Stiff Knee After Knee Replacement: What's the Best Treatment Approach?
Some patients who get a total knee replacement (TKR) develop a very stiff knee afterwards. Scar tissue and soft tissue contracture (tightening of the muscles) are often the main cause of the problem. In this study, surgery and intense rehab are used to treat patients with too much scarring, a condition called arthrofibrosis. The results are presented for 18 knees in 17 patients with arthrofibrosis after TKR.
Treatment included removing the scar tissue, a procedure called an arthrotomy. Sometimes the plastic spacer inside the joint was taken out. In others patients, the spacer was left in. Intensive physical therapy followed for six to 12 weeks. A special brace called the Customized Knee Device (CKD) was used to help improve joint motion.
Results were measured by pain, motion, function, and patient satisfaction. Good to excellent results were reported by two-thirds of the patients. Only one patient was unhappy with the final outcome. Despite the intense therapy program, five patients (six knees) had to be manipulated to regain motion. Manipulation was done by the surgeon with the patient under anesthesia.
The authors conclude that patients with arthrofibrosis after TKR often have complex and difficult-to-treat problems with loss of motion. The rehab program after arthrotomy seemed to have good results for many of the patients. Other studies using intense rehab have shown improved results, too. The best combination of rehab activities remains unknown at this time and the subject of future studies.
Michael A. Mont, MD, et al. Surgical Treatment and Customized Rehabilitation for Stiff Knee Arthroplasties. In Clinical Orthopaedics and Related Research. May 2006. No. 446. Pp. 193-200.