Monday, March 9, 2009

Patellar problem is the major cause of stiffness after total knee arthroplasty!!!

Yercan HS et al investigated the prevalence of stiffness after total knee arthroplasty, and the results of the treatment options. Yercan HS et al performed 1188 posterior-stabilized total knee arthroplasties between 1987 and 2003.

They found:
1. The prevalence of stiffness was 5.3%, at a mean follow-up 31 months postoperatively. The average age was 71 years (range, 54-88).
2. The patients with painful stiffness were treated by two modalities: manipulation and secondary surgery.
3. In the manipulation group (n:46), the mean range of motion improved from 67 degrees before manipulation to 117 degrees afterward. This improvement was maintained at final follow-up as 114 degrees.
4. There was no significant difference between the motion, immediately after manipulation and at final follow-up. However, motion at final follow-up was better for those manipulated early to those done later (p=0.021).
5. In the secondary surgery group (n:10), the mean gain in motion was 49 degrees at final follow-up and average pain score was found 43.
6. Patellar problems--component loosening and clunk syndromes--were found in 4 patients (40%).

Conclusion:
1. Early manipulation gives better gain of motion than done later and our patients had not lost flexion during follow-up.
2. The patella should always be evaluated in every stiff arthroplasty.
3. The researching surgeons opined, patellar problems are a good prognostic factor for the success of revision surgery.
4. The researching surgeons also opined that open arthrolysis does not correct a limited flexion arc, but it does relieve pain.
5. Arthroscopic release is not reliable for severely stiff knees and we prefer to perform it in less painful and moderately stiff knees within 3 to 6 months after operation.

References:
Yercan HS et al; Knee. 2006 Mar;13(2):111-7. Epub 2006 Feb 20.


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