Avoiding a Stiff Knee After Joint ReplacementTotal knee replacement (TKR) is designed to reduce pain while also improving motion and function. Some patients have significant joint stiffness after the operation. In this article, orthopedic surgeons review ways to prevent and treat this problem.
As Ben Franklin once said, An ounce of prevention is worth a pound of cure. In the case of joint stiffness after TKR, it is much better to avoid the problem than try to treat it. That's been the experience of many patients and surgeons faced with this complication.
Prevention begins by recognizing risk factors. Patients with poor motion before surgery are not as likely to have a good result. Likewise, poor motion when under the effects of anesthesia during the operation is also a negative prognostic sign.
Anticoagulants (blood thinners) are routinely prescribed for all joint replacement patients. The goal is to prevent blood clots. Some studies show that patients taking a particular blood thinner (coumadin) have a higher rate of joint stiffness. Those patients who were taking low molecular weight (LMW) heparin have better results.
The problem of stiffness after TKR may be multifactorial. The patient must follow the pre-operative and postoperative rehab programs carefully. The surgeon must pay attention to the position of the kneecap and balance the soft tissue structures on both sides of the joint.
Using the right implant size for the individual patient is also important. Once joint stiffness occurs, it is often resistant to treatment. Surgery to manipulate the joint may be needed but the results are often disappointing.
Patients, surgeons, and rehab specialists must work together to prevent the problem of stiffness after TKR. A similar effort is needed when stiffness does occur. Surgical technique is important but not all factors are within the surgeon's control. Patients must be compliant with their prescribed program. This is often difficult when there is pain involved.
Walter B. Beaver, Jr, and Thomas K. Fehring. Prevention and Treatment of Stiffness Following Total Knee Arthroplasty. In Current Opinion in Orthopaedics. January 2008. Vol. 19. No. 1. Pp. 72-74.
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