Lysis of Adhesion for Arthrofibrosis After Total Knee Arthroplasty Is Associated With Increased Risk of Subsequent Revision Total Knee Arthroplasty

Cregar, William M.; Khazi, Zain; Lu, Yining; Gerlinger, Tad L.

doi:10.1016/j.arth.2020.07.018

Cited by 17 publications

(10 citation statements)

References 26 publications

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“…31,[33][34][35][36] Alarmingly, studies have reported the odds of revision to be as high as 2.43 after MUA and 11.4 to 14.6 after ALA compared with nonarthrofibrotic knees. 14,37 Various etiologies of stiffness have been found at the time of revision including oversized implants, loose implants, or malrotation, in addition to isolated arthrofibrosis, which encompass an upwards of 80% of cases. 38 After failure of ALA or MUA, revision TKA has improved both ROM and Knee Society cores; however, revision should be used with caution because high rates of rerevision and complications have been reported.…”

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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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: 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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“…[39][40][41] While there are various treatment strategies for arthrofibrosis, each has demonstrated limited success. 6,42,43 Current treatment options are often insufficient due to lack of standardized characterization and definition of arthrofibrosis, making a deeper understanding crucial.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of arthrofibrosis after primary TKA is reported at approximately 5% 2,6 ; similarly, the incidence of arthrofibrosis after revision TKA ranges from 2% to 7% 39–41 . While there are various treatment strategies for arthrofibrosis, each has demonstrated limited success 6,42,43 . Current treatment options are often insufficient due to lack of standardized characterization and definition of arthrofibrosis, making a deeper understanding crucial.…”

Section: Discussionmentioning

confidence: 99%

Human outgrowth knee fibroblasts from patients undergoing total knee arthroplasty exhibit a unique gene expression profile and undergo myofibroblastogenesis upon TGFβ1 stimulation

Bayram

Thaler

Bettencourt

et al. 2022

J of Cellular Biochemistry

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Arthrofibrosis is characterized by excessive extracellular matrix (ECM) deposition that results in restricted joint motion after total knee arthroplasties (TKAs). Currently, treatment options are limited. Therefore, an in vitro model of knee-related myofibroblastogenesis is valuable to facilitate investigation of the arthrofibrotic process, diagnostic and therapeutic options. In this study, we obtained intraoperative posterior capsule (PC), quadriceps tendon (QT), and suprapatellar pouch (SP) tissues from the knees of four patients undergoing primary TKAs for osteoarthritis. From these tissues, we isolated primary cells by the outgrowth method and subsequently characterized these cells in the absence and presence of the pro-myofibroblastic cytokine, transforming growth factor beta 1 (TGFβ1). Light microscopy of knee outgrowth cells revealed spindle-shaped cells, and immunofluorescence (IF) analysis demonstrated staining for the fibroblast-specific markers TE-7 and vimentin (VIM). These knee outgrowth fibroblasts differentiated readily into myofibroblasts as reflected by enhanced α-smooth muscle actin (ACTA2) mRNA and protein expression and increased mRNA expression of collagen type 1 (COL1A1) and type 3 (COL3A1) with collagenous matrix deposition in the presence of TGFβ1.Outgrowth knee fibroblasts were more sensitive to TGFβ1-mediated myofibroblastogenesis than adipose-derived mesenchymal stromal/stem cells (MSCs). While outgrowth knee fibroblasts isolated from three anatomical regions in four patients exhibited similar gene expression, these cells are distinct from other fibroblastic cell types (i.e., Dupuytren's fibroblasts) as revealed by RNA-sequencing. In conclusion, our study provides an in vitro myofibroblastic model of outgrowth knee fibroblasts derived from patients undergoing

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“…Modifiable risk factors include surgical technique, concomitant or multiple procedures, pain management, body mass index, rehabilitation, and prolonged immobilization. [29][30][31][32][33] Nonmodifiable risk factors include the severity of trauma, pre-existing stiffness and/or inflammation, heterotopic ossification, infection, early-onset osteoarthritis, sex, and genetic predisposition. 9,28,34 Risk factors are often dependent on the joint involved and the etiology of stiffness.…”

Section: Preventionmentioning

confidence: 99%

Arthrofibrosis Nightmares: Prevention and Management Strategies

Lee

Therrien

Song

et al. 2022

Sports Medicine and Arthroscopy Review

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Arthrofibrosis (AF) is an exaggerated immune response to a proinflammatory insult leading to pathologic periarticular fibrosis and symptomatic joint stiffness. The knee, elbow, and shoulder are particularly susceptible to AF, often in the setting of trauma, surgery, or adhesive capsulitis. Prevention through early physiotherapeutic interventions and anti-inflammatory medications remain fundamental to avoiding motion loss. Reliable nonoperative modalities exist and outcomes are improved when etiology, joint involved, and level of dysfunction are considered in the clinical decision making process. Surgical procedures should be reserved for cases recalcitrant to nonoperative measures. The purpose of this review is to provide an overview of the current understanding of AF pathophysiology, identify common risk factors, describe prevention strategies, and outline both nonoperative and surgical treatment options. This manuscript will focus specifically on sterile AF of the knee, elbow, and shoulder.

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Lysis of Adhesion for Arthrofibrosis After Total Knee Arthroplasty Is Associated With Increased Risk of Subsequent Revision Total Knee Arthroplasty

Cited by 17 publications

References 26 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

Human outgrowth knee fibroblasts from patients undergoing total knee arthroplasty exhibit a unique gene expression profile and undergo myofibroblastogenesis upon TGFβ1 stimulation

Arthrofibrosis Nightmares: Prevention and Management Strategies

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