Arthrofibrosis Associated With Total Knee Arthroplasty

Cheuy, Victor A.; Foran, Jared R.H.; Paxton, Roger; Bade, Michael; Zeni, Joseph A.; Stevens-Lapsley, Jennifer E.

doi:10.1016/j.arth.2017.02.005

Cited by 184 publications

(188 citation statements)

References 90 publications

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“…This combined with the other risk factors identified could be used to identify an "at risk group" pre-operatively, who may benefit from peri-operative interventions or at least made aware during the consent process that they are at risk of increased symptoms of stiffness and are less likely to be satisfied. There are multiple post-operative interventions suggested to prevent stiffness from occurring [6]. However, with greater understanding of fibrosis pathways there may be inhibitors that may stop the post-operative stiffness from developing [1], which may improve the patients functional outcome and satisfaction.…”

Section: Discussionmentioning

confidence: 99%

“…Arthrofibrosis is a significant complication following TKA, which is reported to have an incidence of between 1 and 13% [6]. Post-operative fibrosis of the knee is defined as a limited range of movement (in flexion and/or extension), that is not attributable to specific cause, but due to soft-tissue fibrosis that was not present pre-operatively [13].…”

Section: Discussionmentioning

confidence: 99%

“…Stiffness after knee arthroplasty may have a genetic component and epidemiological studies have found chromosomal changes in those reporting such symptoms [14], with an increased understanding of the biological basis for such a host response [16]. This is leading to a greater awareness that stiffness is potentially avoidable both from a mechanical and biological perspective [6].…”

Section: Introductionmentioning

confidence: 99%

“…It is recognized that reported symptoms of stiffness, failing to squat and kneel, after surgery results in a poor outcome for the patient [17]. Approximated five percent of patients suffer stiffness as a significant complication after their TKA [6], and some require manipulation under anaesthesia [22] or revision surgery because of persistent stiffness [18]. Stiffness after knee arthroplasty may have a genetic component and epidemiological studies have found chromosomal changes in those reporting such symptoms [14], with an increased understanding of the biological basis for such a host response [16].…”

Section: Introductionmentioning

confidence: 99%

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Increased symptoms of stiffness 1 year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction

Clement

Bardgett

Weir

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Purpose Symptoms of stiffness after total knee arthroplasty (TKA) cause significant morbidity, but there is limited data to facilitate identification of those most at risk after surgery. Stratifying risk can aid earlier directed treatment options. Methods A retrospective cohort consisting of 2589 patients undergoing a primary TKA was identified from an established arthroplasty database. Patient demographics, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and short form (SF) 12 scores were collected pre-operatively and 1 year post-operatively. In addition, patient satisfaction was assessed for 1 year. Patients with a worse WOMAC stiffness score in 1 year were defined as the "increased" stiffness group and the other cohort as the non-stiffness group. Results At 1 year after surgery 129 (5%) patients had a significant increase in their stiffness symptoms (20%, 95% confidence interval (CI) 17.9-22.0, p < 0.001), and had significantly (all p < 0.001) less of an improvement in their pain, function and total WOMAC scores, and SF-12 scores compared to the non-stiffness group (n = 2460). Patient satisfaction was significantly lower (odds ratio (OR) 0.178, CI 0.121 to 0.262, p < 0.001) for the increased stiffness group. Logistic regression analysis identified male gender (OR 1.66, p = 0.02), lung disease (OR 2.06, p = 0.002), diabetes (OR 1.82, p = 0.02), back pain (OR 1.81, p = 0.005), and a pre-operative stiffness score of 44 or more (OR 5.79, p < 0.001) were significantly predictive of increased stiffness. Conclusion Patients with increased symptoms of stiffness after TKA have a worse functional outcome and a lower rate of patient satisfaction, and patients at risk of being in this group should be informed pre-operatively. Level of evidence Retrospective prognostic study, Level III.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Increased symptoms of stiffness 1 year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction

Clement

Bardgett

Weir

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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“…Joint capsule contracture and the formation of intra‐articular fibrotic lesions can result in severe limitations in joint mobility . Fibrosis often develops after joint trauma or major surgical procedures such as total knee arthroplasty (TKA) and anterior cruciate ligament (ACL) reconstruction . Approximately, 3–10% of TKA patients are treated for arthrofibrosis, while 2–35% of ACL reconstruction patients and 14.5% of patients with knee intra‐articular fractures require intervention .…”

mentioning

confidence: 99%

Sulfasalazine Resolves Joint Stiffness in a Rabbit Model of Arthrofibrosis

Atluri

Brouillette

Seol

et al. 2019

Journal Orthopaedic Research

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Joint stiffness due to fibrosis/capsule contracture is a seriously disabling complication of articular injury that surgical interventions often fail to completely resolve. Fibrosis/contracture is associated with the abnormal persistence of myofibroblasts, which over‐produce and contract collagen matrices. We hypothesized that intra‐articular therapy with drugs targeting myofibroblast survival (sulfasalazine), or collagen production (β‐aminopropionitrile and cis‐hydroxyproline), would reduce joint stiffness in a rabbit model of fibrosis/contracture. Drugs were encapsulated in poly[lactic‐co‐glycolic] acid pellets and implanted in joints after fibrosis/contracture induction. Capsule α‐smooth muscle actin (α‐SMA) expression and intimal thickness were evaluated by immunohistochemistry and histomorphometry, respectively. Joint stiffness was quantified by flexion‐extension testing. Drawer tests were employed to determine if the drugs induced cruciate ligament laxity. Joint capsule fibroblasts were tested in vitro for contractile activity and α‐SMA expression. Stiffness in immobilized joints treated with blank pellets (control) was significantly higher than in non‐immobilized, untreated joints (normal) (p = 0.0008), and higher than in immobilized joints treated with sulfasalazine (p = 0.0065). None of the drugs caused significant cruciate ligament laxity. Intimal thickness was significantly lower than control in the normal and sulfasalazine‐treated groups (p = 0.010 and 0.025, respectively). Contractile activity in the cells from controls was significantly increased versus normal (p = 0.001). Sulfasalazine and β‐aminopropionitrile significantly inhibited this effect (p = 0.005 and 0.0006, respectively). α‐SMA expression was significantly higher in control versus normal (p = 0.0021) and versus sulfasalazine (p = 0.0007). These findings support the conclusion that sulfasalazine reduced stiffness by clearing myofibroblasts from fibrotic joints. Statement of clinical significance: The results provide proof‐of‐concept that established joint stiffness can be resolved non‐surgically. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:629–638, 2020

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The efficacy of vitamin E in preventing arthrofibrosis after joint replacement

Fan,

Yuh,

Lekkala

et al. 2024

Anim Models and Exp Med

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BackgroundArthrofibrosis is a joint disorder characterized by excessive scar formation in the joint tissues. Vitamin E is an antioxidant with potential anti‐fibroblastic effect. The aim of this study was to establish an arthrofibrosis rat model after joint replacement and assess the effects of vitamin E supplementation on joint fibrosis.MethodsWe simulated knee replacement in 16 male Sprague–Dawley rats. We immobilized the surgical leg with a suture in full flexion. The control groups were killed at 2 and 12 weeks (n = 5 per group), and the test group was supplemented daily with vitamin E (0.2 mg/mL) in their drinking water for 12 weeks (n = 6). We performed histological staining to investigate the presence and severity of arthrofibrosis. Immunofluorescent staining and α2‐macroglobulin (α2M) enzyme‐linked immunosorbent assay (ELISA) were used to assess local and systemic inflammation. Static weight bearing (total internal reflection) and range of motion (ROM) were collected for functional assessment.ResultsThe ROM and weight‐bearing symmetry decreased after the procedure and recovered slowly with still significant deficit at the end of the study for both groups. Histological analysis confirmed fibrosis in both lateral and posterior periarticular tissue. Vitamin E supplementation showed a moderate anti‐inflammatory effect on the local and systemic levels. The vitamin E group exhibited significant improvement in ROM and weight‐bearing symmetry at day 84 compared to the control group.ConclusionsThis model is viable for simulating arthrofibrosis after joint replacement. Vitamin E may benefit postsurgical arthrofibrosis, and further studies are needed for dosing requirements.

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Arthrofibrosis Associated With Total Knee Arthroplasty

Cited by 184 publications

References 90 publications

Increased symptoms of stiffness 1 year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction

Increased symptoms of stiffness 1 year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction

Sulfasalazine Resolves Joint Stiffness in a Rabbit Model of Arthrofibrosis

The efficacy of vitamin E in preventing arthrofibrosis after joint replacement

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