What can be done about joint stiffness after a total knee replacement (TKR)? When all else fails, the implant can be revised. But does this really solve the problem? That's what researchers at the Florida Orthopedic Institute report on in this study.

Sixteen knees were revised based on patients' complaints of pain and stiffness. Everyone had efforts made to restore motion before revision, including a trial of physical therapy. Some had the joint stretched or manipulated under anesthesia. Several had release of scar tissue by arthroscopic surgery.

In the end, implants in all the knees were changed. The surgeon decided at the time of the operation what to remove and what to use as a replacement. Dense scar tissue was seen in all the patients. Continuous passive motion machines were used after the revision surgery. And everyone had physical therapy.

Data showed two-thirds of the patients were happy with the results. They had less pain, more motion, and greater knee function. The remaining patients had complications or continued stiffness after the revision.

The authors report that even though the patients were satisfied, the results were only "modest" improvements from the surgeon's point of view. Too many patients didn't have a good outcome after the revision. The authors concluded that it may be unrealistic toexpect much improvement after revision of TKR for stiffness.

Reference:

George J. Haidukewych, MD, et al. Functional Results after Revision of Well-Fixed Components for Stiffness after Primary Total Knee Arthroplasty. In The Journal of Arthroplasty. February 2005. Vol. 20. No. 2. Pp. 133-138.'