Background: Severe stiffness after total knee
arthroplasty is a debilitating problem. In patients with securely
fixed and appropriately aligned components, arthrolysis of adhesions
and exchange to a thinner tibial polyethylene insert may appear
to be a reasonable and logical solution. We reviewed our experience
with this procedure to determine its efficacy.
Methods: From 1992 through 1998, seven knees with
marked stiffness after total knee arthroplasty were treated at our
institution with arthrolysis of adhesions and conversion to a thinner
tibial polyethylene insert. Only patients in whom the total knee prosthesis
was well aligned, well fixed, and not associated with infection
were included. There were five women and two men with a mean age
at revision of sixty-one years (range, thirty-eight to seventy-four
years). The average time to revision was twelve months, and the
mean arc of motion prior to revision was 38.6° (range, 15° to 60°).
The duration of follow-up after the insert exchange averaged 4.2
years (range, two to eight years).
Results: Mean Knee Society pain and function scores
changed from 44 and 36.4 points preoperatively to 39.6 and 46 points
at the time of final follow-up. Two knees were rerevised, one because
of infection and the other because of aseptic loosening of the components.
The five remaining knees were painful and stiff at the time of final
follow-up. Four of these five knees were severely painful, and one
knee was moderately and occasionally painful. The mean arc of motion
of these five knees was 58° (range, 40° to 70°) at the time of final
Conclusion: Isolated tibial insert exchange, arthrolysis,
and débridement failed to provide a viable solution to
the difficult and poorly understood problem of knee stiffness in
a group of carefully selected patients following total knee arthroplasty.
We therefore have little enthusiasm for the continued use of this