The stiff total knee arthroplasty: evaluation and management.

Arthrofibrosis after total knee arthroplasty is a relatively common complication. A variety of modalities have been employed to treat this problem, including physical therapy, injections, and manipulations. We examined a group of consecutive posterior stabilized total knee arthroplasties to determine the prevalence of arthrofibrosis, as defined by flexion <90 degrees, and the effect of manipulation under anesthesia on outcome. Approximately 11% of the patients met the criteria for arthrofibrosis. Manipulation under anesthesia was successful in improving flexion from an average of 67 degrees premanipulation to 111 degrees postmanipulation. The group that required manipulation did as well statistically as the group as a whole, which had a mean flexion of 114 degrees at 1 year.