Skip to main content

The Stiff Knee

  • Chapter
  • First Online:
Complex Cases in Total Knee Arthroplasty

Abstract

It is not uncommon for patients to describe a stiff knee in the immediate postoperative period. While they believe their knee is “stiff,” often these stiff knees have ROM of greater than 120° flexion. For the sake of discussion, this discussion will focus on knees with less than 90° of flexion in the immediate postoperative period. Lotke et al. were a bit more restrictive in their definition of stiffness. They considered a knee stiff if there was greater than a15° flexion contracture and less than 75° of motion. With this definition, an overall incidence in over 1000 consecutive knees was 1.3%. As expected limited preoperative ROM was more likely to have postoperative limitations in this series.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 179.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 229.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 239.00
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bédard M, Vince KG, Redfern J, Collen SR. Internal rotation of the tibial component is frequent in stiff total knee arthroplasty. Clin Orthop Relat Res. 2011;469(8):2346–55.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kettelkamp D. Gait characteristics of the knee: normal, abnormal, and postreconstruction. In: American Academy of Orthopaedic Surgeons symposium on reconstructive surgery of the knee. St. Louis: CV Mosby; 1978. p. 47–57.

    Google Scholar 

  3. Laubenthal KN, Smidt GL, Kettelkamp DB. A quantitative analysis of knee motion during activities of daily living. Phys Ther. 1972;52(1):34–43.

    Article  CAS  PubMed  Google Scholar 

  4. 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):1479–84.

    Article  PubMed  Google Scholar 

  5. Scranton PE Jr. Management of knee pain and stiffness after total knee arthroplasty. J Arthroplasty. 2001;16(4):428–35.

    Article  PubMed  Google Scholar 

  6. Daluga D, Lombardi AV Jr, Mallory TH, Vaughn BK. Knee manipulation following total knee arthroplasty: analysis of prognostic variables. J Arthroplasty. 1991;6(2):119–28.

    Article  CAS  PubMed  Google Scholar 

  7. Mauerhan DR, Mokris JG, Ly A, Kiebzak GM. Relationship between length of stay and manipulation rate after total knee arthroplasty. J Arthroplasty. 1998;13(8):896–900.

    Article  CAS  PubMed  Google Scholar 

  8. Goudie ST, Deakin AH, Ahmad A, Maheshwari R, Picard F. Flexion contracture following primary total knee arthroplasty: risk factors and outcomes. Orthopedics. 2011;34(12):e855–9.

    PubMed  Google Scholar 

  9. Ritter MA, Stringer EA. Predictive range of motion after total knee replacement. Clin Orthop. 1979;(143):115–9.

    Google Scholar 

  10. Babis GC, Trousdale RT, Pagnano MW, Morrey BF. Poor outcomes of isolated tibial inset exchange and arthrolysis for the management of stiffness following total knee arthroplasty. J Bone Joint Surg Am. 2001;83-A(10):1534–6.

    Article  CAS  PubMed  Google Scholar 

  11. Wislon SE, Munro ML, Sandwell JC, Ezzett KA, Colwell CW. Isolated tibial polyethylene insert exchange outcomes after total knee arthroplasty. Clin Orthop Relat Res. 2010;468(1):96–101.

    Article  Google Scholar 

  12. Ghani H, Maffulli N, Khandua V. Management of stiffness following total knee arthroplasty: a systematic review. Knee. 2012;19(6):751–9.

    Article  CAS  PubMed  Google Scholar 

  13. Donaldson JR, Tudor F, Gollish J. Revision surgery for the stiff total knee arthroplasty. Bone Joint J. 2016;98-B(5):622–7.

    Article  CAS  PubMed  Google Scholar 

  14. Keeney JA, Clohisy JC, Curry M, Maloney WJ. Revision total knee arthroplasty for restricted motion. Clin Orthop Relat Res. 2005;440:135–40.

    Article  PubMed  Google Scholar 

  15. Heesterbeek PJ, Goosen JH, Schimmel JJ, Defoort KC, van Hellemondt GG, Wymenga AB. Moderate clinical improvement after revision arthroplasty of the severely stiff knee. Knee Surg Sports Traumatol Arthrosc. 2016;24(10):3235–41.

    Article  CAS  PubMed  Google Scholar 

  16. Kim GK, Mortazavi SM, Parvizi J, Purtill JJ. Revision for stiffness following TKA: a predictable procedure? Knee. 2012;19(4):332–4.

    Article  PubMed  Google Scholar 

  17. Hartman CW, Ting NT, Berger RA, Rosenberg AG, Della Valle CJ. Revision total knee arthroplasty for stiffness. J Arthoplasty. 2010;25(Suppl 6):62–6.

    Article  Google Scholar 

  18. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011;4699(11):2992–4.

    Article  Google Scholar 

  19. Le DH, Goodman SB, Maloney WJ, Huddleston JJ. Current modes of failure in TKA: infection, instability, and stiffness predominate. Clin Orthop Relat Res. 2014;472(7):2197–200.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Nicholls DW, Dorr LD. Revision surgery for stiff total knee arthroplasty. J Arthroplasty. 1990;5(Suppl):S73–7.

    Article  PubMed  Google Scholar 

  21. Haidukewych GJ, Jacofsky DJ, Pagnano MW, Trousdale RT. Functional results after revision of well-fixed components for stiffness after total knee arthroplasty. J Arthroplasty. 2005;20:133–8.

    Article  PubMed  Google Scholar 

  22. Hartman CW, Ting NT, Moric M, Berger RA, Rosenberg AG, Della Valle CJ. Revision total knee arthroplasty for stiffness. J Arthroplasty. 2010;25z(6 Suppl):62–6.

    Article  Google Scholar 

  23. Christensen CP, Crawford JJ, Olin MD, Vail TP. Revision of the stiff total knee arthroplasty. J Arthroplasty. 2002;17(4):409–15.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David A. Crawford MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Cushner, F.D., Crawford, D.A., Berend, K.R., Petis, S., Trousdale, R. (2018). The Stiff Knee. In: Tria, A., Scuderi, G., Cushner, F. (eds) Complex Cases in Total Knee Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-69380-4_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-69380-4_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-69379-8

  • Online ISBN: 978-3-319-69380-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics