{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:59:33Z","timestamp":1790636373848,"version":"4.1.0"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Orthop Unfall"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The stiff total knee arthroplasty (TKA) remains a major driver of dissatisfaction after\n      primary implantation. Persisting myofibroblasts and a transforming growth factor-beta\n      (TGF-\u03b2)\u2013driven scar matrix underlies painful limitations in flexion\/extension, either\n      independent of or in addition to mechanical problems. A pragmatic diagnostic pathway includes\n      structured history and examination, conventional radiographs, mandatory exclusion of\n      periprosthetic joint infection, and targeted three-dimensional computed tomography (3D-CT) and\n      single-photon emission computed tomography (SPECT-CT) for malposition\/overstuffing; metal\n      artifact reduction sequence MRI (MARS-MRI) supports soft-tissue\u2013predominant pathology.\n      Management is time-critical: early multimodal, opioid-sparing analgesia, strict oedema\n      control, and pain-adapted physiotherapy; if flexion remains &lt;\u00a090\u201395\u00b0 by week 6\u20138,\n      manipulation under anaesthesia (MUA) (ideally \u2264\u00a012 weeks) with immediate remobilization is\n      indicated. Persistent adhesions are treated arthroscopically or openly; mechanical causes or\n      failure warrant revision, including rotating-hinge strategies in selected cases. Early risk\n      stratification, a stepwise algorithm, and tightly controlled rehabilitation stabilize\n      range-of-motion gains and reduce reinterventions, although patient-reported outcomes may\n      remain limited.<\/jats:p>","DOI":"10.1055\/a-2811-4624","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:03:37Z","timestamp":1773792217000},"page":"435-443","source":"Crossref","is-referenced-by-count":1,"title":["Diagnosis and Management of the Stiff Total Knee Arthroplasty"],"prefix":"10.1055","volume":"164","author":[{"given":"Lisa","family":"Wiederhold","sequence":"additional","affiliation":[{"name":"Orthop\u00e4dische Klinik K\u00f6nig-Ludwig-Haus, Deutschland","place":["W\u00fcrzburg"],"department":["Orthop\u00e4die"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Anderson","sequence":"additional","affiliation":[{"name":"Orthop\u00e4dische Klinik K\u00f6nig-Ludwig-Haus, Deutschland","place":["W\u00fcrzburg"],"department":["Orthop\u00e4die"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Oberfeld","sequence":"additional","affiliation":[{"name":"Orthop\u00e4dische Klinik K\u00f6nig-Ludwig-Haus, Deutschland","place":["W\u00fcrzburg"],"department":["Orthop\u00e4die"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Rudert","sequence":"additional","affiliation":[{"name":"Orthop\u00e4dische Klinik K\u00f6nig-Ludwig-Haus, Deutschland","place":["W\u00fcrzburg"],"department":["Orthop\u00e4die"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"707","DOI":"10.5435\/JAAOS-D-14-00049","article-title":"Establishing Realistic Patient Expectations Following Total Knee\n          Arthroplasty","volume":"23","author":"A Husain","year":"2015","journal-title":"J Am Acad Orthop Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1186\/s40814-022-01026-y","article-title":"Multimodal conservative management of arthrofibrosis after total knee arthroplasty\n          compared to manipulation under anesthesia: a feasibility study with retrospective cohort\n          comparison","volume":"8","author":"MR Rauzi","year":"2022","journal-title":"Pilot Feasibility Stud"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"16469","DOI":"10.1038\/srep16469","article-title":"Fibrosis is a common outcome following total knee arthroplasty","volume":"5","author":"N Abdul","year":"2015","journal-title":"Sci Rep"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.arth.2005.06.004","article-title":"Predictive risk factors for stiff knees in total knee arthroplasty","volume":"21","author":"R Gandhi","year":"2006","journal-title":"J Arthroplasty"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.RVW.23.00140","article-title":"Arthrofibrosis After Total Knee Arthroplasty: A Critical Analysis\n          Review","volume":"11","author":"MS Ramos","year":"2023","journal-title":"JBJS Rev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"S116","DOI":"10.1016\/j.arth.2013.04.056","article-title":"Why are total knees failing today? 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