title: A Novel, Nonoperative Treatment Demonstrates Success for Stiff Total Knee Arthroplasty after Failure of Conventional Therapy.
abstract: BACKGROUND
  Certain patients continue to suffer from knee stiffness following total knee arthroplasty (TKA) despite undergoing conventional therapies. Astym therapy to these patients may offer an effective, safe, nonoperative treatment. This study evaluates the effects of Astym therapy upon (1) range of motion and (2) subjective functional improvements in post-TKA patients who suffered from stiffness recalcitrant to other nonoperative interventions.
  
  
  METHODS
  Twenty-three post-TKA patients (29 knees) who had recalcitrant knee stiffness were included in this study. Pre- and post-Astym improvements in range of motion and Knee Society scores were compared. We analyzed knees based on the presence of flexion deficit or contracture. Further stratification was made into knees that received Astym therapy before and after a 3-month period of standard rehabilitation. Differences in range of motion from pre- to post-Astym were evaluated by measuring (1) degree of flexion deficit or contracture and (2) total arc of passive motion. Improvements in subjective functional status were determined by evaluating Knee Society scores pre- and post-Astym therapy. A two-tailed Student t-test was used to compare weighted mean differences from pre- to post-Astym for the above parameters.
  
  
  RESULTS
  The mean flexion deficit improved significantly (p < 0.001) in all patients after Astym therapy. The mean flexion contracture improved significantly in (p = 0.001) in 91% of patients after Astym therapy. Knees with flexion deficits or contractures both improved in total arc of motion when compared with pretherapy. Overall, patients who underwent treatment with Astym therapy reported significant mean improvements in both Knee Society objective (80 vs. 57 points; p < 0.0001) and functional scores (80 vs. 54 points; p = 0.0003) when compared with their pretherapy objective and functional scores. No harms were reported.
  
  
  CONCLUSIONS
  Astym therapy is a novel, nonoperative treatment that may be an effective treatment option for post-TKA patients suffering from persistent knee stiffness. Further studies are needed to validate this intervention as a part of cost-effective, standard treatment after TKA.
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
authors.forename: Morad
authors.initials: M
authors.lastname: Chughtai
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
authors.forename: Chris
authors.initials: C
authors.lastname: Cherian
authors.affiliation: Department of Orthopedics, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
authors.forename: Jeffrey Jai
authors.initials: JJ
authors.lastname: Cherian
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
authors.forename: Randa D K
authors.initials: RD
authors.lastname: Elmallah
authors.affiliation: Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Qais
authors.initials: Q
authors.lastname: Naziri
authors.affiliation: Department of Orthopaedic Surgery, Beth Israel Medical Center, New York.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Harwin
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
authors.forename: Anil
authors.initials: A
authors.lastname: Bhave
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000534:rehabilitation*; D003286:Contracture / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D007592:Joint Diseases / Q000209:etiology / Q000534:rehabilitation; D007719:Knee Joint / Q000601:surgery; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D016896:Treatment Outcome