cadera / hip - Active Congress.......

VIERNES / FRIDAY
278
13.00 - 14.30 h
RODILLA / KNEE
Complicaciones
Complications
Moderador / Moderator: Leo Whiteside
EVALUATION OF THE
PAINFUL KNEE AFTER TKA
J. Romero, M.D.
Endoclinic Zurich, Center for Arthroplasty
and Joint Surgery,
Klinik Hirslanden, Switzerland
Total knee arthroplasty (TKA) is a most effective
treatment for advanced degenerative
joint disease of the knee. Although satisfactory
results can be expected in most of the
patients, occasionally the outcome may be
compromised by pain and poor range of motion
after uneventful surgery and postoperative
course. Stiffness of the knee is a frustrating
complication for both the patient and the
surgeon. A variety of activities of daily living
and the overall quality of life is compromised
by limited fl exion and incomplete extension.
Stiffness may or may not be accompanied
by pain at rest, but the attempt to forcefully
increase the arc of motion of a stiff knee is
usually painful. Ambulating with a knee that
does not fully extend increases the muscular
work of walking and decreases endurance,
particularly in the quadriceps muscle. Walking
of a level surface is possible if the knee fl exes
only 45° to 55° during swing phase. Ascending
or descending stairs requires about 85°
of fl exion. Standing from a chair is facilitated
if the foot can be brought under the seat; this
usually requires 95° of fl exion. The patients
demands after total knee arthroplasty have
increased over the last years since most of
them enjoy bicycling, mountain hiking, skiing
and other sports activities which require fl exion
well beyond 90°. High fl exion angles are
required by a variety of cultural and religious
habits such as prayer (125°) and squatting
for eating or hygiene (135°). Therefore the
defi nition for stiffness is not absolute and
depends on the patients demand. In practice,
a patient who fl exes less than 100° or lacks
more than 10° for full extension considers
his surgery usually as a failure. If attempts
at non-operative management such as pain
medication, physiotherapy, and perhaps
under certain conditions manipulation under
anesthesia have failed, and the knee remains
with poor range of motion, surgery may be
the only option. If an operative treatment is
considered it is mandatory to evaluate the
underlying condition of the limited arc of motion.
It may have a mechanical or a biological
origin. If the main complaint is pain without
loss of motion, the origin of pain is primarly
mechanical, however psychological factors
may also play a certain role. In any case
evaluation of the painful total knee arthroplasty
consists of a thorough history, as well
as physical and several other invasive and
non-invasive examinations, and laboratory
and imaging testing.
The painful knee without stiffness
It is important to obtain the information from
the patient on when he developed a painful
knee after TKA. If the patient was never
pain-free following surgery, diagnosis such
as instability, prosthetic malpositioning and
malsizing with soft tissue impingement,
lateral patellar facet syndrome or patellar