Arthroscopic arthrolysis after total knee arthroplasty.
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Date
2020
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Abstract
Arthrofibrosis is an uncommon reason for poor outcomes after Total Knee Arthroplasty (TKA).
There is paucity of evidence for the management of this complication. The aim of this study was
to assess the longitudinal changes in the range of motion pre- and post-TKA, pre- and post-arthroscopy
and at final follow up in patients who had arthroscopic arthrolysis for arthrofibrosis after TKA.
Patients were identified from a prospectively collected database who had an arthroscopic
arthrolysis for decreased range of movement following TKA which was not present immediately
post-TKA and not attributable to any other cause. Patients underwent a systematic arthrolysis,
manipulation under anaesthesia (MUA) and intensive physical therapy thereafter. The main
outcome measures were range of motion (ROM) recorded at different intervals and overall
patient satisfaction.
A total of 16 patients were included for analysis. Patients were followed-up for a mean of 20
months (range 1 - 48 months) after the arthroscopic arthrolysis and MUA. The median prearthroscopic
ROM was 28° (IQR 18°- 40°) and following arthroscopy was found to be 90° (IQR
88°- 100°). These gains however decreased with time to a median of 65° (IQR 38°- 88°) at final
follow up. The mean improvement in the range of motion from the pre-arthroscopy value to that
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found at final follow-up was 32 (95% CI = 19.0 - 45.3, p < 0.001). Three quarters of patients
were satisfied with the outcome of the procedure. One patient developed a complication in the
form of an iatrogenic patella fracture.
Where other causes for knee loss of movement and pain have been ruled out, and arthrofibrosis
is likely to be the sole cause of knee stiffness, arthroscopic debridement may be of benefit to
improve ROM even if performed more than one year after the arthroplasty.
Description
Masters Degree. University of KwaZulu-Natal, Durban.