Open arthrolysis for stiff knee after primary total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIANG Qihong , HU Yihe , ZENG Min ,  XIE Jie

Department of Orthopaedics, Xiangya Hospital of Central South University, Changsha Hunan, 410008, P.R.China;

Corresponding author：

XIE Jie, Email: xszm268@163.com

Keywords：

Total knee arthroplasty; stiff knee; arthrolysis; complication

DOI：

10.7507/1002-1892.201808092

Video：

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Objective To evaluate the effectiveness of open arthrolysis in treatment of the patient with stiff knee in late stage after primary total knee arthroplasty (TKA).Methods Between January 2014 and October 2017, 7 female patients (7 knees) with stiff knee in late stage after primary TKA were admitted. The patients were 57-71 years old (mean, 63 years). There were 2 left knees and 5 right knees. All patients underwent TKA because of knee osteoarthritis. The interval between TKA and open arthrolysis was 8-30 months (mean, 13.6 months). There were 4 patients with 10-20° of extension deficit before arthrolysis. The range of motion of knee was (54.3±12.1)°. The clinical score, functional score, and total score of Knee Society Score (KSS) before arthrolysis were 76.3±7.6, 67.9±11.1, and 144.1±16.1, respectively. During the arthrolysis, periarticular soft tissue scar was removed, the range of motion of knee was restored, the gap balance and well patellar tracking were maintained. Intensive rehabilitation after operation was supplemented.Results All wounds healed by first intention, without early stage complications. All patients were followed up 12-32 months with an average of 20.1 months. No abnormality of prosthesis was found by post-operative X-ray films. The knee movement improved significantly when compared with that before arthrolysis. The range of motion was less than 90° in 1 patient and 10° of extension deficit remained in 1 patient after operation. The range of motion was (92.9±4.9)° at last follow-up. The clinical score, functional score, and total score of KSS were 81.9±5.1, 74.3±9.8, and 156.1±13.7, respectively at last follow-up. The above indexes were superior to those before operation (P<0.05).Conclusion Open arthrolysis combined with intensive rehabilitation is a significant way to improve knee function for the patient with stiff knee in late stage after primary TKA.

Citation： JIANG Qihong, HU Yihe, ZENG Min, XIE Jie. Open arthrolysis for stiff knee after primary total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(3): 307-311. doi: 10.7507/1002-1892.201808092 Copy

1.	Cheuy VA, Foran JRH, Paxton RJ, et al. Arthrofibrosis associated with total knee arthroplasty. J Arthroplasty, 2017, 32(8): 2604-2611.
2.	Kornuijt A, Das D, Sijbesma T, et al. Manipulation under anesthesia following total knee arthroplasty: a comprehensive review of literature. Musculoskelet Surg, 2018, 102(3): 223-230.
3.	Vanlommel L, Luyckx T, Vercruysse G, et al. Predictors of outcome after manipulation under anaesthesia in patients with a stiff total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2017, 25(11): 3637-3643.
4.	Cohen JS, Gu A, Lopez NS, et al. Efficacy of revision surgery for the treatment of stiffness after total knee arthroplasty: A systematic review. J Arthroplasty, 2018, 33(9): 3049-3055.
5.	Hug KT, Amanatullah DF, Huddleston JI, et al. Protocol-driven revision for stiffness after total knee arthroplasty improves motion and clinical outcomes. J Arthroplasty, 2018, 33(9): 2952-2955.
6.	Moya-Angeler J, Bas MA, Cooper HJ, et al. Revision arthroplasty for the management of stiffness after primary TKA. J Arthroplasty, 2017, 32(6): 1935-1939.
7.	Bodendorfer BM, Kotler JA, Zelenty WD, et al. Outcomes and predictors of success for arthroscopic lysis of adhesions for the stiff total knee arthroplasty. Orthopedics, 2017, 40(6): e1062-e1068.
8.	Fitzsimmons SE, Vazquez EA, Bronson MJ. How to treat the stiff total knee arthroplasty?: a systematic review. Clin Orthop Relat Res, 2010, 468(4): 1096-1106.
9.	Manrique J, Gomez MM, Parvizi J. Stiffness after total knee arthroplasty. J Knee Surg, 2015, 28(2): 119-126.
10.	Kim J, Nelson CL, Lotke PA. Stiffness after total knee arthroplasty. Prevalence of the complication and outcomes of revision. J Bone Joint Surg (Am), 2004, 86-A(7): 1479-1484.
11.	Yercan HS, Sugun TS, Bussiere C, et al. Stiffness after total knee arthroplasty: prevalence, management and outcomes. Knee, 2006, 13(2): 111-117.
12.	Scranton PE Jr. Management of knee pain and stiffness after total knee arthroplasty. J Arthroplasty, 2001, 16(4): 428-435.
13.	Donaldson JR, Tudor F, Gollish J. Revision surgery for the stiff total knee arthroplasty. Bone Joint J, 2016, 98-B(5): 622-627.
14.	Heesterbeek PJ, Goosen JH, Schimmel JJ, et al. Moderate clinical improvement after revision arthroplasty of the severely stiff knee. Knee Surg Sports Traumatol Arthrosc, 2016, 24(10): 3235-3241.
15.	Mont MA, Seyler TM, Marulanda GA, et al. Surgical treatment and customized rehabilitation for stiff knee arthroplasties. Clin Orthop Relat Res, 2006, (446): 193-200.
16.	Hutchinson JR, Parish EN, Cross MJ. Results of open arthrolysis for the treatment of stiffness after total knee replacement. J Bone Joint Surg (Br), 2005, 87(10): 1357-1360.
17.	Kalson NS, Borthwick LA, Mann DA, et al. International consensus on the definition and classification of fibrosis of the knee joint. Bone Joint J, 2016, 98-B(11): 1479-1488.
18.	Vun SH, Shields DW, Sen A, et al. A national questionnaire survey on knee manipulation following total knee arthroplasty. J Orthop, 2015, 12(4): 193-196.
19.	侯晓玲, 罗泽宇, 王浩洋, 等. 收肌管阻滞麻醉联合局部浸润麻醉镇痛对初次人工全膝关节置换术后康复的影响. 中国修复重建外科杂志, 2018, 32(8): 1006-1011.
20.	Kumar L, Kumar AH, Grant SA, et al. Updates in enhanced recovery pathways for total knee arthroplasty. Anesthesiol Clin, 2018, 36(3): 375-386.
21.	Stevens-Lapsley JE, Balter JE, Wolfe P, et al. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Phys Ther, 2012, 92(2): 210-226.

1. Cheuy VA, Foran JRH, Paxton RJ, et al. Arthrofibrosis associated with total knee arthroplasty. J Arthroplasty, 2017, 32(8): 2604-2611.
2. Kornuijt A, Das D, Sijbesma T, et al. Manipulation under anesthesia following total knee arthroplasty: a comprehensive review of literature. Musculoskelet Surg, 2018, 102(3): 223-230.
3. Vanlommel L, Luyckx T, Vercruysse G, et al. Predictors of outcome after manipulation under anaesthesia in patients with a stiff total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2017, 25(11): 3637-3643.
4. Cohen JS, Gu A, Lopez NS, et al. Efficacy of revision surgery for the treatment of stiffness after total knee arthroplasty: A systematic review. J Arthroplasty, 2018, 33(9): 3049-3055.
5. Hug KT, Amanatullah DF, Huddleston JI, et al. Protocol-driven revision for stiffness after total knee arthroplasty improves motion and clinical outcomes. J Arthroplasty, 2018, 33(9): 2952-2955.
6. Moya-Angeler J, Bas MA, Cooper HJ, et al. Revision arthroplasty for the management of stiffness after primary TKA. J Arthroplasty, 2017, 32(6): 1935-1939.
7. Bodendorfer BM, Kotler JA, Zelenty WD, et al. Outcomes and predictors of success for arthroscopic lysis of adhesions for the stiff total knee arthroplasty. Orthopedics, 2017, 40(6): e1062-e1068.
8. Fitzsimmons SE, Vazquez EA, Bronson MJ. How to treat the stiff total knee arthroplasty?: a systematic review. Clin Orthop Relat Res, 2010, 468(4): 1096-1106.
9. Manrique J, Gomez MM, Parvizi J. Stiffness after total knee arthroplasty. J Knee Surg, 2015, 28(2): 119-126.
10. Kim J, Nelson CL, Lotke PA. Stiffness after total knee arthroplasty. Prevalence of the complication and outcomes of revision. J Bone Joint Surg (Am), 2004, 86-A(7): 1479-1484.
11. Yercan HS, Sugun TS, Bussiere C, et al. Stiffness after total knee arthroplasty: prevalence, management and outcomes. Knee, 2006, 13(2): 111-117.
12. Scranton PE Jr. Management of knee pain and stiffness after total knee arthroplasty. J Arthroplasty, 2001, 16(4): 428-435.
13. Donaldson JR, Tudor F, Gollish J. Revision surgery for the stiff total knee arthroplasty. Bone Joint J, 2016, 98-B(5): 622-627.
14. Heesterbeek PJ, Goosen JH, Schimmel JJ, et al. Moderate clinical improvement after revision arthroplasty of the severely stiff knee. Knee Surg Sports Traumatol Arthrosc, 2016, 24(10): 3235-3241.
15. Mont MA, Seyler TM, Marulanda GA, et al. Surgical treatment and customized rehabilitation for stiff knee arthroplasties. Clin Orthop Relat Res, 2006, (446): 193-200.
16. Hutchinson JR, Parish EN, Cross MJ. Results of open arthrolysis for the treatment of stiffness after total knee replacement. J Bone Joint Surg (Br), 2005, 87(10): 1357-1360.
17. Kalson NS, Borthwick LA, Mann DA, et al. International consensus on the definition and classification of fibrosis of the knee joint. Bone Joint J, 2016, 98-B(11): 1479-1488.
18. Vun SH, Shields DW, Sen A, et al. A national questionnaire survey on knee manipulation following total knee arthroplasty. J Orthop, 2015, 12(4): 193-196.
19. 侯晓玲, 罗泽宇, 王浩洋, 等. 收肌管阻滞麻醉联合局部浸润麻醉镇痛对初次人工全膝关节置换术后康复的影响. 中国修复重建外科杂志, 2018, 32(8): 1006-1011.
20. Kumar L, Kumar AH, Grant SA, et al. Updates in enhanced recovery pathways for total knee arthroplasty. Anesthesiol Clin, 2018, 36(3): 375-386.
21. Stevens-Lapsley JE, Balter JE, Wolfe P, et al. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Phys Ther, 2012, 92(2): 210-226.

Chinese Journal of Reparative and Reconstructive Surgery

Open arthrolysis for stiff knee after primary total knee arthroplasty

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