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Prevention and treatment of stiffness following total knee arthroplasty

Beaver, Walter B Jr; Fehring, Thomas K

Current Opinion in Orthopaedics: January 2008 - Volume 19 - Issue 1 - p 72–74
doi: 10.1097/BCO.0b013e3282f2ccda
Knee reconstruction: Edited by Robert S. Sterling

Purpose of review: Stiffness following total knee arthroplasty is a complication and a concern of both patient and surgeon. This review will focus on the salient literature concerning stiffness following total knee arthroplasty over the last 3 years.

Recent findings: The prevalence of stiffness following total knee arthroplasty ranges from 1 to 6% in recent studies. In one study, statistically significant risk factors associated with stiffness following total knee replacement included poor preoperative range of motion, poor intraoperative range of motion, and patella infera. Another study noted a higher prevalence of stiffness in patients on coumadin versus low molecular weight heparin. Treating this problem remains difficult. Range of motion rarely improves more than 6 months postoperatively without intervention. Early manipulation is usually effective. Only modest improvement in pain, range of motion and function can be expected, however, through formal revision arthroplasty for lack of flexion. In contrast, revision for a significant flexion contracture (greater than 15°) is usually effective.

Summary: The best way to treat the stiff total knee arthroplasty is through avoidance. Through proper patient motivation with physical therapy and careful surgical technique, careful ligamentous balancing, flexion and extension gap equalization and maintenance of posterior condylar offset should minimize the prevalence of this complication should be minimized.

OrthoCarolina, Charlotte, North Carolina, USA

Correspondence to Walter B. Beaver, 1915 Randolph Road, Charlotte, NC 28207, USA Tel: +704 339 1506; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.