course TKR with Pre-operative Stiffness - Alexander McLawhorn MD Alexander McLawhorn Recon - TKA Stiffness 6/4/2019 232 views (2) Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques The 67-Year-Old Stiff Knee: More Than 20 Years of Experience - I Can Solve It! - John J. Callaghan, MD Recon - TKA Stiffness 4/25/2018 295 views (1) Recon⎪TKA Stiffness Orthobullets Team Recon - TKA Stiffness Listen Now 15:6 min 6/4/2020 19 plays (0)