Arthrofibrosis after Knee Replacement – Open Lysis of Adhesions (Open Arthrolysis):
If physical therapy, manipulation under anesthesia (MUA) and arthroscopic lysis of adhesions fail, open lysis of adhesions or open arthrolysis (open removal of scar tissue) can be considered.
This procedure is performed between 6 months and 1 year after total knee replacement.
In this procedure, the knee joint is surgically opened and the scar tissue within the joint (intra-articular fibrosis) is removed. This procedure is also helpful in removing the scar tissue that is present outside the knee joint (extra-articular fibrosis) like quadriceps fibrosis.
In this procedure, the scar tissue in all the compartments inside the knee joint described in arthroscopic lysis of adhesions are released or resected. In addition, the structures outside the knee joint are also treated as follows: The adherent scar tissue limiting mobility of the muscles in the front of the thigh (quadriceps) and the bone (femur) can be released (adhesiolysis) and the quadriceps can be lengthened (quadricepsplasty) using a variety of techniques. Scarred and contracted soft tissue structures in and around the knee joint can also be released (soft tissue releases) as needed. It is easier to reach the areas behind the knee prosthesis (posterior recess) and release posterior capsule with open lysis as compared to arthroscopic lysis. In addition, tight PCL can be released in cruciate retaining knee replacements, lateral release can be performed as needed, loose bodies can be removed and soft titssue impingement can be treated.
With the availability of arthroscopic lysis of adhesions, open lysis of adhesions alone is less commonly performed these days. Open lysis of adhesions is performed more commonly during revision knee replacement for arthrofibrosis. Therefore, the amount of published medical literature available of open lysis of adhesions is much less as compared to arthroscopic lysis of adhesions and revision knee replacement for arthrofibrosis.
Potential complications associated with open lysis of adhesions include the possibility of recurrence of arthrofibrosis in addition to other surgical complications.
The plastic component between the two metal components of the total knee replacement (tibial polyethylene exchange) can be replaced with a thinner one (downsizing) to improve motion. Rarely, aggressive removal of scar tissue can result in instability of the knee joint and in such cases, the polyethylene can be replaced with a thicker one (upsizing) to improve stability.