Background: Arthrofibrosis affects up to 13% of patients after total knee arthroplasty (TKA), causing major pain, and functional deficits, reducing quality of life, and is responsible for 10% of revision surgeries within the first five years. Arthroscopic lysis of adhesions (LOAs) is a potential treatment option to improve patients' pain and function, but current literature is limited and inconclusive. The purpose of this study was to report outcomes of TKA patients undergoing LOA and identify risk factors for failure.
Methods: Charts were reviewed for 103 patients who underwent LOA for arthrofibrosis following TKA from 2012 to 2022 by three surgeons in a single private practice. Patient demographics, comorbidities, operative factors, and outcomes were reported and compared between LOA patients who did and did not undergo revision TKA.
Results: An LOA significantly improved knee flexion by 51.2°, extension by 8.9°, and total range of motion (ROM) by 60°. At final follow-up (mean 1.7 years), patients had mean extension of 2.8° (SD 4.9), flexion of 103° (SD 20.1) and total ROM 100.0° (SD 22.1). There were 14 (13.6%) patients who underwent revision TKA, eight (7.8%) of whom were for arthrofibrosis. The patient who underwent revision had significantly lower pre-LOA knee flexion, 72.5 versus 80.9°. Male sex (odds ratio [OR] 0.10), body mass index (OR 0.80), and pre-LOA knee flexion (OR 0.94) were significant predictors of requiring revision TKA for arthrofibrosis.
Conclusions: Arthroscopic lysis of adhesions significantly improved ROM for TKA patients who had arthrofibrosis and subsequent revisions were lower than those reported in literature. An LOA is a viable option for the treatment of arthrofibrosis that may reduce the risk of requiring revision TKA in select patients.
Keywords: arthrofibrosis; knee arthroscopy; lysis of adhesions; postoperative complications; primary total knee arthroplasty.
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