Arthroscopic arthrolysis after total knee arthroplasty.

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 v 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.