title: Revision surgery for the stiff total knee arthroplasty.
abstract: OBJECTIVE
  The aim of this study was to examine the results of revision total knee arthroplasty (TKA) undertaken for stiffness in the absence of sepsis or loosening.
  
  
  METHODS
  We present the results of revision surgery for stiff TKA in 48 cases (35 (72.9%) women and 13 (27.1%) men). The mean age at revision surgery was 65.5 years (42 to 83). All surgeries were performed by a single surgeon. Stiffness was defined as an arc of flexion of < 70° or a flexion contracture of > 15°. The changes in the range of movement (ROM) and the Western Ontario and McMasters Osteoarthritis index scores (WOMAC) were recorded.
  
  
  RESULTS
  At a mean follow up of 59.9 months (12 to 272) there was a mean improvement in arc of movement of 45.0°. Mean flexion improved from 54.4° (5° to 100°) to 90° (10° to 125°) (p < 0.05) and the mean flexion contracture decreased from 12.0° (0° to 45°) to 3.5° (0° to 25°) (p < 0.05). The mean WOMAC scores improved for pain, stiffness and function. In patients with extreme stiffness we describe a novel technique, which we have called the 'sloppy' revision. This entails downsizing the polyethylene insert by 4 mm and using a more constrained liner to retain stability.
  
  
  CONCLUSIONS
  To our knowledge, this is the largest series of revision surgeries for stiffness reported in the literature where infection and loosening have been excluded.
  
  
  CONCLUSIONS
  Whilst revision surgery is technically demanding, improvements in ROM and outcome can be achieved, particularly when the revision is within two years of the primary surgery. Cite this article: Bone Joint J 2016;98-B:622-7.
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: J R
authors.initials: JR
authors.lastname: Donaldson
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Tudor
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Gollish
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D012086:Reoperation; D012189:Retrospective Studies
keywords: knee; arthroplasty; revision; stiffness; range of motion