Arthrofibrosis After Total Knee Arthroplasty: Pathophysiology, Diagnosis, and Management

Orthop Clin North Am. 2019 Jul;50(3):269-279. doi: 10.1016/j.ocl.2019.02.005. Epub 2019 Apr 16.

Abstract

Arthrofibrosis is the pathologic stiffening of a joint caused by an exaggerated inflammatory response. As a common complication following total knee arthroplasty (TKA), this benign-appearing connective tissue hyperplasia can cause significant disability among patients because the concomitant knee pain and restricted range of motion severely hinder postoperative rehabilitation, clinical outcomes, and basic activities of daily living. The most effective management for arthrofibrosis in the setting of TKA is prevention, including preoperative patient education programs, aggressive postoperative physical therapy regimens, and anti-inflammatory medications. Operative treatments include manipulation under anesthesia, arthroscopic debridement, and quadricepsplasty.

Keywords: Arthrofibrosis; Arthroscopic debridement; Manipulation under anesthesia; Quadricepsplasty; Total knee arthroplasty.

Publication types

  • Review

MeSH terms

  • Activities of Daily Living
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Arthralgia / etiology
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Arthroscopy
  • Debridement
  • Fibrosis
  • Humans
  • Joint Diseases / diagnosis
  • Joint Diseases / pathology*
  • Joint Diseases / physiopathology
  • Joint Diseases / therapy*
  • Knee Joint / pathology*
  • Knee Joint / physiopathology
  • Knee Joint / surgery
  • Manipulation, Orthopedic
  • Physical Therapy Modalities
  • Postoperative Complications / diagnosis
  • Postoperative Complications / pathology
  • Postoperative Complications / physiopathology
  • Postoperative Complications / therapy
  • Range of Motion, Articular
  • Reoperation
  • Risk Factors

Substances

  • Anti-Inflammatory Agents, Non-Steroidal