Shoulder to knee: lessons learnt
A controversial issue is deciding when to intervene with a stiff knee. Harder still is what to do when stiffness is still a problem many months after surgery. In today's age, under the constant scrutiny of funders, institutions and surgical peers amongst others, surgeons are aware of the problems of overservicing, iatrogenic problems and working in an evidence‐free zone. Managing the stiff knee after total joint replacement is one of those chestnuts.
Formby et al.1 have reported a simple approach that leverages the established experience with frozen shoulders, namely, hydrodilatation. In frozen shoulders, the painful restricted range of motion is relieved by dilating the shoulder joint with sterile fluid. The fluid serves to ‘tear’ joint adhesions in all directions as the fluid balloons outward stressing all parts of the joint capsule. This procedure can be done either in theatre or in a radiology suite. The latter is more common.
Interestingly, hydrodilatation of the knee, per se, has not been a specific option despite the successes in the shoulder. Usually, any form of hydrodilatation is performed in conjunction with arthroscopy and the impact of the distention is missed. Formby et al. report a small series from a wider and longer experience showing that up to 20 degrees of additional range can be achieved and maintained following hydrodilatation alone. As in the shoulder, done as a day procedure, under light sedation and without the need for operative instrumentation, hydrodilatation of the knee may be a simple, safe, resourceful and cost‐effective means of treating knee stiffness after total joint replacement.
Sometimes, the simplest things can be the sweetest.