title: Total knee arthroplasty of the stiff knee: three hundred and four cases.
abstract: OBJECTIVE
  The purpose of this study was to analyse the results of total knee arthroplasty (TKA) in stiff knees (flexion ≤90° and/or flexion contracture ≥20°). Our hypothesis was that despite having poorer results than those obtained in a "standard" population and a high rate of complications, TKA was a satisfactory treatment in patients with osteoarthritis of the knee associated with significant stiffness.
  
  
  METHODS
  Three hundred and four consecutive primary HLS TKAs (Tornier), whose data were prospectively collected between October 1987 and October 2012, were retrospectively analysed at a mean of 60 months (range, 12-239) postoperatively. Two groups, those with a "flexion contracture" and those with a "flexion deficit", were assessed for postoperative range of motion (as integrated to the Knee Society score [KSS]), physical activity level and patient satisfaction.
  
  
  RESULTS
  At the latest follow-up, range of motion was significantly improved, as was the KSS. Ninety-four percent of patients were satisfied or very satisfied, and activity levels were increased after surgery. The complication rate, however, was high in patients with a preoperative flexion deficit (17%). Pain and residual stiffness were the most common complications.
  
  
  CONCLUSIONS
  TKA provides satisfactory results in patients with knee osteoarthritis associated with significant pre-operative stiffness. The surgical plan should be adapted to anticipate complications, which are particularly frequent in the presence of a flexion deficit.
authors.affiliation: Department of Orthopaedic Surgery, Hôpital de la Croix-Rousse, Centre Albert Trillat, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France, carodebette@yahoo.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Debette
authors.forename: Sébastien
authors.initials: S
authors.lastname: Lustig
authors.forename: Elvire
authors.initials: E
authors.lastname: Servien
authors.forename: Timothy
authors.initials: T
authors.lastname: Lording
authors.forename: Vincent
authors.initials: V
authors.lastname: Villa
authors.forename: Guillaume
authors.initials: G
authors.lastname: Demey
authors.forename: Philippe
authors.initials: P
authors.lastname: Neyret
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000453:epidemiology; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery*; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome