Stiffness associated with total knee arthroplasty.

Multiple factors may lead to stiffness after total knee arthroplasty (TKA), including patient diagnosis, preoperative range of motion (ROM), prosthetic geometry used, surgical technique, intraoperative ROM after capsular closure, postoperative rehabilitation, and wound healing factors. An ipsilateral arthritic hip can also inhibit postoperative recovery and lead to knee stiffness. Exposure of the ankylosed knee can be difficult. One must take care to avoid excessive stress on the patellar tendon insertion leading to patellar tendon avulsion. The 2 most common methods to facilitate exposure are a proximal release or a tibial tubercle osteotomy. When patients fail to achieve satisfactory ROM after TKA, manipulation under anesthesia is considered. It is usually performed approximately 6 weeks postoperatively. The best indicator of each patient's potential is his or her intraoperative flexion against gravity with the capsule closed at the end of the procedure.