2026 COA: TKA for Stiffness with Hinged vs Non-Hinged Implants with/without Irradiation Therapy .

11 studies evaluating patients with acquired idiopathic stiffness (AIS) following total knee arthroplasty (TKA) were included in this systematic review and network meta-analysis, with 5 studies eligible for quantitative analysis comparing hinged and non-hinged revision prostheses with or without adjuvant irradiation. Pooled outcomes of interest included range of motion (ROM), functional scores, complications, and implant survivorship. Revision using hinged prostheses without irradiation resulted in significantly greater improvements in arc of motion compared with non-hinged prostheses without irradiation. Although hinged prostheses with irradiation demonstrated a similar magnitude of ROM improvement, the difference was not statistically significant. Overall, hinged prostheses appear to provide superior ROM gains in revision TKA for AIS, while the benefit of adjuvant irradiation remains unclear.