Knee Arthroscopy After Total Knee Arthroplasty: Not a Benign Procedure

Lovro, Luke R.; Kang, Haeyoun; Bolia, Ioanna K; Homere, Andrew; Weber, Alexander E.; Heckmann, Nathanael

doi:10.1016/j.arth.2020.06.082

Cited by 11 publications

(9 citation statements)

References 24 publications

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“…13,25 A high complication rate of 13.9% was seen in this study (Table 4), in line with prior literature, with reported rates between 13% and 19% after MUA and up to 23.2% after ALA for all-cause complications. 18,23,[28][29][30][31][32] Specific patient comorbidities were not associated with increased risk of overall complications in this study, as had been suggested in previous studies. [2][3][4]10 Interestingly, CCI was correlated with an increased overall risk of complications, suggesting overall health status, rather than specific comorbidities that may be risk factors of complications after interventions for arthrofibrosis.…”

Section: Discussionsupporting

confidence: 81%

“…39,40 The relative complication rate for ALA was markedly higher in this study, driven by the high incidence of SSIs. Lovro et al 29 highlighted the nonbenign nature of arthroscopic intervention after TKA in a large series of TKA patients from the Medicare database. Similar to this study, an 18.8% TKA revision rate was seen after Graph showing complication-free survival time.…”

Section: Discussionmentioning

confidence: 99%

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High Complication Rate Associated With Arthroscopic Lysis of Adhesions Versus Manipulation Under Anesthesia for Arthrofibrosis After Total Knee Arthroplasty

Thomas

Liu

Varady

et al. 2022

J Am Acad Orthop Surg

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Background:Arthrofibrosis after total knee arthroplasty (TKA) is often treated by arthroscopic lysis of adhesions (ALAs) or manipulation under anesthesia (MUA). This study compared the 2-year complication rates of ALA and MUA and range-of-motion (ROM) outcomes for ALA, early MUA (<3 months after TKA), and delayed MUA (>3 months after TKA).Methods:This retrospective cohort study included 425 patients undergoing ALA or MUA after primary TKA from 2001 to 2018. Demographics, clinical variables, and complication rates were collected from clinical records and compared using Student t-tests and Kaplan-Meier log-rank tests. Multivariable logistic regressions were used for adjusted analysis. ROM data were analyzed using fixed and mixed-effects models.Results:ALA patients were younger (55.2 versus 58.9 years, P < 0.001) and underwent surgery later from the index TKA (12 versus 1.9 months, P < 0.001). The Charlson Comorbidity Index was higher in the MUA group. Preoperative ROM was significantly worse in the MUA cohort, but did not differ between groups after the procedure (117°, P = 0.27) or at 2 years. Demographics and ROM outcomes were equivalent between early MUA and delayed MUA (P = 0.75). The incidence of repeat arthrofibrosis (7.1%) and revision arthroplasty (2.4%) was similar between ALA and MUA cohorts while ALA patients had significantly more surgical site infections (3.8%) compared with MUA patients (0.47%, P = 0.017).Discussion:Equivalent ROM outcomes were seen between ALA, early MUA, and delayed MUA for the treatment of arthrofibrosis after TKA. However, this study demonstrated a markedly higher complication rate, particularly surgical site infection, after ALA, suggesting that MUA may be the preferred option for treating arthrofibrosis at both early and late time points.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

High Complication Rate Associated With Arthroscopic Lysis of Adhesions Versus Manipulation Under Anesthesia for Arthrofibrosis After Total Knee Arthroplasty

Thomas

Liu

Varady

et al. 2022

J Am Acad Orthop Surg

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“…There were several hypotheses for the increased risk of infection as proposed by Werner et al, including violation of the joint capsule, persistent post-arthroscopy synovitis, bacterial seeding of the joint during KA and postoperative portal tracts as possible mechanisms for subsequent infection [ 22 ]. Lovro et al studied 192 TKA patients who underwent subsequent knee arthroscopy using the information from the Medicare database with an FU of 5.45 years [ 17 ]. The incidence of revision for infection was 6.3%.…”

Section: Discussionmentioning

confidence: 99%

“…Those studies had shortcomings in that they involved relatively few patients, leading to limited statistical power, and the follow-up period was also short. As the follow-up period lengthens, late infection might occur [ 17 ]. Lovro et al noted that knee arthroscopy after arthroplasty was not a benign procedure, with a significantly higher risk of PJI compared to post-TKA patients who did not undergo arthroscopy; however, the authors did not report the conditions of other non-infectious complications [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…As the follow-up period lengthens, late infection might occur [ 17 ]. Lovro et al noted that knee arthroscopy after arthroplasty was not a benign procedure, with a significantly higher risk of PJI compared to post-TKA patients who did not undergo arthroscopy; however, the authors did not report the conditions of other non-infectious complications [ 17 ]. In terms of therapeutic efficacy, the results from previous studies have varied [ 5 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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The role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study

et al. 2020

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Background To investigate the feasibility, safety and therapeutic efficacy of arthroscopy in managing the 3 most common soft tissue complications, peripatellar impingement (PI), arthrofibrosis (AF) and generalized synovitis (GS), after total knee arthroplasty (TKA). Methods A retrospective review of patients undertaking arthroscopy for PI, AF and GS was conducted. Outcome measures included complications, postoperative range of motion (ROM), Knee Society Score (KSS) and rates of symptom recurrence, prosthesis revision. Intraoperative findings and surgical procedures were also recorded. Paired t test, Fisher’s exact test, Kruskal-Wallis test and post hoc analysis with Bonferroni correction were used for statistical evaluation. Results A total of 74 patients, including 35 patients with peripatellar impingement, 25 patients with arthrofibrosis and 14 patients with generalized synovitis, with a mean age of 66.1 ± 7.9 years, were analysed. The mean follow-up (FU) duration was 81.3 ± 40.6 months. All patients underwent arthroscopic surgery safely without intraoperative complications. However, there were 4 postoperative complications, including 1 acute myocardial infarction and 3 periprosthetic joint infections. Overall, patients acquired improvements in ROM from 81.7 ± 23.1° to 96.8 ± 20.5° (p < 0.05), in KSS knee score from 64.2 ± 9.6 to 78.7 ± 12.1 (p < 0.05) and in KSS function score from 61.1 ± 7.4 to 77.3 ± 12.2 (p < 0.05) postoperatively. Patients in all 3 groups had improvements in ROM (p < 0.05), KSS knee score (p < 0.05) and KSS function score (p < 0.05). The overall recurrence rate was 22.9% (95% confidence interval (CI) 15.1–34.9%), and the overall revision rate was 14.9% (95% CI 8.6–25.6%). There were significant differences in both the symptom recurrence and prosthesis revision rates among the groups (p < 0.05). The PI group had a significantly lower symptom recurrence rate (11.4%, 95% CI 4.5–28.7%) and revision rate (8.6%, 95% CI 2.9–25.3%) (p < 0.017), while the GS group had a significantly higher recurrence rate (42.9%, 95% CI 23.4–78.5%) and revision rate (35.7%, 95% CI 17.6–72.1%) (p < 0.017). Conclusions In the setting of symptomatic TKA, although carrying certain risks for PJI and other complications, arthroscopic intervention could be feasible and provide clinical improvement in most cases at an average of 81.3 months follow-up. Patients with PI had the best outcomes, while patients with GS had the worst outcomes. Level of evidence Level IV

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Arthroscopie du genou prothétique

Pioger¹

2023

l'Arthroscopie Du Genou

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Knee Arthroscopy After Total Knee Arthroplasty: Not a Benign Procedure

Cited by 11 publications

References 24 publications

High Complication Rate Associated With Arthroscopic Lysis of Adhesions Versus Manipulation Under Anesthesia for Arthrofibrosis After Total Knee Arthroplasty

High Complication Rate Associated With Arthroscopic Lysis of Adhesions Versus Manipulation Under Anesthesia for Arthrofibrosis After Total Knee Arthroplasty

The role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study

Arthroscopie du genou prothétique

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