Functional range Walking 60 deg Sitting 90 deg Ascending descending stairs 110 deg Tie shoes 110 deg Squatting 120 deg Knee during gait Knee functional range ID: 934091
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Slide1
The Stiff TKR
HTO visit
HCMC, Vietnam 2017
Slide2Functional range
Walking 60
deg
Sitting 90
deg
Ascending/ descending stairs 110
deg
Tie shoes 110
deg
Squatting 120
deg
Slide3Knee during gait
Slide4Knee functional range
Slide5Definition
Difficult and variable
Usually <90
deg
flexion
Slide6Definition
Beware of Fixed flexion deformity!!!
Slide7Causes
Patients
Surgeons
Complications
Slide8Patients
Pre-op range (
ankylosis
/ fusion)
Extreme
varus
deformity
Pre-op diagnosis
SepsisTraumaJCA/ Erosive arthropathy
Ipsilateral
painful joints
Female
Young age
Body habitus
Psychological factors
Slide9Surgeon
Malalignment
of components
Coronal
Femur
Axial
Tibia
Saggittal
Patella Poor soft tissue balance
Poor closure
Post op rehabilitation
Slide10Complications
Arthrofibrosis
H
aemarthrosis
Delayed wound healing
Infection
Peri
-prosthetic fracture
Intra-articular Loose bodiesUnstable componentsCRPSSevere heterotopic ossification
Slide11Assessment
Bloods
XR’s
CT
Slide12Approach
Painful
Infection
Fracture
Instability
Soft tissue
subsidence
Malalignment
Heterotopic ossification
CRPS
Poor pain management
Psychological
Painless
Adhesions
Muscle contractures
Body habitus
Implant
malalignment
Heterotopic ossification
Slide13Assessments
Painful
Wound
Soft tissue
Tenderness
Stability
CRPS signs
Soft
end point
Painfree
Soft tissue
Hard
end point
Slide14Radiology
Good quality
AP
Lateral
Skyline
Fracture
Subsidence
Heterotopic bone
Asymmetrical gapMalalignment
Slide15X rays
Slide16XRays
Slide17XRays
Slide18Slide19Imbalance
Slide20Other investigations
CRP
ESR
Bone scan
CT scan
Slide21Management
Pain management
Treat primary cause
Manipulation
Early better
Not after 3 months
Arthrolysis
– open
vs arthroscopicQuadricepsplasty
Revision TKR
Careful evaluation
Slide22Thank you