title: Revision total knee arthroplasty for restricted motion.
abstract: Persistent stiffness is an infrequent but notable complication occurring after total knee arthroplasty. A limited approach (soft tissue releases and component retention with tibial insert downsizing) has previously been associated with poor results, although comprehensive revision of both components seems more successful. We retrospectively reviewed 23 patients (25 knees) who had revision total knee arthroplasty for painful limitation of motion. At a mean of 36.7 months after surgery we assessed pain, motion arc, and Knee Society clinical and functional scores. The effectiveness of a limited approach for selected patients (n = 12) was compared with more comprehensive revision of both components (n = 11). Patients with the limited approach had improvements in mean knee motion arc (25.7 degrees), mean clinical score (37.8 points), and mean functional score (20.8 points). Patients with component revision had a mean improvement in knee motion arc (17.9 degrees) but little change in the clinical score (3.6 points) or functional score (-1.0 points). The severity of preoperative flexion contractures and limited motion in patients having component revision likely contributed to the limited improvement. The data suggest a limited soft tissue approach may be appropriate for a select group of patients. The success of component revision for patients with severely restricted motion and more extensive flexion contracture was less predictable than authors of previous reports suggest.
  
  
  METHODS
  Therapeutic study, Level III-1 (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Wilford Hall Medical Center (USAF), San Antonio, TX, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Keeney
authors.forename: John C
authors.initials: JC
authors.lastname: Clohisy
authors.forename: Madelyn
authors.initials: M
authors.lastname: Curry
authors.forename: William J
authors.initials: WJ
authors.lastname: Maloney
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008875:Middle Aged; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation