“Arthro” means “joint” and “fibrosis” means “formation of excessive scar tissue”. Arthrofibrosis can affect any joint like shoulder, elbow, wrist, hand joints, hip, knee, ankle, foot joints and spine.
Arthrofibrosis most commonly affects the knee joint. Arthrofibrosis of knee is sometimes called “Frozen Knee” or “Stiff Knee Syndrome”. Arthrofibrosis of the knee can follow soft tissue injuries or fractures in and around the knee, arthroscopic knee surgeries like anterior cruciate ligament reconstruction or meniscal surgery, open knee surgeries and knee replacement. It is most commonly follows anterior cruciate ligament reconstruction.
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.
The characteristic symptoms and signs of arthrofibrosis following knee replacement are inability to bring the knee fully straight (flexion contracture) and decreased ability to bend 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 universally accepted pharmacological or biological treatment method available to completely prevent or completely cure established arthrofibrosis. 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 knee replacement.
Physical therapy with adequate pain control is considered within 6 weeks after 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 arthroscopic lysis of adhesions) is considered between 3 and 6 months after total knee replacement.
Open removal of scar tissue (open arthrolysis or open 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.
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