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Patient selection, planning can help avoid stiff knees after total knee replacement

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ORLANDO, Fla. — Despite its reduced incidence after total knee replacement, orthopedists should still prepare themselves and their patients for knee stiffness as a possible postoperative outcome.

“About one in 100 patients who undergo total knee replacement (TKR) will need a revision TKR for stiffness,” Edwin P. Su, MD, said during his presentation at the 26th Annual Current Concepts in Joint Replacement Winter Meeting, here.

The condition is multifactorial and affected by intraoperative or component-related issues, rehabilitation, pain control or patient motivation. Therefore, the stiff knee, which was been defined as a knee with less than 95· of flexion and a 10· flexion contracture, can be hard to prevent and resolve, Su explained.

“Our management of this problem must begin with the management of patient expectation,” he said. “We must strive to prevent it by careful patient selection [and] preoperative planning.”

Inform patients

To improve patient expectations, Su said that surgeons should tell patients that their postoperative motion is likely to be similar to their preoperative motion. For patients who do develop post-TKR knee stiffness, surgeons should discuss the expected estimated increase in range of motion prior to performing an intervention such as manipulation.

“Most patients gain about 10° to 15° from your intervention, but flexible patients may actually lose the motion,” Su said.

He performs manipulation under anesthesia at 6 weeks to 3 months postoperatively for patients who lack functional range of motion or stop showing progress with physical therapy.

“This will resolve about 80% of the problems,” Su noted.

If surgery is required, options include full or partial component revision.

“A full revision is the most powerful intervention that we can make to address this,” he said. “It will give you a clean slate to correct the problem.”

• Reference:

Su EP. The knee that won’t straighten: Trying to avoid surgery. Paper #96. Presented at the 26th Annual Current Concepts in Joint Replacement Winter Meeting. Dec. 9-12, 2009. Orlando, Fla.

Su is a consultant to Smith & Nephew Orthopaedics.