Revision Knee Replacement:
Revision knee replacement (revision knee arthroplasty) is the last resort in treating arthrofibrosis. Revision is considered in patients with long standing, severe arthrofibrosis (chronic severe arthrofibrosis) and in patients who failed to improve with other treatment approaches like manipulation under anesthesia, arthroscopic or open removal of scar tissue (resistant arthrofibrosis).
Revision knee replacement is usually performed 1 year after the initial knee replacement. Revision knee replacement could be considered after 6 months and better outcomes are reported if it is done within 2 years.
Before making a diagnosis of arthrofibrosis, the knee has to be thoroughly evaluated by a physician (arthrofibrosis specialist) experienced in knee stiffness and arthrofibrosis following knee replacement (to find out the cause of stiffness following total knee replacement. Specifically, low-grade infection has to be excluded as the cause of painful stiff total knee replacement. Also, painful knee conditions causing muscle spasm leading to knee stiffness should be excluded. If a specific cause for the stiffness is found, the cause is treated. Various revision procedures have been descried in the literature depending on the cause of stiffness in each patient.
After excluding other possible causes of stiffness following total knee replacement, the diagnosis of arthrofibrosis is considered. Arthrofibrosis may also coexist with other causes of stiffness. Revision knee replacement for arthrofibrosis is complex and is technically demanding. The goals of revision surgery in arthrofibrosis are to improve flexion contracture, range of flexion, arc of motion, pain, functional outcome and patient satisfaction. This is achieved by a combination of soft tissue releases / lengthening, additional bone resection and revision of prosthesis with removal of scar tissue as well as the newly formed bone if needed, depending on individual circumstances in each patient.
We use low dose radiation to the knee immediately before revision surgery to prevent further scarring and formation bone in soft tissues. Postoperatively we prescribe aggressive physical therapy as well as home flexionator / extensionator therapy for 3 months. We have good results with this approach.