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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2016

01-10-2016 | Knee

Moderate clinical improvement after revision arthroplasty of the severely stiff knee

Authors: P. J. C. Heesterbeek, J. H. M. Goosen, J. J. P. Schimmel, K. C. Defoort, G. G. van Hellemondt, A. B. Wymenga

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2016

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Abstract

Purpose

Revision of the severe stiff total knee arthroplasty (TKA) is challenging, and clinical outcome is inferior to other indications for revision. The purpose of the present study was to determine clinical outcome of TKA revision in patients with severe stiffness (range of motion (ROM) ≤ 70°) and evaluate a possible influence of accompanying findings, such as component malposition, aseptic loosening or instability.

Methods

A prospective cohort of 40 patients with a preoperative ROM ≤ 70° and a minimum of 2-year follow-up after total system revision (Genesis or Legion stemmed condylar implant) was evaluated. ROM, Knee Society Scoring System (KSS) and visual analogue scale (VAS) pain scores were obtained preoperatively and at 2 years. Patient satisfaction and complication rate were assessed. Component malposition was most frequently reported as accompanying finding (n = 27). Comparisons between pre- and postoperative outcome (p < 0.05) and between different subgroups (component malposition, aseptic loosening, and instability) based on accompanying findings were made (no statistical comparison).

Results

ROM, KSS and VAS pain scores improved significantly (p < 0.001): median ROM at two years 85° (range 10–125) and median gain 25° (range −10 to +85). Median VAS satisfaction was 53.5 points (range 15–98). Seventeen patients reported at least one complication, including one re-revision. Six patients underwent manipulation under anaesthesia, and five were referred to the pain clinic. No clear differences between subgroups were observed.

Conclusions

TKA revision in patients with severe stiffness resulted in a moderate but significant improved clinical outcome after 2 years. Accompanying abnormalities such as component malposition, aseptic loosening or instability did not influence clinical outcome. Realistic patient counselling on the moderate outcome and possible remaining limitations in daily life might help to improve patient satisfaction.

Level of evidence

Therapeutic studies—case series with no comparison group, Level IV.
Literature
1.
Baker P, Cowling P, Kurtz S, Jameson S, Gregg P, Deehan D (2012) Reason for revision influences early patient outcomes after aseptic knee revision. Clin Orthop Relat Res 470:2244–2252CrossRefPubMedPubMedCentral
2.
Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L (2001) Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res 392:46–55CrossRefPubMed
3.
Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS (1993) Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 286:40–47PubMed
4.
Bong MR, Di Cesare PE (2004) Stiffness after total knee arthroplasty. J Am Acad Orthop Surg 12:164–171CrossRefPubMed
5.
Christensen CP, Crawford JJ, Olin MD, Vail TP (2002) Revision of the stiff total knee arthroplasty. J Arthroplasty 17:409–415CrossRefPubMed
6.
Freeman TA, Parvizi J, Dela Valle CJ, Steinbeck MJ (2010) Mast cells and hypoxia drive tissue metaplasia and heterotopic ossification in idiopathic arthrofibrosis after total knee arthroplasty. Fibrogenes Tissue Repair 3:17CrossRef
7.
Ghani H, Maffulli N, Khanduja V (2012) Management of stiffness following total knee arthroplasty: a systematic review. Knee 19:751–759CrossRefPubMed
8.
Gonzalez DV, Leali A, Haas S (2007) Etiology and surgical interventions for stiff total knee replacements. HSS J 3:182–189CrossRef
9.
Haidukewych GJ, Jacofsky DJ, Pagnano MW, Trousdale RT (2005) Functional results after revision of well-fixed components for stiffness after primary total knee arthroplasty. J Arthroplasty 20:133–138CrossRefPubMed
10.
Hartman CW, Ting NT, Moric M, Berger RA, Rosenberg AG, Della Valle CJ (2010) Revision total knee arthroplasty for stiffness. J Arthroplasty 25:62–66CrossRefPubMed
11.
Harvey IA, Barry K, Kirby SP, Johnson R, Elloy MA (1993) Factors affecting the range of movement of total knee arthroplasty. J Bone Joint Surg Br 75:950–955PubMed
12.
Heesterbeek PJ, Verdonschot N, Wymenga AB (2008) In vivo knee laxity in flexion and extension: a radiographic study in 30 older healthy subjects. Knee 15:45–49CrossRefPubMed
13.
Hofmann S, Romero J, Roth-Schiffl E, Albrecht T (2003) Rotational malalignment of the components may cause chronic pain or early failure in total knee arthroplasty. Orthopade 32:469–476PubMed
14.
Keeney JA, Clohisy JC, Curry M, Maloney WJ (2005) Revision total knee arthroplasty for restricted motion. Clin Orthop Relat Res 440:135–140CrossRefPubMed
15.
Kim GK, Mortazavi SM, Parvizi J, Purtill JJ (2012) Revision for stiffness following TKA: a predictable procedure? Knee 19:332–334CrossRefPubMed
16.
Kim J, Nelson CL, Lotke PA (2004) Stiffness after total knee arthroplasty Prevalence of the complication and outcomes of revision. J Bone Joint Surg Am 86-A:1479–1484PubMed
17.
Nagamine R, White SE, McCarthy DS, Whiteside LA (1995) Effect of rotational malposition of the femoral component on knee stability kinematics after total knee arthroplasty. J Arthroplasty 10:265–270CrossRefPubMed
18.
Nicholls DW, Dorr LD (1990) Revision surgery for stiff total knee arthroplasty. J Arthroplasty 5(Suppl):S73–S77CrossRefPubMed
19.
Nicoll D, Rowley DI (2010) Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Joint Surg Br 92:1238–1244CrossRefPubMed
20.
21.
Patil N, Lee K, Huddleston JI, Harris AH, Goodman SB (2010) Aseptic versus septic revision total knee arthroplasty: patient satisfaction, outcome and quality of life improvement. Knee 17:200–203CrossRefPubMed
22.
Ries MD, Badalamente M (2000) Arthrofibrosis after total knee arthroplasty. Clin Orthop Relat Res 380:177–183CrossRefPubMed
23.
Ritter MA, Stringer EA (1979) Predictive range of motion after total knee replacement. Clin Orthop Relat Res 143:115–119PubMed
24.
Romero J, Stahelin T, Binkert C, Pfirrmann C, Hodler J, Kessler O (2007) The clinical consequences of flexion gap asymmetry in total knee arthroplasty. J Arthroplasty 22:235–240CrossRefPubMed
25.
Scuderi GR (2005) The stiff total knee arthroplasty: causality and solution. J Arthroplasty 20:23–26CrossRefPubMed
26.
van Kempen RW, Schimmel JJ, van Hellemondt GG, Vandenneucker H, Wymenga AB (2013) Reason for revision TKA predicts clinical outcome: prospective evaluation of 150 consecutive patients with 2-years followup. Clin Orthop Relat Res 471:2296–2302CrossRefPubMedPubMedCentral
27.
Victor J, Van DD, Labey L, Van GF, Parizel P, Bellemans J (2009) A common reference frame for describing rotation of the distal femur: a ct-based kinematic study using cadavers. J Bone Joint Surg Br 91:683–690CrossRefPubMed
28.
Yercan HS, Sugun TS, Bussiere C, Ait Si ST, Davies A, Neyret P (2006) Stiffness after total knee arthroplasty: prevalence, management and outcomes. Knee 13:111–117CrossRefPubMed
Metadata
Title
Moderate clinical improvement after revision arthroplasty of the severely stiff knee
Authors
P. J. C. Heesterbeek
J. H. M. Goosen
J. J. P. Schimmel
K. C. Defoort
G. G. van Hellemondt
A. B. Wymenga
Publication date
01-10-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3712-7

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