MANAGING STIFFNESS AFTER TOTAL KNEE ARTHROPLASTY: SURGICAL STRATEGIES AND RESULTS

Introduction Knee stiffness is a common complication following total knee arthroplasty (TKA). Several surgical options are available to address this issue, including manipulation under anesthesia (MUA), arthrolysis and TKA revision. This study aimed to assess the functional outcomes following surgeries for stiffness after TKA. Material This retrospective study, conducted in collaboration with 13 French centers, included all patients who underwent surgery for stiffness following primary TKA. A total of 490 patients were included in the study (344 MUA, 85 arthroscopic arthrolysis, 12 open arthrolysis, 49 TKA revisions). The mean delay between TKA and stiffness surgery was 8 months ±15. The mean follow-up was 5.5±2.5 years Results Five years after MUA, ROM improved by 33.0° (p<0.001). At the final follow-up, the OKS was 35.4 ± 9.6. A high satisfaction rate was recorded (77.5%). The overall complication rate following MUA was 4.7% (n=16). Five years after arthroscopic arthrolysis, the ROM improved by 22.5° (p<0.001). At the final follow-up, the OKS was 28.7 ± 10.2. The satisfaction rate was 60%. The global complication rate after arthroscopic arthrolysis was 6% (n=5). Five years after open arthrolysis, the ROM improved by 23° (ns). At the final follow-up, the OKS was 23.0 ± 10. The satisfaction rate was 9%. There were no complications after open arthrolysis. Five years after TKA revision, the ROM improved by 12° (p<0.05). At the final follow-up, the OKS was 24.0 ± 10. The satisfaction rate was 46%. The overall complication rate following TKA revision was 18.4% (n=9). Conclusion Substantial improvement in ROM was observed throughout the five-year follow-up period after MUA and arthroscopic arthrolysis, with low complication rates and high patient satisfaction. Open arthrolysis was not an efficient strategy. TKA revision surgery is a salvage procedure involving a risk of complications and recurrence of stiffness.