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Knee stiffness is a widely known and worrying condition in several postoperative knees. Less is known about native stiff knee. The aim of this manuscript is to summarize the available literature on native stiff knee epidemiology, classification and treatment.
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In 1989 stiff knee was defined as a knee with less than 50° of total range of motion. If range of motion is <30°, it is defined as an ankylosed knee. Knee stiffness can be divided into three main types: flexion contractures, extension contractures, and combined contractures. Different risk factors have been associated to native stiff knee and grouped into modifiable or not modifiable. Furthermore, risk factors can be divided into patients’ related no patients’-related.
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Different treatment modalities can be indicated to treat knee stiffness, including manipulation under anesthesia (MUA), arthroscopic and open surgical release. When stiffness is associated with articular disruption TKA represent an option. TKA in native stiff knee can be challenging for the surgeon. Implant’s choice and knee exposure are the first steps. In some cases, additional release and extensive can be considered. A stepwise approach and careful preoperative planning are mandatory to obtain long-term satisfactory outcomes.
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Native stiff knee is a rare but invalidating condition. Different treatment modalities have been proposed as treatment. However, considering that it is frequently associated to sever arthritis, TKA can be an option in painful stiff knees. Nature of knee stiffness necessitates a customized approach to ensure successful management and achieve satisfying outcomes.
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Total joint arthroplasty (TJA) is one of the most common orthopaedic procedures. Nevertheless, several complications can lead to implant failure.
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Peri-prosthetic joint infections (PJI) certainly represent a significant challenge in TJA, constituting a major cause of prosthetic revision. The surgeon may have an important role in reducing the PJI rate by limiting the impact of significant risk factors associated to either the patient, the operative environment or the post-operative care.
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In the pre-operative period, several preventive measures may be adopted to manage reversible medical comorbidities. Other recognised pre-operative risk factors are urinary tract infections, intra-articular corticosteroid injections and nasal colonisation with Staphylococcus (S.) aureus, particularly the methicillin-resistant strain (MRSA).
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In the intra-operative setting, protective measures for PJI include antibiotic prophylaxis, surgical-site antisepsis and use of pre-admission chlorhexidine washing and pulsed lavage during surgery. In this setting, the use of plastic adhesive drapes and sterile stockinette, as well as using personal protection systems, do not clearly reduce the risk of infection. On the contrary, using sterile theatre light handles and splash basins as well as an increased traffic in the operating room are all associated with an increased risk for PJI.
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In the post-operative period, other infections causing transient bacteraemia, blood transfusion and poor wound care are considered as risk factors for PJI.
Cite this article: Ratto N, Arrigoni C, Rosso F, Bruzzone M, Dettoni F, Bonasia DE, Rossi R. Total knee arthroplasty and infection: how surgeons can reduce the risks. EFORT Open Rev 2016;1: 339-344 DOI: 10.1302/2058-5241.1.000032.
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who suffered a low-energy trauma and sustained a partial articular fracture (Schatzker 3/ AO OTA 41B2). Does age matter in determining management? The age of the patient and his/her previous functional status can be critical in deciding
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Osteotomie Komitee der Deutschen Knie Gesellschaft (DKG), Munich, Germany
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Osteotomie Komitee der Deutschen Knie Gesellschaft (DKG), Munich, Germany
AO Research Institute Davos, Davos, Switzerland
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The present narrative review provides a summary of postoperative therapy modalities and their effectiveness following osteotomies around the knee.
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The topics that are discussed in the scientific discourse include support of cartilage cell regeneration, pain management, drainage insertion, tourniquet use, pharmacological and mechanical thromboembolism prophylaxis, weight-bearing protocols and bone consolidation.
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There is evidence for the use of pharmacological thromboembolism prophylaxis and weight-bearing protocols.
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A standardized postoperative treatment concept following osteotomies around the knee cannot be derived due to lack of evidence for the other topics in current literature.
Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
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Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain
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, which is important for planning the surgical management of these fractures. The Müller AO ( Arbeitsgemeinschaft für Osteosynthesefragen ) classification of fractures is also commonly used ( 6 ). Considering that tibial plateau fractures are intra
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R Galla M Agneskirchner J . Osteotomies around the knee, indications - planning - surgical techniques using plate fixators . Davos: Switzerland : AO Publishing, Thieme Verlag , 2008 . 11. Paley D
Princess Grace Hospital, London, UK
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Princess Grace Hospital, London, UK
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Princess Grace Hospital, London, UK
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Princess Grace Hospital, London, UK
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/accommodations/meeting expenses for Smith and Nephew and AO, all outside the submitted work. FSH reports board membership of the Bone and Joint Journal and the Annals of the Royal College of Surgeons ; consultancy for Smith & Nephew, Corin, MatOrtho and Stryker; payment for
Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Dai W Leng X Wang J Shi Z Cheng J Hu X & Ao Y . Intra-articular mesenchymal stromal cell injections are no different from placebo in the treatment of knee osteoarthritis: a systematic review and meta-analysis of randomized controlled
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Traumatology, Arthroscopy 2018 26 3362 – 3367 . ( https://doi.org/10.1007/s00167-018-4896-4 ) 21 Chalmers BP Kapadia M Chiu YF Henry MW Miller AO & Carli AV . Treatment and outcome of periprosthetic joint infection in unicompartmental knee
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. 67 - 69 The first case (hoffa-type coronal fracture) occurred during surgery, but was only noticed directly thereafter and was successfully treated in a non-weight-bearing cast for six weeks. 69 The other two cases concerned AO-B2 type displaced
