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
Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA Revision Orthobullets Team Recon - TKA Heterotopic Ossification Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA - Parapatellar Approach Derek T. Bernstein Stephen Incavo Recon - TKA Patellar Prosthesis Loosening
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 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? QID: 4808 Type & Select Correct Answer 1 Knee range of motion 0 to 60 degrees at 2 months postoperatively 83% (4101/4919) 2 Knee range of motion 0 to 60 degrees at 8 months postoperatively 5% (234/4919) 3 Knee range of motion 30 to 120 degrees at 2 months postoperatively 8% (384/4919) 4 Knee range of motion 30 to 120 degrees at 8 months postoperatively 2% (87/4919) 5 Knee range of motion 30 to 120 degrees at 2 weeks postoperatively 2% (90/4919) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK 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 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%. 23% (90/391) 2 the preoperative arc of motion will not influence the ultimate range of motion after formal component revision. 3% (11/391) 3 change from a posterior cruciate ligament-retaining to a posterior cruciate ligament-substituting design has a much greater chance of success. 21% (82/391) 4 manipulation under anesthesia will effectively improve range of motion if postoperative stiffness develops following revision. 3% (11/391) 5 the major postoperative focus will be to regain near full extension. 49% (193/391) L 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic 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)? QID: 5998 Type & Select Correct Answer 1 CPM is likely to improve early range of motion and final range of motion. 7% (33/491) 2 CPM may improve early range of motion but is unlikely to improve final range of motion. 90% (444/491) 3 CPM is likely to decrease postoperative pain. 1% (5/491) 4 CPM is likely to improve extension but not flexion. 1% (3/491) 5 CPM is likely to restore quicker ambulatory ability. 1% (5/491) L 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic 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? QID: 5985 Type & Select Correct Answer 1 Aggressive physical therapy 17% (102/602) 2 Manipulation under anesthesia 17% (102/602) 3 Investigation for periprosthetic infection 60% (360/602) 4 Revision knee arthroplasty 4% (27/602) 5 Resection arthroplasty 0% (3/602) L 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic
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 C 7/25/2019 896 views 3.5 (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 C 6/4/2019 271 views 3.5 (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 B 4/25/2018 321 views 5.0 (1) Recon⎪TKA Stiffness Orthobullets Team Recon - TKA Stiffness Listen Now 15:6 min 6/4/2020 120 plays 0.0 (0)