Sharma Mrinal, Sharma Saurabh, Upadhyaya Akshay Raj
Asian Institute of Medical Sciences, Badkal Flyover Road, Sec 21A, Faridabad, Delhi NCR India.
Indian J Orthop. 2021 Jul 29;55(5):1158-1174. doi: 10.1007/s43465-021-00457-8. eCollection 2021 Oct.
Stiff knees are defined as those with an arc of motion < 50°. They pose a considerable surgical challenge to the operating surgeon. Based on our experience to deal with these complex cases, we have developed a working classification that outlines a flowchart to manage the stiff/ankylosed knees.
It was a retrospective study conducted in our department. Out of 570 TKA performed in last 5 years, 57 had stiffness and four had bony ankyloses (total 61 knees). Patients were classified based on the fibrous or bony ankylosis and preoperative ROM.
Patients were followed for an average 2.4 years (1.8-5.5 years). KSS pain scores improved from an av. 32 preop (18-64) to av. 76 postoperatively (61-90). The KSS function scores improved from a preoperative value of 36 (16-56) to an av. 78 (52-90) postoperatively. ROM improved from an average of 35.6° (0°-44°) preoperatively to an average of 95.6° (ROM 73°-118°) postoperatively. Extension lag was an av. 8° (3°-12°) and was seen in 13 patients postoperatively. Residual fixed flexion deformity was an av. 7° (3°-14°) and seen in 17 patients. The stiff knees (type 1 and type 2) fared better than ankylosed knees (type 3) in all aspects. Complication rate was high (24%) in our series.
Our classification of stiff/ankylosed knees guides the surgeon to decide upon which approach to take, which implants to keep handy and has a predictive and prognostic value.
僵硬膝被定义为活动弧度＜50°的膝关节。它们给手术医生带来了相当大的手术挑战。基于我们处理这些复杂病例的经验，我们制定了一种实用的分类方法，该方法勾勒出了一个用于处理僵硬/强直膝的流程图。
这是在我们科室进行的一项回顾性研究。在过去5年中进行的570例全膝关节置换术（TKA）中，57例出现僵硬，4例出现骨性强直（共61个膝关节）。根据纤维性或骨性强直以及术前活动度对患者进行分类。
患者平均随访2.4年（1.8 - 5.5年）。膝关节协会（KSS）疼痛评分从术前平均32分（18 - 64分）提高到术后平均76分（61 - 90分）。KSS功能评分从术前的36分（16 - 56分）提高到术后平均78分（52 - 90分）。活动度从术前平均35.6°（0° - 44°）提高到术后平均95.6°（活动度73° - 118°）。术后平均伸直滞后8°（3° - 12°），13例患者出现该情况。残留固定屈曲畸形平均为7°（3° - 14°），17例患者出现该情况。在所有方面，僵硬膝（1型和2型）的情况比强直膝（3型）更好。我们系列中的并发症发生率较高（24%）。
我们对僵硬/强直膝的分类有助于指导外科医生决定采用何种方法、准备哪些合适的植入物，具有预测和预后价值。
