Moderate Clinical Improvement After Revision Arthroplasty of the Severely Stiff Knee

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2015 Jul 29

PMID 26215774

Citations 8

Authors

P J C Heesterbeek

J H M Goosen

J J P Schimmel

K C Defoort

G G van Hellemondt

A B Wymenga

Affiliations

Soon will be listed here.

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.

Citing Articles

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Acceptable migration of a fully cemented rotating hinge-type knee revision system measured in 20 patients with model-based RSA with a 2-year follow-up.

van Laarhoven S, Te Molder M, van Hellemondt G, Heesterbeek P Acta Orthop. 2023; 94:185-190.

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Kinematic Alignment of Failed Mechanically Aligned Total Knee Arthroplasty Restored Constitutional Limb Alignment and Improved Clinical Outcomes: A Case Report of 7 Patients.

Sappey-Mariner E, Wu S, Bini S J Pers Med. 2022; 12(11).

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Hot spots and trends in knee revision research since the 21st century: a bibliometric analysis.

Zhai K, Ma W, Huang T Ann Transl Med. 2021; 9(5):388.

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The stiff total knee arthroplasty: causes, treatment modalities and results.

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References

Ritter M, Stringer E . Predictive range of motion after total knee replacement. Clin Orthop Relat Res. 1979; (143):115-9. View

Romero J, Stahelin T, Binkert C, Pfirrmann C, Hodler J, Kessler O . The clinical consequences of flexion gap asymmetry in total knee arthroplasty. J Arthroplasty. 2007; 22(2):235-40. DOI: 10.1016/j.arth.2006.04.024. View

van Kempen R, Schimmel J, van Hellemondt G, Vandenneucker H, Wymenga A . Reason for revision TKA predicts clinical outcome: prospective evaluation of 150 consecutive patients with 2-years followup. Clin Orthop Relat Res. 2013; 471(7):2296-302. PMC: 3676611. DOI: 10.1007/s11999-013-2940-8. View

Hartman C, Ting N, Moric M, Berger R, Rosenberg A, Della Valle C . Revision total knee arthroplasty for stiffness. J Arthroplasty. 2010; 25(6 Suppl):62-6. DOI: 10.1016/j.arth.2010.04.013. View

Nagamine R, White S, McCarthy D, Whiteside L . Effect of rotational malposition of the femoral component on knee stability kinematics after total knee arthroplasty. J Arthroplasty. 1995; 10(3):265-70. DOI: 10.1016/s0883-5403(05)80172-x. View

Heesterbeek P, Verdonschot N, Wymenga A . In vivo knee laxity in flexion and extension: a radiographic study in 30 older healthy subjects. Knee. 2007; 15(1):45-9. DOI: 10.1016/j.knee.2007.09.007. View

Hofmann S, Romero J, Roth-Schiffl E, Albrecht T . [Rotational malalignment of the components may cause chronic pain or early failure in total knee arthroplasty]. Orthopade. 2003; 32(6):469-76. DOI: 10.1007/s00132-003-0503-5. View

Barrack R, Schrader T, Bertot A, Wolfe M, Myers L . Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res. 2001; (392):46-55. DOI: 10.1097/00003086-200111000-00006. View

Ries M, Badalamente M . Arthrofibrosis after total knee arthroplasty. Clin Orthop Relat Res. 2000; (380):177-83. DOI: 10.1097/00003086-200011000-00024. View

10.

Kim G, Mortazavi S, Parvizi J, Purtill J . Revision for stiffness following TKA: a predictable procedure?. Knee. 2011; 19(4):332-4. DOI: 10.1016/j.knee.2011.06.016. View

11.

Patil N, Lee K, Huddleston J, Harris A, Goodman S . Aseptic versus septic revision total knee arthroplasty: patient satisfaction, outcome and quality of life improvement. Knee. 2009; 17(3):200-3. DOI: 10.1016/j.knee.2009.09.001. View

12.

Berger R, Rubash H, Seel M, Thompson W, Crossett L . Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res. 1993; (286):40-7. View

13.

Victor J, Van Doninck D, Labey L, Van Glabbeek F, Parizel P, Bellemans J . A common reference frame for describing rotation of the distal femur: a ct-based kinematic study using cadavers. J Bone Joint Surg Br. 2009; 91(5):683-90. DOI: 10.1302/0301-620X.91B5.21827. View

14.

Nicoll D, Rowley D . Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Joint Surg Br. 2010; 92(9):1238-44. DOI: 10.1302/0301-620X.92B9.23516. View

15.

Kim J, Nelson C, Lotke P . Stiffness after total knee arthroplasty. Prevalence of the complication and outcomes of revision. J Bone Joint Surg Am. 2004; 86(7):1479-84. View

16.

Haidukewych G, Jacofsky D, Pagnano M, Trousdale R . Functional results after revision of well-fixed components for stiffness after primary total knee arthroplasty. J Arthroplasty. 2005; 20(2):133-8. DOI: 10.1016/j.arth.2004.09.057. View

17.

Baker P, Cowling P, Kurtz S, Jameson S, Gregg P, Deehan D . Reason for revision influences early patient outcomes after aseptic knee revision. Clin Orthop Relat Res. 2012; 470(8):2244-52. PMC: 3392406. DOI: 10.1007/s11999-012-2278-7. View

18.

Bong M, Di Cesare P . Stiffness after total knee arthroplasty. J Am Acad Orthop Surg. 2004; 12(3):164-71. DOI: 10.5435/00124635-200405000-00004. View

19.

Keeney J, Clohisy J, Curry M, Maloney W . Revision total knee arthroplasty for restricted motion. Clin Orthop Relat Res. 2005; 440:135-40. DOI: 10.1097/01.blo.0000185312.43955.c8. View

20.

Gonzalez Della Valle A, Leali A, Haas S . Etiology and surgical interventions for stiff total knee replacements. HSS J. 2008; 3(2):182-9. PMC: 2504257. DOI: 10.1007/s11420-007-9053-4. View