Arthrofibrosis of the knee can follow total knee replacement, arthroscopic knee surgeries like ligament reconstruction or meniscal surgery, open knee surgeries, soft tissue injuries or fractures in and around the knee as well as other causes. Arthrofibrosis of the knee following total knee replacement may be even more functionally disabling than the original arthritic knee for which total knee replacement was initially done. It is a very frustrating condition to the patient and it is difficult to treat. This site provides detailed information specifically about “Knee Arthrofibrosis Following Total Knee Replacement” based on the current scientific medical literature. Please feel free to contact if you have specific questions.
The causes and the development of the arthrofibrosis following total knee replacement remain unclear. Factors like genetic predisposition, immune response, and etc have been proposed as risk factors. There is chronic inflammation leading to excessive scar tissue formation (fibrosis) and thickening of the soft tissue. Sometimes, there is formation of cartilage and bone in soft tissue. Arthrofibrosis of the knee following total knee replacement is characterized by inability to bring the knee fully straight (flexion contracture) and decreased bending of the knee (decreased range of flexion). Also, there is persistent (chronic) severe pain necessitating narcotic pain medications. The patients encounter difficulty with various activities of daily living, standing and walking. The diagnosis of arthrofibrosis is suspected when the pain, knee stiffness and inflammation do not progressively improve after knee replacement. There are no specific laboratory tests available for diagnosis. Radiology may be useful in excluding other causes of stiffness. At present, there is no prevention or treatment available for arthrofibrosis. Aggressive physical therapy, manipulation under anesthesia (MUA), arthroscopic removal of scar tissue, open removal of scar tissue, and revision knee replacement are the main treatment approaches currently available to treat arthrofibrosis following total knee replacement. Aggressive physical therapy with adequate pain control is considered within 6 weeks after total knee replacement. Mechanical devices like flexionator and extensionator are useful. Manipulation under anesthesia (MUA) with or with out injection of steroid into the knee joint is considered between 6 and 12 weeks after knee replacement. Serial cast application, splints and braces are helpful. Arthroscopic removal of scar tissue (arthroscopic arthrolysis or lysis of adhesions) is considered between 3 and 6 months after total knee replacement. Open removal of scar tissue (open arthrolysis or lysis of adhesions) from within and outside the knee joint and soft tissue releases and lengthening are considered between 6 months and 1 year after total knee replacement. Revision knee replacement (revision arthroplasty) is considered in patients with long standing, severe arthrofibrosis (chronic severe arthrofibrosis) and in patients who failed to improve with other treatment approaches (resistant arthrofibrosis). Revision knee replacement is usually performed 1 year after the initial knee replacement. We use low dose radiation to the knee before surgery and aggressive physical therapy as well as home flexionator / extensionator therapy for 3 months after surgery.