SynthesisInternational orthopaedics2021
Causes of stiffness after total knee arthroplasty: a systematic review.
Synthesis in International orthopaedics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 32 citations in OpenAlex.
- Complications and downsides of the robotic total knee arthroplasty: a systematic review.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Pooled it
- Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis.PloS one · 2023Pooled it
- Sensor-guided gap balance versus manual gap balance in primary total knee arthroplasty: a meta-analysis.Journal of orthopaedic surgery and research · 2022Pooled it
- Chronic Pain and Stiffness After Total Knee Arthroplasty: A Comprehensive, Phenotype-Based Review of Mechanisms, Diagnosis and Management.Journal of clinical medicine · 2026Review
- Research Trends on Perioperative Complications of Knee Replacement: A Bibliometric Analysis.Clinics in orthopedic surgery · 2026Review
- Effect of traction therapy on muscle satellite cell proliferation and differentiation in a rat model of knee stiffness.Stem cell research & therapy · 2024Article
- Robotic-assisted total knee arthroplasty is not associated with improved accuracy in implant position and alignment compared to conventional instrumentation in the execution of a preoperative digital plan.Journal of experimental orthopaedics · 2024Article
- The acute cross-education effect of foam rolling on the thigh muscles in patients after total knee arthroplasty.Frontiers in rehabilitation sciences · 2024Article
- No difference in sports participation and patient-reported functional outcomes between total knee arthroplasty and unicompartmental knee arthroplasty at minimum 2-year follow-up in a matched control study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Total knee arthroplasty improves sports activity and the patient-reported functional outcome at mid-term follow-up.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Article
- Association of circulating gene expression signatures with stiffness following total knee arthroplasty for osteoarthritis: a pilot study.Scientific reports · 2022Article
- Preoperative Strength Training for Clinical Outcomes Before and After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.Frontiers in surgery · 2022Review
- Evaluation of the Efficacy and Safety of an Exercise Program for Persons with Total Hip or Total Knee Replacement: Study Protocol for a Randomized Controlled Trial.International journal of environmental research and public health · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundKnee stiffness after total knee arthroplasty (TKA) often leads to pain and discomfort, failing to meet patients' expectations on the surgical procedure. Despite the growing debate on the topic, a comprehensive literature analysis of stiffness causes has never been conducted. Thus, the purpose of the present study was to systematically review the literature regarding the main causes of stiffness after TKA.
methodsPubmed Central, Scopus, and EMBASE databases were systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines for studies on stiffness and pain or discomfort after TKA through November 2020. Overall, 25 articles matched the selection criteria and were included in the study. Clinical relevance and strength of evidence of the included studies were graded using the risk of bias and the methodological index for non-randomized studies quality assessment tools.
resultsThe main causes of pain and discomfort due to stiffness were surgery-related issues, i.e., component malpositioning and over-voluming, implant loosening, psychological distress, and obesity, which could be considered "modifiable" factors, and expression of profibrotic markers, high material hypersensitivity-related cytokines level, male gender, previous contralateral TKA, and high pre-operative pain, which could be considered "non-modifiable" factors.
conclusionThe use of alternative technologies such as surgical robots, anatomy-based devices, and more inert and less stiff component materials could help in reducing stiffness caused by both modifiable and even some non-modifiable factors. Furthermore, early diagnostic detection of stiffness onset could consistently support surgeons in patient-specific decision-making.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.