Does the severity or cause of preoperative stiffness affect the clinical results and range of motion after total knee arthroplasty?

• Published in: PloS one Vol. 13; no. 10; p. e0205168
• Main Authors: Lee, Seung Ah, Kang, Seung-Baik, Chang, Chong Bum, Chang, Moon Jong, Kim, Young Jun, Song, Min Kyu, Jeong, Jin Hwa
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 11.10.2018; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Aged, 80 and over; Arthritis; Arthritis - etiology; Arthritis - surgery; Arthroplasty (knee); Arthroplasty, Replacement, Knee; Biocompatibility; Biology and Life Sciences; Biomedical materials; Clinical outcomes; Complications; Engineering and Technology; Female; Follow-Up Studies; Humans; Infections; Infectious diseases; Joint surgery; Knee; Knee Joint; Knee Prosthesis; Male; Medicine; Medicine and Health Sciences; Middle Aged; Osteoarthritis; Patients; Physical Sciences; Postoperative Complications; Preoperative Period; Prostheses; Prosthetics; Range of Motion, Articular; Retrospective Studies; Rheumatoid arthritis; Severity of Illness Index; Stiffness; Surgery; Surgical implants; Treatment Outcome; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0205168

The purpose of this study was to assess the overall clinical results and range of motion (ROM) after total knee arthroplasty (TKA) in patients with preoperative stiffness. We also aimed to determine whether the severity or cause of the stiffness can affect the clinical outcome after surgery. This retrospective study included 122 knees (117 patients) with follow-up of more than 2 years (mean age, 64.3 years). TKA was performed using posterior-stabilized, varus-valgus constrained (VVC), and hinged prostheses. To determine the effect of the severity of stiffness on the clinical outcome, the subjects were divided into two groups: the severe group (preoperative ROM ≤ 50°; 18 knees) and the moderate group (preoperative ROM, 50°-90°; 104 knees). Then, clinical results and ROM were compared according to the severity or cause of preoperative stiffness. After surgery, preoperative ROM (mean, 78°; range, 25°- 90°) was improved (mean, 107°; range, 70°- 130°). The severe group more frequently used the VVC or hinged prostheses (72% vs. 18%). Furthermore, the severe group had worse knee and function scores as well as more complications (33% vs. 13%), even though the severe group had a greater ROM increment (47° vs. 27°) after surgery. Patients with osteoarthritis and rheumatoid arthritis showed better ROM and clinical results compared to patients with infectious or traumatic arthritis. Although TKA in stiff knees can be successful, the results are inferior in knees with severe stiffness and knees with infectious or traumatic arthritis.