Article

Preoperative Knee Stiffness and Total Knee Arthroplasty Outcomes

Hamilton Arthroplasty Group, Hamilton Health Sciences Juravinski Hospital, Hamilton, Ontario, Canada.
The Journal of arthroplasty (Impact Factor: 2.37). 01/2012; 27(8):1437-41. DOI: 10.1016/j.arth.2011.12.015
Source: PubMed

ABSTRACT A retrospective case-control study was conducted to evaluate 1-year total knee arthroplasty (TKA) outcomes among preoperative stiff knees, range of motion (ROM) 80° or less, compared with nonstiff preoperative knees, ROM 100° or greater. A total of 134 stiff knee cases were compared with a matched cohort of 134 non-stiff knee controls. Knee Society Score and Oxford Knee Score change scores from baseline to 1 year were similar between the groups. Stiff knees experienced a significantly greater mean improvement in ROM from baseline to 1 year (30.8° ± 18.8°) as compared with nonstiff knees (1.1° ± 12.8°) (P < .0001). Although ultimate ROM of a TKA can be restricted secondary to preoperative stiffness, improvements in outcomes and ROM are not affected. We conclude that progression of stiffness should not in and of itself lead to earlier intervention of TKA in most cases.

0 Followers
 · 
74 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: Preoperative range of motion (ROM) has been regarded as one of the most important factors in predicting postoperative ROM following total knee arthroplasty (TKA). Mobile-bearing TKA designs have been suggested to possibly improve the knee kinematics compared to fixed-bearing designs. The purpose of this study was to examine the difference in postoperative flexion as a function of preoperative flexion in a consecutive series of TKAs done using a posterior-stabilized rotating-platform prosthesis. METHODS: ROM was assessed in 153 consecutive TKAs done using a rotating-platform posterior cruciate-substituting design. Patients were divided into two groups based on their preoperative ROM (Group 1 < 95°, Group 2 > 95°). The Knee Society Score (KSS) and ROM were assessed preoperatively, 3 months and 12 months postoperatively. RESULTS: There was no difference in flexion 12 months after surgery between groups (mean 120° and 123°, respectively. n.s.). After 3 month follow-up, no increase in ROM was experienced by either group. Patients in Group 1 experienced significantly greater increases in both ROM (p < 0.001) and KSS (p < 0.05). There was no difference in the KSS at 12 months after surgery between groups. CONCLUSION: In this series of patients undergoing TKA with a rotating-platform prosthesis, the preoperative ROM was not predictive of the postoperative ROM. Patients with stiff knees preoperatively may benefit from a mobile-bearing design prosthesis. LEVEL OF EVIDENCE: Case-control study, Level III.
    Knee Surgery Sports Traumatology Arthroscopy 01/2013; 22(7). DOI:10.1007/s00167-013-2378-2 · 2.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to analyse the results of total knee arthroplasty (TKA) in stiff knees (flexion ≤90° and/or flexion contracture ≥20°). Our hypothesis was that despite having poorer results than those obtained in a "standard" population and a high rate of complications, TKA was a satisfactory treatment in patients with osteoarthritis of the knee associated with significant stiffness. Three hundred and four consecutive primary HLS TKAs (Tornier), whose data were prospectively collected between October 1987 and October 2012, were retrospectively analysed at a mean of 60 months (range, 12-239) postoperatively. Two groups, those with a "flexion contracture" and those with a "flexion deficit", were assessed for postoperative range of motion (as integrated to the Knee Society score [KSS]), physical activity level and patient satisfaction. At the latest follow-up, range of motion was significantly improved, as was the KSS. Ninety-four percent of patients were satisfied or very satisfied, and activity levels were increased after surgery. The complication rate, however, was high in patients with a preoperative flexion deficit (17 %). Pain and residual stiffness were the most common complications. TKA provides satisfactory results in patients with knee osteoarthritis associated with significant pre-operative stiffness. The surgical plan should be adapted to anticipate complications, which are particularly frequent in the presence of a flexion deficit.
    International Orthopaedics 12/2013; DOI:10.1007/s00264-013-2252-3 · 2.02 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to determine the frequency and cause of failure after total knee arthroplasty and compare the results with those reported by our similar investigation conducted 10years ago. A total of 781 revision TKAs performed at our institution over the past 10years were identified. The most common failure mechanisms were: loosening (39.9%), infection (27.4%), instability (7.5%), periprosthetic fracture (4.7%), and arthrofibrosis (4.5%). Infection was the most common failure mechanism for early revision (<2years from primary) and aseptic loosening was the most common reason for late revision. Polyethylene (PE) wear was no longer the major cause of failure. Compared to our previous report, the percentage of revisions performed for polyethylene wear, instability, arthrofibrosis, malalignment and extensor mechanism deficiency has decreased.
    The Journal of Arthroplasty 07/2014; 29(9). DOI:10.1016/j.arth.2013.07.024 · 2.37 Impact Factor