Original Article

Management of Stiffness following Total Knee Arthroplasty: International Survey on Surgeon Preferences

¹ Specialty Registrar in Trauma & Orthopaedics, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
² Specialty Registrar in Trauma & Orthopaedics, Royal London Hospital, Whitechapel, London E1 1BB, UK
³ Medical Student, University of Cambridge, CB2 8PQ, UK
⁴ Consultant Orthopaedic Surgeon, Addenbrooke’s Cambridge University Hospital, Hills Road, Cambridge CB2 0QQ, UK

^* Corresponding author: drkhskumar@yahoo.com

Received: 15 December 2020
Accepted: 10 February 2021

Abstract

Introduction: Stiffness following total knee arthroplasty (TKA) is a challenging complication and can result in a poor functional outcome. There is considerable debate concerning the definition, work-up, and optimal management of this complication. The aim of this study was to record the definition of stiffness, management practices, and expectations of outcome among surgeons from an international community using a peer-reviewed questionnaire. Methods: A 23-item peer-reviewed online questionnaire was sent to all members of SICOT to gauge and record the management practices and expectations of outcome in the management of patients with stiffness following TKA. Results: A total of 315 surgeons completed this peer-reviewed questionnaire. Manipulation under anaesthesia (MUA) was the preferred treatment option for stiffness post-TKA, with a majority of the surgeons opting to carry out this procedure between 6 and 12 weeks following the index TKA. Physiotherapy and a continuous passive motion device were also used by the majority of surgeons following MUA, as additional treatment measures. Discussion: MUA is perceived to be a safe and effective primary treatment option for stiffness following TKA. It is best performed between weeks 6 and 12 with expected gains in range of motion from 10 to 20 degrees in 75% of patients.