Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC.
Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
J Arthroplasty. 2018 Sep;33(9):3049-3055. doi: 10.1016/j.arth.2018.04.036. Epub 2018 Apr 30.
Knee stiffness following total knee arthroplasty (TKA) may cause pain and reduced functionality, contributing to unsatisfactory surgical outcomes. Revision surgery remains a possible treatment for refractory postoperative stiffness. However, the efficacy of the procedure has not been systematically evaluated.
A systematic review of the literature was performed to identify studies that reported on outcomes for patients who underwent revision surgery for postoperative stiffness after TKA.
Ten studies (including 485 knees) were reviewed. The most common etiologies of stiffness requiring revision TKA were component malposition, malalignment, overstuffing, aseptic loosening, arthrofibrosis, patella baja, and heterotopic ossification. Of 9 studies reviewing range of motion outcomes after revision TKA, 7 studies documented significant improvement and 2 found trends toward improvement. Seven of 8 studies documenting Knee Society knee scores and 7 of 9 studies documenting functional scores found improvement after revision TKA. All studies reporting on pain found improvement at final follow-up after revision TKA.
Revision TKA results in increased range of motion, improved functionality, and reduced pain in most patients who require surgery for stiffness. The present literature is inadequate to predict which patients will achieve adequate outcomes from revision TKA based on the specific etiology of their stiffness, although identification of the etiology may help in surgical planning. Surgeons performing revision TKA should counsel patients on the risks and benefits of undergoing revision surgery, with the understanding that outcomes for well-selected patients are generally favorable.
全膝关节置换术后膝关节僵硬可引起疼痛和功能受限，导致手术效果不理想。翻修手术仍然是治疗术后顽固性僵硬的一种可能的治疗方法。然而，该手术的疗效尚未得到系统评估。
对文献进行系统回顾，以确定报道全膝关节置换术后僵硬患者行翻修手术治疗结局的研究。
共纳入 10 项研究（共 485 膝）。需要翻修 TKA 治疗僵硬的最常见病因是假体位置不当、对线不良、过度填充、无菌性松动、关节纤维性僵硬、髌骨低位和异位骨化。9 项研究中，7 项研究记录了术后关节活动度的显著改善，2 项研究发现有改善趋势。8 项研究中 7 项记录了膝关节学会膝关节评分，9 项研究中 7 项记录了功能评分，均发现翻修 TKA 后有改善。所有报告翻修 TKA 后疼痛改善的研究均在最后随访时进行评估。
翻修 TKA 可使大多数需要手术治疗僵硬的患者的关节活动度增加、功能改善和疼痛减轻。目前的文献不足以根据僵硬的具体病因预测哪些患者将从翻修 TKA 中获得足够的结果，但确定病因可能有助于手术规划。行翻修 TKA 的外科医生应告知患者翻修手术的风险和益处，同时应了解，对于选择合适的患者，其手术结果通常是有利的。
