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首页> 外文期刊>Journal of orthopaedics and traumatology: official journal of the Italian Society of Orthopaedics and Traumatology >Stiffness in total knee arthroplasty
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Stiffness in total knee arthroplasty

机译：全膝关节置换的刚度

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Stiffness is a relatively uncommon complication after total knee arthroplasty. It has been denned as a painful limitation in the range of movement (ROM). Its pathogenesis is still unclear even if some risk factors have been identified. Patient-related conditions may be difficult to treat. Preoperative ROM is the most important risk factor, but an association with diabetes, reflex sympathetic dystrophy, and general pathologies such as juvenile rheumatoid arthritis and ankylosing spondylitis has been demonstrated. Moreover, previous surgery may be an additional cause of an ROM limitation. Postoperative factors include infections, arthroflbrosis, heterotrophic ossifications, and incorrect rehabilitation protocol. Infections represent a challenging problem for the orthopaedic surgeon, and treatment may require long periods of antibiotics administration. However, it is widely accepted that an aggressive rehabilitation protocol is mandatory for a proper ROM recovery and to avoid the onset of arthrofi-brosis and heterotrophic ossifications. Finally, surgery-related factors represent the most common cause of stiffness; they include errors in soft-tissue balancing, component malpositioning, and incorrect component sizing. Although closed manipulation, arthroscopic and open arthrolysis have been proposed, they may lead to unpredictable results and incomplete ROM recovery. Revision surgery must be proposed in the case of well-documented surgical errors. These operations are technically demanding and may be associated with high risk of complications; therefore they should be accurately planned and properly performed.
机译：刚度是全膝关节置换术后相对罕见的并发症。它被认为是移动范围（ROM）的痛苦限制。即使已确定某些危险因素，其发病机理仍不清楚。与患者有关的疾病可能难以治疗。术前ROM是最重要的危险因素，但已证明与糖尿病，反射性交感神经营养不良和一般性疾病（如青少年类风湿性关节炎和强直性脊柱炎）有关。而且，先前的手术可能是ROM受限的另一个原因。术后因素包括感染，关节纤维化，异养性骨化和不正确的康复方案。对于整形外科医生而言，感染是一个具有挑战性的问题，治疗可能需要长期服用抗生素。但是，为使ROM恢复正常并避免关节纤维化和异养骨化的发生，必须采取积极的康复方案。最后，与手术相关的因素代表了僵硬的最常见原因。它们包括软组织平衡错误，组件位置不正确以及组件尺寸错误。尽管已提出了封闭操作，关节镜和开放式关节溶解术，但它们可能导致不可预测的结果和不完全的ROM恢复。如果有确凿的手术错误，则必须提出翻修手术。这些操作在技术上要求很高，可能会带来很高的并发症风险;因此，应准确计划和正确执行它们。

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