COPYRIGHT © 2006 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED  Management of Stiffness Following Total Knee Arthroplasty BY JAVAD PARVIZI, MD, FRCS, T. DAVID T ARITY , BS, MARLA J. STEINBECK, PHD, ROMAN G. POLITI, BS, ASHISH JOSHI, MD, MPH, JAMES J. PURTILL, MD, AND PETER F. SHARKEY , MD Introduction tiffness following total knee arthroplasty is a disabling complication 1-7 . Although some predisposing factors have been identified, in most cases the exact etiology of the stiffness cannot be discerned. The reported prevalence of this complication has ranged widely from 1.3% to 12% 1,8-10 . The difference in rate may be due in part to varied definitions of stiffness 11 . Several factors affecting the postoperative range of motion that have been identified include the preoperative range of motion, contracture of the extensor mechanism and capsular structure, the preoperative diagnosis, personality of the patient, lack of patient compliance with the rehabilitation protocol, and the patient’s threshold for pain 12-18 . Technical factors, such as overstuffing the patellofemo- ral joint, mismatch of the flexion and extension gaps, inac- curate ligament balancing, component malpositioning, use of oversized components, joint-line elevation, excessive tightening of the extensor mechanism, and underresection of the patella have also been implicated 1,19 . Various manage- ment protocols have been proposed to address this compli- cation. This exhibit presents our institutional experience with the management of stiffness following total knee ar- throplasty. We report the findings of a case-control study that was designed to predict the factors responsible for stiff- ness after total knee arthroplasty. In addition, the results of an ongoing basic-science study attempting to unravel the molecular mechanism of arthrofibrosis following total knee arthroplasty are presented. We also provide the outline of our current treatment strategy for the management of stiff- ness following total knee arthroplasty. S Fig. 1 Demographic distribution of patients in the study and control groups. TKA = total knee arthroplasty, and BMI = body-mass index.