Yercan Huseyin S, Sugun Tahir S, Bussiere Christophe, Ait Si Selmi Tarik, Davies Andrew, Neyret Philippe
Department of Orthopaedics and Traumatology, Centre Livet-Hopital Croix Rousse, Rue de Margnolles, 69300 Caluire, France.
Knee. 2006 Mar;13(2):111-7. doi: 10.1016/j.knee.2005.10.001. Epub 2006 Feb 20.
We investigated the prevalence of stiffness after total knee arthroplasty, and the results of the treatment options in our practice. Between 1987 and 2003, we performed 1188 posterior-stabilized total knee arthroplasties. The prevalence of stiffness was 5.3%, at a mean follow-up 31 months postoperatively. The average age was 71 years (range, 54-88). The patients with painful stiffness were treated by two modalities: manipulation and secondary surgery. In the manipulation group (n:46), the mean range of motion improved from 67 degrees before manipulation to 117 degrees afterward. This improvement was maintained at final follow-up as 114 degrees. There was no significant difference between the motion, immediately after manipulation and at final follow-up. However, motion at final follow-up was better for those manipulated early to those done later (p=0.021). In the secondary surgery group (n:10), the mean gain in motion was 49 degrees at final follow-up and average pain score was found 43. Patellar problems--component loosening and clunk syndromes--were found in 4 patients (40%). Early manipulation gives better gain of motion than done later and our patients had not lost flexion during follow-up. The patella should always be evaluated in every stiff arthroplasty. In our opinion, patellar problems are a good prognostic factor for the success of revision surgery and open arthrolysis does not correct a limited flexion arc, but it does relieve pain. Arthroscopic release is not reliable for severely stiff knees and we prefer to perform it in less painful and moderately stiff knees within 3 to 6 months after operation.
我们调查了全膝关节置换术后僵硬的发生率以及我们实际采用的治疗方案的效果。1987年至2003年期间，我们共进行了1188例后稳定型全膝关节置换术。僵硬的发生率为5.3%，术后平均随访31个月。平均年龄为71岁（范围54 - 88岁）。疼痛性僵硬的患者采用两种治疗方式：手法治疗和二次手术。在手法治疗组（n = 46）中，平均活动范围从手法治疗前的67度改善至术后的117度。在最终随访时，这一改善维持在114度。手法治疗后即刻与最终随访时的活动度无显著差异。然而，早期接受手法治疗的患者在最终随访时的活动度优于后期接受治疗的患者（p = 0.021）。在二次手术组（n = 10）中，最终随访时平均活动度增加49度，平均疼痛评分为43分。4例患者（40%）出现髌股问题——假体松动和弹响综合征。早期手法治疗比后期治疗能获得更好的活动度改善，且我们的患者在随访期间未出现屈曲丢失。在每例僵硬的关节置换病例中都应始终评估髌骨情况。我们认为，髌股问题是翻修手术成功的良好预后因素，开放关节松解术虽不能纠正有限的屈曲弧度，但可缓解疼痛。关节镜下松解对于严重僵硬的膝关节不可靠，我们更倾向于在术后3至6个月内，对疼痛较轻和中度僵硬的膝关节进行该操作。
