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

Abstract

Background To investigate the therapeutic efficacy of arthroscopy in 3 common soft-tissue complications, peripatellar impingement, arthrofibrosis and generalized synovitis, after total knee arthroplasty (TKA). Methods A retrospective review of patients undertaking arthroscopy for peripatellar impingement(PI), arthrofibrosis(AF) and generalized synovitis(GS) was conducted. Outcome measures included range of motion (ROM), and Knee Society Score (KSS). Intraoperative findings, surgical procedures and the existence of recurrence, prosthesis revision and/or complications were recorded. Paired t test, Fisher exact test, Kruskal-Wallis test and post hoc analysis with Bonferroni correction were used to for statistical evaluation. Results 74 patients, including 35 patients peripatellar impingement, 25 with arthrofibrosis and 14 with generalized synovitis, with a mean age of 66.1 years were analyzed. The mean follow up(FU) duration was 81.3 months. Overall, patients acquired improvement on ROM from 81.7° to 96.8° (p < 0.05), on KSS knee score from 64.2 to 78.7 (p < 0.05), and on KSS function score from 61.1 to 77.3 (p < 0.05) postoperatively. Patients in all 3 groups had improvements on ROM (p < 0.05), KSS knee (p < 0.05) and KSS function score (p < 0.05). The overall recurrence rate was 22.9% (17/74) and revision rate was 14.9% (11/74). There were statistical differences on symptoms recurrence rate and the prosthesis revision rate among groups (p < 0.05). PI group had significant less symptom recurrence rate and revision rate of 11.4% and 8.6% respectively (p < 0.017), while GS group had the greatest recurrence rate (42.9%) and revision rate (35.7%) respectively (p < 0.017). There were 4 perioperative complications, including 1 acute myocardial infarction and 3 periprosthetic joint infections. Conclusions In the setting of symptomatic TKA, arthroscopic intervention could provide clinical improvement in most cases at an average 81.3 months follow-up. Patients with PI had the best outcome while patients with GS had the worst.

Knee Arthroscopy After Prior Total Knee ArthroplastyType of Study: Narrative Review

“…24 No postarthroscopy surgical site infections or PJIs have been reported after intervention for PCS in many smaller studies 3,6–10,12–14,16,19–22,25,26 ; however, a larger and more recent cohort study reported a 4.1% rate of PJI for knee arthroscopy after TKA. 5…”

“…An additional form of patellar fibrosis has been recently described as tethered patellar syndrome, in which fibrous bands connect the inferior pole of the patellar implant to the intercondylar notch. 5 This results in tethering of the patella that restricts patellar motion and may produce anterior knee pain.…”

“…Peripatellar Soft-Tissue Impingement PCS and patellar synovial hyperplasia are the most commonly described of these soft-tissue impingement lesions and can be categorized together as peripatellar fibrosis/impingement or patellar clunk and/or crepitus. 4,5 These forms of soft-tissue impingement that occur after TKA when posterior stabilized implants are used and occur by way of a similar pathologic process of soft-tissue hyperplasia. Whereas PCS is characterized by a hypertrophic suprapatellar fibrous nodule that develops on the undersurface of the quadriceps tendon, patellar synovial hyperplasia occurs at the superior aspect of the patella but without a discrete nodule.…”

“…When anterior knee pain is present without clear crepitus or a patellar clunk, a CT scan could be considered to further assess for implant malrotations. 5 There is some evidence that ultrasonography or metal artifact reducing MRI protocols can allow for visualization of the suprapatellar fibrous nodule, which can aid in making the diagnosis. [16][17][18] These imaging modalities are not routinely used because the diagnosis is usually made clinically as described earlier.…”

“…24 No postarthroscopy surgical site infections or PJIs have been reported after intervention for PCS in many smaller studies 3,[6][7][8][9][10][12][13][14]16,[19][20][21][22]25,26 ; however, a larger and more recent cohort study reported a 4.1% rate of PJI for knee arthroscopy after TKA. 5 Portal placement must be scrutinized when treating peripatellar soft-tissue impingement in a prosthetic knee to both protect implants and provide adequate visualization and instrument access. The total number and location of portals are controversial with combinations of 2, 3, or 4 of the standard peripatellar portals (anterolateral, anteromedial, superolateral, and superomedial).…”