Outcome Of Arthroscopic Arthrolysis Of Arthrofibrosis After Total Knee Replacement

Introduction Chronic pain and stiffness occurring after total knee arthroplasty are frustrating for both the patient and the surgeon. After total knee arthroplasty (TKA), there is a relatively small group of patients who develop a painful joint with suboptimal range of motion (ROM) despite optimal surgical technique and good radiographic appearance. Arthrofibrosis, for the most part, is an uncommon complication of primary TKA. It is thought to be caused by excessive fibroplasia, which results in the formation of adhesions that constrain the extensor mechanism. It is known that arthrofibrosis develops in response to surgical intervention in approximately 3-4% of patients undergoing TKA, and the resulting pain and loss of range of motion leads to disability. The options for the patient and the surgeon in this situation are either to accept the reduced range of motion or have it addressed with nonsurgical or surgical means. The surgical options are four fold: manipulation under anesthesia (MUA), arthroscopic arthrolysis, open arthrolysis or revision of some or all of the components. Arthrofibrosis responds poorly to treatment, which may include physiotherapy, long-term peridural anesthesia (# 2 weeks), closed manipulation, arthroscopic debridement, and open procedures, including revision surgery with exchange of prosthetic components. However, manual manipulation has significant risk, including complications such as distal femoral fracture and patellar tendon rupture. Open arthrolysis is a more invasive option, and it allows a wide access to the anterior and posterior aspects of the joint. The arthroscopic approach is a powerful and controlled method that is effective both for focal, discrete lesions as well as for more global arthrofibrosis, and avoids the risk of fracture inherent to MUA. Arthroscopic arthrolysis consists of lysis of direct adhesions and is indicated in the case of arthrofibrosis in patients with a difficult rehabilitation and no other apparent cause of stiffness and pain. The ideal indication is a painless, stiff knee that has not improved after 3–6 months of conservative treatment. Although poor results have been reported in painful stiff knees, we think this seems to be a consequence of wrong diagnosis. Arthroscopic management of arthrofibrosis after TKA can be an efficient, relatively cheap and safe mode of treatment, if performed with experienced hands, and followed by regional pain block and immediate intensive physiotherapy. The purpose of this study was to evaluate the clinical and functional results of arthroscopic management in patients with knee stiffness after TKA without evidence of infection, fracture, wear, and component loosening or malposition.