Revision surgery for the stiff total knee arthroplasty.

Aims The aim of this study was to examine the results of revision total knee arthroplasty (TKA) undertaken for stiffness in the absence of sepsis or loosening. Patients and Methods We present the results of revision surgery for stiff TKA in 48 cases (35 (72.9%) women and 13 (27.1%) men). The mean age at revision surgery was 65.5 years (42 to 83). All surgeries were performed by a single surgeon. Stiffness was defined as an arc of flexion of <70 degrees or a flexion contracture of >15 degrees. The changes in the range of movement (ROM) and the Western Ontario and McMasters Osteoarthritis index scores (WOMAC) were recorded. Results At a mean follow up of 59.9 months (12 to 272) there was a mean improvement in arc of movement of 45.0. Mean flexion improved from 54.4 degrees (5 degrees to 100 degrees) to 90 degrees (10 degrees to 125 degrees) (p < 0.05) and the mean flexion contracture decreased from 12.0 degrees (0 degrees to 45 degrees) to 3.5 degrees (0 degrees to 25 degrees) (p < 0.05). The mean WOMAC scores improved for pain, stiffness and function. In patients with extreme stiffness we describe a novel technique, which we have called the 'sloppy' revision. This entails downsizing the polyethylene insert by 4 mm and using a more constrained liner to retain stability. Conclusion To our knowledge, this is the largest series of revision surgeries for stiffness reported in the literature where infection and loosening have been excluded.