Revision Total Knee Arthroplasty for Arthrofibrosis

Rutherford, Richard W.; Jennings, Jason M.; Levy, Daniel L.; Parisi, Thomas J.; Martin, John R.; Dennis, Douglas A.

doi:10.1016/j.arth.2018.03.037

Cited by 35 publications

(26 citation statements)

References 20 publications

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“…18 While TKA provides effective relief, 21 when nonoperative measures fail to address the symptoms and/or progression of OA, the potential risk of revision and other complications warrant the consideration of other options in early-to-moderate OA or for patients for whom TKA is not appropriate. 5,9,[22][23][24][25][26][27][28][29][30][31] Injectable biologic therapies may play a promising role in addressing both these disease processes in their early stages. 23,32,33 Two potential targets for these injections are BMLs associated with "bottom-up" sub-chondral disease and/or the intraarticular space which may play a role in mediating classic "top-down" knee OA.…”

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confidence: 99%

Are Subchondral Intraosseous Injections Effective and Safe for the Treatment of Knee Osteoarthritis? A Systematic Review

et al. 2019

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Knee osteoarthritis (OA) is a highly prevalent disease and treatment options for early stages of OA are needed. Intraosseous injections of bone substitute and biologic materials have been proposed to expand the therapeutic arsenal by potentially halting OA progression and delaying the need for knee arthroplasty in patients with early/moderate-stage disease. Therefore, the goal of this study was assessed the efficacy and safety of subchondral intraosseous injection for the treatment of knee OA. A systematic review was performed on PubMed-Medline, and the Cochrane Database of systematic reviews. English and Spanish retrospective and prospective studies assessing the results of subchondral intraosseous injection of bone substitute materials and/or biologicals in human patients with knee OA, with a minimum of 6 months of follow-up were collected. A total of 1,081 potential articles were identified through our search. Six studies were included with a total of 163 patients. The mean follow-up was 18 months (range: 6–24 months). Patient reported outcomes measures (PROMs), complications, and conversion to total knee arthroplasty (TKA) were collected. All six studies showed PROMs improvement relative to baseline. Overall, the five studies reporting visual-analog scale (VAS) pain outcomes improved from a baseline mean score of 6.68 to 2.74. Also, knee injury and osteoarthritis score (KOOS), Tegner-Lysholm, and/or international knee documentation committee (IKDC) scores rose compared with baseline scores in all studies. Overall, 2.5% (4/163) of patients had a complication attributed to study-related treatment. Most patients (81%, 86/106) remained TKA-free at a 1-year follow-up. Subchondral intraosseous injections of bone substitute materials and platelet-rich plasma (PRP) suggest (1) improved PROMs of pain and functional status, (2) low complication rate, and (3) relatively low rates of conversion to TKA. However, the current studies investigating these treatments exhibited high degree of heterogeneity in both measurement of outcomes and delivery of treatment, with a high risk of bias. This procedure should not be utilized in advanced knee OA. In light of the limitations of the current literature, advising in favor or against this therapy for early to moderate knee OA is challenging.

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Are Subchondral Intraosseous Injections Effective and Safe for the Treatment of Knee Osteoarthritis? A Systematic Review

et al. 2019

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“…Furthermore, if MUA and LOA are unsuccessful in treating the stiffness associated with arthrofibrosis, then the option of revision TKA should be considered. In a retrospective review, Rutherford et al found revision TKAs for arthrofibrosis had significant improvement in range of motion in both flexion and extension [30].…”

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confidence: 99%

Arthrofibrosis after total knee arthroplasty: patients with keloids at risk

et al. 2021

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Background Arthrofibrosis remains one of the leading causes for revision in primary total knee arthroplasty (TKA). Similar in nature to arthrofibrosis, hypertrophic scars and keloid formation are a result of excessive collagen formation. There is paucity in the literature on whether there is an association between keloid formation and the development of arthrofibrosis following TKA. Therefore, the purpose of this study was to utilize a large nationwide database to identify and compare the rates of postoperative complications related to arthrofibrosis after primary TKA in patients with history of hypertrophic scar and keloid disorders versus those without. Methods Patient records from 2010 to the second quarter of 2016 were queried from an administrative claims database, comparing rates of arthrofibrosis, manipulation under anesthesia (MUA), lysis of adhesions (LOA), and revision TKA in patients with chart diagnosis of keloids versus those without in patients who underwent primary TKA. Data analysis was performed using R statistical software (R Project for Statistical Computing, Vienna, Austria) utilizing multivariate logistic regression, chi square analysis, or Welch’s t- test where appropriate with p values < 0.05 being considered statistically significant. Results Of 545,875 primary TKAs, 11,461 (2.1%) had a keloid diagnosis at any time point in their record, while 534,414 (97.9%) had not. Patients in the keloid cohort had a significantly higher association with ankylosis within 30 days (OR, 1.7), 90 days (OR, 1.2), 6 months (OR, 1.2), and 1 year (OR, 1.3) following primary TKA. The keloid cohort also had a significantly greater risk of MUA (90-day OR, 1.1; 6-month OR, 1.1; 1-year OR, 1.2) and LOA (90-day OR, 2.2; 6-month OR, 2.0; 1-year OR, 1.9). Conclusion Patients with keloids have increased odds risk of arthrofibrosis following primary TKA. These patients are subsequently at a higher odds risk of undergoing the procedures necessary to treat arthrofibrosis, such as MUA and LOA. Future studies investigating confounding factors such as race, prior surgery, range of motion, and postoperative recovery are needed to confirm the association of keloid diagnosis and arthrofibrosis following primary TKA demonstrated in this study. Level of Evidence Level III retrospective comparative study.

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“…Зачастую в мировой литературе наличие артрофиброза коленного сустава рассматривается как самостоятельная причина неудовлетворенности пациента лечением [4,5,7,8,[23][24][25]. В то же время существуют исследования, которые описывают явление артрофиброза как следствие других причин инфекционной и механической этиологии [26,27]. Вероятно, это связано с отсутствием точного общепринятого определения артрофиброза [25].…”

Section: Discussionunclassified

Evaluation of Pain Syndrome in Patients after Total Knee Replacement

Мурылев

Алексеев

Елизаров

et al. 2019

Traumatology and Orthopedics of Russia

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Total joint replacement is one the most effective methods for treatment of degenerative, systemic and posttraumatic diseases of the knee. However, up to 25% of patients remain dissatisfied with surgery outcomes. In the majority of cases the patients complain of pain in the operated joint. Identification of pain cause in the operated joint can turn to become a challenge for the surgeon.Purpose of the study — to identify the causes of pain syndrome basing on examination algorithm in patients after TKR as well as to assess the diagnostic value of each particular examination method.Materials and Methods. The authors analyzed results of comprehensive examination of 79 patients who complained of chronic knee pain after primary TKR and seeked medical help from the beginning of 2016 until December 2018. Inclusion criteria were as follows: knee prosthesis and presence of pain syndrome in the operated joint. Exclusion criteria: fistulous peri-prosthetic infection, suspected “culture-negative” infection and revisions. All patients included into the study were managed according to the standard algorithm of comprehensive examination.Results. The most likely causes of pain were identified during the examination. Infection was observed in 39 patients (49.4%), errors in three-dimensional positioning of components was considered as a probable cause of pain in 14 patients (17.7%), aseptic loosening was reported in 13 cases (16.5%), ligamentous instability — in 6 patients (7.6%), extraarticular pain origin was observed in 5 patients (6.3%) and peri-prosthetic fractures were reported in two patients (2.5%). The authors confirmed a combination of several pain causes in 17 patients (21.5%).Conclusion. Examination of patients with painfull knee joint prosthesis should be comprehensive due to potential combination of issues in each particular case. Integral and systematic approach to pain diagnostics in the operated joint is the “key to success” for planning further treatment tactics and for understanding the necessity and scope of revision procedure.

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Revision Total Knee Arthroplasty for Arthrofibrosis

Cited by 35 publications

References 20 publications

Are Subchondral Intraosseous Injections Effective and Safe for the Treatment of Knee Osteoarthritis? A Systematic Review

Are Subchondral Intraosseous Injections Effective and Safe for the Treatment of Knee Osteoarthritis? A Systematic Review

Arthrofibrosis after total knee arthroplasty: patients with keloids at risk

Evaluation of Pain Syndrome in Patients after Total Knee Replacement

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