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Purpose <p>Post-total knee arthroplasty (TKA) stiffness remains a clinically important cause of pain, restricted range of motion (ROM), functional limitation, and reintervention. This narrative review synthesises current evidence on the pathophysiology, evaluation, and staged management of post-TKA stiffness, with particular emphasis on manipulation under anaesthesia (MUA).</p> Methods <p>A narrative review was performed using literature relating to post-TKA stiffness, arthrofibrosis, diagnostic evaluation,&#xa0;rehabilitation, MUA, lysis of adhesions, and revision TKA. Evidence was synthesised thematically to support a practical diagnostic and management framework.</p> Results <p>Acquired idiopathic stiffness occurs in approximately 3.6% to 4.0% of TKAs, while MUA is required in roughly 2.6% to&#xa0;3.6% of cases. The available literature supports a diagnosis-of-exclusion approach, in which infection, component&#xa0;malposition, instability, and other secondary causes are excluded before arthrofibrosis is diagnosed. MUA remains&#xa0;the principal first-line procedural intervention once early conservative measures fail. Earlier MUA, generally within 6–12 weeks, is associated with greater ROM gain than delayed intervention, although outcomes remain influenced by baseline ROM severity, patient selection, and the quality of post-manipulation rehabilitation.</p> Conclusion <p>Post-TKA stiffness is a heterogeneous complication requiring structured evaluation and staged management. When MUA fails, escalation to arthrolysis or revision TKA should be individualised and guided by the distinction between persistent soft-tissue fibrosis and correctable mechanical pathology. A practical algorithm is proposed to support diagnosis, timing of intervention, and escalation after failed MUA.</p>

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Reluctant knee: understanding and managing stiffness after total knee arthroplasty

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月25日

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  • Sakeena Hosanee,
  • Nnena Elebo,
  • Nkhodiseni Sikhauli,
  • Jurek Rafal Tomasz Pietrzak

摘要

Purpose

Post-total knee arthroplasty (TKA) stiffness remains a clinically important cause of pain, restricted range of motion (ROM), functional limitation, and reintervention. This narrative review synthesises current evidence on the pathophysiology, evaluation, and staged management of post-TKA stiffness, with particular emphasis on manipulation under anaesthesia (MUA).

Methods

A narrative review was performed using literature relating to post-TKA stiffness, arthrofibrosis, diagnostic evaluation, rehabilitation, MUA, lysis of adhesions, and revision TKA. Evidence was synthesised thematically to support a practical diagnostic and management framework.

Results

Acquired idiopathic stiffness occurs in approximately 3.6% to 4.0% of TKAs, while MUA is required in roughly 2.6% to 3.6% of cases. The available literature supports a diagnosis-of-exclusion approach, in which infection, component malposition, instability, and other secondary causes are excluded before arthrofibrosis is diagnosed. MUA remains the principal first-line procedural intervention once early conservative measures fail. Earlier MUA, generally within 6–12 weeks, is associated with greater ROM gain than delayed intervention, although outcomes remain influenced by baseline ROM severity, patient selection, and the quality of post-manipulation rehabilitation.

Conclusion

Post-TKA stiffness is a heterogeneous complication requiring structured evaluation and staged management. When MUA fails, escalation to arthrolysis or revision TKA should be individualised and guided by the distinction between persistent soft-tissue fibrosis and correctable mechanical pathology. A practical algorithm is proposed to support diagnosis, timing of intervention, and escalation after failed MUA.