{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:07:56Z","timestamp":1789024076646,"version":"build-2803163510"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of the Witwatersrand"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["International Orthopaedics (SICOT)"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats: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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A narrative review was performed using literature relating to post-TKA stiffness, arthrofibrosis, diagnostic evaluation,\u00a0rehabilitation, MUA, lysis of adhesions, and revision TKA. Evidence was synthesised thematically to support a practical diagnostic and management framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Acquired idiopathic stiffness occurs in approximately 3.6% to 4.0% of TKAs, while MUA is required in roughly 2.6% to\u00a03.6% of cases. The available literature supports a diagnosis-of-exclusion approach, in which infection, component\u00a0malposition, instability, and other secondary causes are excluded before arthrofibrosis is diagnosed. MUA remains\u00a0the principal first-line procedural intervention once early conservative measures fail. Earlier MUA, generally within 6\u201312 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00264-026-06905-0","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T23:36:51Z","timestamp":1782344211000},"page":"2337-2346","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reluctant knee: understanding and managing stiffness after total knee arthroplasty"],"prefix":"10.1007","volume":"50","author":[{"given":"Sakeena","family":"Hosanee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nnena","family":"Elebo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nkhodiseni","family":"Sikhauli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jurek Rafal Tomasz","family":"Pietrzak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"6905_CR1","doi-asserted-by":"publisher","unstructured":"Ramos MS, Pasqualini I, Surace PA, Molloy RM, Deren ME, Piuzzi NS (2023) Arthrofibrosis After Total Knee Arthroplasty: A Critical Analysis Review. 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