Preoperative Knee Stiffness and Total Knee Arthroplasty Outcomes

Article · January 2012with14 Reads
DOI: 10.1016/j.arth.2011.12.015 · Source: PubMed
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.
    • Preoperative knee range of motion, surgical technique, postoperative rehabilitation, and patient specific biologic factors all play a role in stiffness after primary TKA. Most authors agree that limited pre-operative range of motion is the strongest predictor of postoperative stiffness192021. Revision TKA is one method used to treat severe stiffness following primary TKA [22].
    [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.
    Full-text · Article · Jul 2014
  • [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.
    Article · Jan 2013
  • [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.
    Article · Dec 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose The primary aim of this study was to identify the time point at which improvements in knee range of motion reach a plateau, if any. The secondary aim of this study was to investigate the correlation between the improvements in knee range of motion and patient-reported outcomes [Oxford knee score (OKS) and SF-36]. The hypothesis is that there is a time point at which the recovery in the knee range of motion after total knee arthroplasty (TKA) plateaus. Method A prospective study of 145 patients who underwent TKA was conducted. All TKAs were performed by the same surgeon. OKS and SF-36 scores were measured preoperatively and at 6, 12, and 24 months. Range of motion was measured preoperatively and at 1, 3, 6, 12, and 24 months postoperatively. Results This study shows that for surgeon/therapist reported range of motion, a plateau in recovery was reached at 12 months after TKA. It was also found that range of extension is significantly correlated with OKS, whereas range of flexion was not significantly correlated with OKS. Conclusions Knowledge of when patients fully recover after TKA will allow appropriate counseling of patients during preoperative consultation. Also, this knowledge will enable surgeons/therapists to better monitor the rehabilitation progress of TKA patients, and make adjustments to the rehabilitation protocol. In addition, our study shows that objective surgeon-/therapist-measured outcome (range of motion) has a significant correlation with subjective patient-reported outcomes (OKS). Hence, both outcome measures should be employed in the postoperative monitoring of patient progress. Level of evidence Prospective case series, Level IV.
    Article · Sep 2014
  • [Show abstract] [Hide abstract] ABSTRACT: The postoperative flexion angle reportedly shows a positive correlation with the preoperative flexion angle, but in some cases, the postoperative flexion angle decreases in patients with a large preoperative flexion angle. The purpose of this study was to investigate factors affecting the range of motion after total knee arthroplasty (TKA) in patients with a large preoperative flexion angle. The study evaluated 120 knees with more than 120 degrees of preoperative flexion angle that underwent NexGen LPS-Flex mobile bearing. The groups with and without a reduction in the postoperative flexion angle were compared. Also, a logistic regression analysis was performed, where the presence or absence of a reduction in the postoperative flexion angle was the dependent variable and age, sex, body mass index (BMI), preoperative femorotibial angle (FTA), γ angle, δ angle, pre/postoperative change amount in posterior condylar offset (PCO), pre/postoperative change amount in joint line, and pre/postoperative change amount in patellar thickness were independent variables. Those with preoperative FTA of 186° or larger did not have a reduction in the postoperative flexion angle, compared with the angle of 185° or smaller. Those with δ angle of 83° or smaller also did not have a reduction in the postoperative flexion angle, compared with the angle of 84° or larger. Our results showed that preoperative FTA and δ angle had an impact on a reduction in the postoperative flexion angle. The installation angle of the tibial component in the sagittal plane is important.
    Article · Feb 2015
  • [Show abstract] [Hide abstract] ABSTRACT: Advanced haemophilic arthropathy of the knee is associated with progressive joint stiffness. Results after total knee arthroplasty (TKA) in stiff knees are considered to be inferior compared to those with less restricted preoperative range of motion (ROM). There is only very limited data on the results of primary TKA in haemophilic patients with stiff knees. The purpose of this retrospective study was to evaluate the clinical outcome after TKA performed in haemophilic patients with preoperative ROM of 50° or less. Twenty one patients (23 knees) undergoing TKA with stiff knees were retrospectively evaluated. Mean follow-up was 8.3 years (range, 2-25). Clinical assessment included ROM, degree of flexion contracture and complication rate. Functional evaluation and pain status were assessed using the Knee Society's Scoring System (KSS). Range of motion improved from 26.7° preoperatively to 73.0° postoperatively. Flexion contracture decreased from 21.7° to 8.3°. KSS increased from 22.9 to 72.9 points. Evaluation of pain revealed a decrease from 8.4 points preoperatively to 2.1 points postoperatively. All these differences were statistically significant (P < 0.005). The complication rate was 8.7% including one late periprosthetic infection, and one aseptic implant loosening. Nine patients who required VY-quadricepsplasty for knee exposure developed a mean postoperative extensor lag of 7°. Total knee arthroplasty in haemophilic patients presenting with stiff knees results in significant improvement of function and reduction in pain. Although the clinical outcome is inferior compared to nonstiff knees reported in the literature, joint replacement surgery can be successfully performed in this particular group of patients. © 2015 John Wiley & Sons Ltd.
    Article · Apr 2015
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