RESULTS OF OPEN ARTHROLYSIS FOR THE TREATMENT OF ARTHROFIBROSIS FOLLOWING UNCEMENTED TOTAL KNEE REPLACEMENT.

Abstract

Introduction: Stiffness following Total Knee Arthroplasty is a serious and debilitating complication. There are many different patient and surgical factors implicated in it cause. Previous studies have suggested that it will occur in approximately 1% of TKR patients. Arthrofibrosis is an uncommon but potentially debilitating cause in an otherwise well positioned implant. The cause of this abnormal scar formation is as yet unknown. The treatment of this condition remains difficult and controversial. Revision of the TKR has been suggested as the gold standard treatment as other operative strategies have had limited success. Our approach to this problem has been to conserve the prosthesis and try to release the scar tissue.

Aim: The aim of this study is to assess the results of open arthrolysis in the treatment of established arthrofibrosis.

Method: 1522 patients undergoing primary uncemented TKR have been prospectively followed up (2022 TKR’s) using the International Knee Society Scores. 13 patients underwent open Arthrolysis for stiffness post-op (Incidence 0.64%). The average age was 65 (range 50–78). 6 cases were simultaneous bilateral procedures (Incidence 1.2% of simultaneous bilateral procedures). The average time between TKR and arthrolysis was 14 months. Our average follow-op was 7.2 years (range 2 – 10 years)

Results: The average ROM just prior to Arthrolysis was 58°. The average ROM six months after surgery had improved to 91° (p< 0.05). The average ROM at last follow-up was 95° (p< 0.05) with an average Knee Society score of 155 (pain 83, function 72).

No patients have required revision of their components.

Conclusions: We have found open arthrolysis a successful approach to post-op arthrofibrosis. Although a large procedure it has been well tolerated by our patients. They have had an improvement in range of movement by six months which has been maintained up to 10 years.