Author(s): Clara Chimeno-Pigrau, Jonathan Matellanes, Marcos Tejada, Alonso J Zumbadoa, Yury Postnikov and Oscar Ares

Abstract: Introduction: Total knee arthroplasty is the most efficient treatment for knee osteoarthritis. 4% to 16% of patients develop stiffness in the knee that impairs them to perform daily activities. There are multiple strategies to treat this condition, from non-operative as rehabilitation to complete replacement of the prosthesis. Open arthrolysis facilitates the posterior capsular release, and no surgical protocol has been described. We present a surgical tip to access this particular region.Surgical technique and postoperative management: In both medial and lateral side, we perform an incision to access the joint capsule, and when the capsule is presented, we incise it in the posterior edge. Once we open the joint and with the knee at 60º of flexion, we use a Cobb elevator to carefully release the posterior adhesion from the bone. When the Cobb elevator can pass from medial to lateral side (or vice versa), the knee is extended and complete extension is accomplished.We recommend an extension orthosis to keep the knee from accidental flexion. Total weight bearing can be made after two to three weeks of partial weight bearing.Conclusion: Stiffness is a rare complication in TKA, but when it happens is a very unpleasant complication for the patient. Open arthrolysis is widely used, but there is not much literature on how to perform it. We present this surgical tip that can be helpful mostly in patients with a flexion contracture, with minimal side effects.

DOI: 10.22271/27078345.2021.v3.i2c.81

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