Περίληψη:
Background: Severe stiffness after total knee arthroplasty is a
debilitating problem. In patients with securely fixed and appropriately
aligned components, arthrolysis of adhesions and exchange to a thinner
tibial polyethylene insert may appear to be a reasonable and logical
solution. We reviewed our experience with this procedure to determine
its efficacy.
Methods: From 1992 through 1998, seven knees with marked stiffness after
total knee arthroplasty were treated at our institution with arthrolysis
of adhesions and conversion to a thinner tibial polyethylene insert..
Only patients in whom the total knee prosthesis was well aligned, well
fixed, and not associated with infection were included. There were five
women and two men with a mean age at revision of sixty-one years (range,
thirty-eight to seventy-four years). The average time to revision was
twelve months, and the mean arc of motion prior to revision was 38.6
degrees (range, 15 degrees to 60 degrees). The duration of follow-up
after the insert exchange averaged 4.2 years (range, two to eight
years).
Results: Mean Knee Society pain and function scores changed from 44 and
36.4 points preoperatively to 39.6 and 46 points at the time of final
follow-up. Two knees were rerevised, one because of infection and the
other because of aseptic loosening of the components. The five remaining
knees were painful and stiff at the time of final follow-up. Four of
these five knees were severely painful, and one knee was moderately and
occasionally painful. The mean arc of motion of these five knees was 58
degrees (range, 40 degrees to 70 degrees) at the time of final
follow-up.
Conclusion: Isolated tibial insert exchange, arthrolysis, and
debridement failed to provide a viable solution to the difficult and
poorly understood problem of knee stiffness in a group of carefully
selected. patients following total knee arthroplasty. We therefore have
little enthusiasm for the continued use of this strategy.
Συγγραφείς:
Babis, GC
Trousdale, RT
Pagnano, MW
Morrey, BF
