Zarządzanie sztywnością po całkowitej artroplastyce kolana: wpływ czasu interwencji i techniki chirurgicznej na wyniki kliniczne

INTRODUCTION: Postoperative knee stiffness following total knee arthroplasty (TKA) is a challenging complication that may require surgical intervention when conservative treatment fails. Although manipulation under anesthesia (MUA) and arthroscopic arthrolysis (AA) are commonly used treatments, their comparative effectiveness and the role of timing in clinical outcomes remain uncertain. PURPOSE: To compare clinical outcomes of MUA and AA for postoperative knee stiffness after TKA and to evaluate the impact of timing from index arthroplasty on range of motion (ROM) improvement. METHODS: A retrospective cohort study was conducted including patients treated for postoperative knee stiffness following TKA between 2003 and 2023, with a minimum 12-month follow-up. Patients underwent MUA or AA. ROM was assessed preoperatively, intraoperatively, and at final follow-up. Outcomes were analysed according to surgical technique and timing of intervention. Complications were recorded. RESULTS: Eighty-four patients were included (mean age 67.8 ± 7.5 years; 63.5% women), with 52 undergoing MUA and 32 AA. Preoperative ROM was comparable between groups (66.1° ± 14.2° vs 61.3° ± 12.3°; p = 0.353). Both techniques significantly improved ROM at final follow-up, with no between-group differences (90.9° ± 11.3° vs 86.7° ± 11.3°; p = 0.361). Mean ROM gain was similar (24.8° ± 12.8° vs 25.4° ± 11.9º; mean difference 0.6, p = 0.732). Earlier intervention was associated with greater ROM gain, with higher improvements observed within 0-3 and 3-6 months compared to > 6 months (28.1° ± 14.2°, 30.1° ± 13.1°, and 21.3° ± 25.9°, respectively; p = 0.038). Subgroup analysis by timing interval showed no differences between MUA and AA. CONCLUSION: Both MUA and AA were effective and demonstrated no significant difference in ROM improvement following TKA stiffness. Earlier intervention was associated with greater ROM gains, suggesting that timing may be an important factor in optimizing outcomes.