Extensor mechanism management helps resolve post-TKR stiffness
ORLANDO, Fla. — Knee stiffness is a problem that joint replacement surgeons must address in patients prior to and after primary total knee replacement, a presenter said at the Current Concepts in Joint Replacement Winter Meeting, here.
Thomas P. Sculco, MD, said that when knee stiffness is extreme, a pie-crusting technique, a lateral snip or a release of the lateral aspect of the quadriceps tendons can better expose the knee and help extend the patient’s extensor mechanism.
“Of course, the basic tenet of knee stiffness is that the ultimate motion of the knee is really determined by what the preoperative motion is,” Sculco said.
Therefore, he said, when treating the stiff knee, surgeons must take into account biologic, mechanical and cognitive factors that affect preoperative motion, because these can all eventually lead to impaired knee motion.
“In the management of the stiff total knee, after the knee has been done, you have a number of treatment options. You can manipulate the knee, that is the time-proven way of doing it. You can scope the knee. You can do an open procedure or you can revise the knee,” Sculco said.
It is most effective to do a manipulation earlier, such as within 6 weeks to 12 weeks of the onset of the stiffness. Patients stand to regain about 38° range of motion (ROM), Sculco said, adding, “I like to do it as soon as I see that the patient has a significant impairment in flexion.”
The literature shows about 30° ROM, mean, can be regained after arthroscopic procedures associated with manipulation that are performed for a stiff TKR, he noted.
“You want to clean out the medial-lateral gutters,” as well as remove as much scar tissue in the infrapatellar area as possible, Sculco said.
“Open lysis procedures are also useful if you have a large or a thick polyethylene component,” he said.
In the well-aligned TKR, those polyethylene components can readily be down-sized. This situation is also amenable to any techniques performed on the extensor mechanism to improve knee ROM, according to Sculco. – by Susan M. Rapp
Reference:
Sculco TP. Paper #101. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 13-16, 2017; Orlando, Florida.
Disclosure: Sculco reports no relevant financial disclosures.
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