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How to Treat the Stiff Total Knee Arthroplasty?: A Systematic Review.

Clinical Orthopaedics and Related Research, 2010

BACKGROUND: Multiple modalities have been used to treat the stiff TKA, including manipulation under anesthesia (MUA), arthroscopy, and open arthrolysis.
QUESTIONS/PURPOSES: We reviewed the literature to address three questions: (1) How many degrees of ROM will a stiff TKA gain after MUA, arthroscopy, and open arthrolysis? (2) Does the timing of each procedure influence this gain in ROM? (3) What is the number of clinically important complications for each procedure? METHODS: We performed a PubMed search of English language articles from 1966 to 2008 and identified 20 articles, mostly Level IV studies.
RESULTS: For patients who have arthrofibrosis after TKA, the gains in ROM after MUA and arthroscopy (with or without MUA) are similar.
MUA is more successful in increasing ROM when performed early but still may be effective when performed late.
The numbers of clinically important complications after MUA and arthroscopy (with or without MUA) are similar.
CONCLUSIONS: Stiffness after TKA is a common problem that can be improved with MUA and/or arthroscopic lysis of adhesions with few complications.