Abstract
BackgroundArthrofibrosis remains one of the leading causes for revision in primary total knee arthroplasty (TKA). Similar in nature to arthrofibrosis, hypertrophic scars and keloid formation are a result of excessive collagen formation. There is paucity in the literature on whether there is an association between keloid formation and the development of arthrofibrosis following TKA. Therefore, the purpose of this study was to utilize a large nationwide database to identify and compare the rates of postoperative complications related to arthrofibrosis after primary TKA in patients with history of hypertrophic scar and keloid disorders versus those without.MethodsPatient records from 2010 to the second quarter of 2016 were queried from an administrative claims database, comparing rates of arthrofibrosis, manipulation under anesthesia (MUA), lysis of adhesions (LOA), and revision TKA in patients with chart diagnosis of keloids versus those without in patients who underwent primary TKA. Data analysis was performed using R statistical software (R Project for Statistical Computing, Vienna, Austria) utilizing multivariate logistic regression, chi square analysis, or Welch’s t- test where appropriate with p values < 0.05 being considered statistically significant.ResultsOf 545,875 primary TKAs, 11,461 (2.1%) had a keloid diagnosis at any time point in their record, while 534,414 (97.9%) had not. Patients in the keloid cohort had a significantly higher association with ankylosis within 30 days (OR, 1.7), 90 days (OR, 1.2), 6 months (OR, 1.2), and 1 year (OR, 1.3) following primary TKA. The keloid cohort also had a significantly greater risk of MUA (90-day OR, 1.1; 6-month OR, 1.1; 1-year OR, 1.2) and LOA (90-day OR, 2.2; 6-month OR, 2.0; 1-year OR, 1.9).ConclusionPatients with keloids have increased odds risk of arthrofibrosis following primary TKA. These patients are subsequently at a higher odds risk of undergoing the procedures necessary to treat arthrofibrosis, such as MUA and LOA. Future studies investigating confounding factors such as race, prior surgery, range of motion, and postoperative recovery are needed to confirm the association of keloid diagnosis and arthrofibrosis following primary TKA demonstrated in this study.Level of EvidenceLevel III retrospective comparative study.
Highlights
Total knee arthroplasty (TKA) has emerged as one of the most frequently performed and successful surgeries in orthopedics today with over 95% survival at 15 years [1, 2]
Patientreported stiffness from arthrofibrosis often results in surgical intervention such as manipulation under anesthesia (MUA), consisting of a surgeon manipulating the knee through full range of motion while the patient is sedated, lysis of adhesion (LOA), which consists of using an open or arthroscopic approach to access and debride adhesions, and revision total knee arthroplasty (TKA) surgery [10, 11, 13]
With regards to US regions, the percentage of TKAs performed on patients with keloid diagnosis in the South and Northeast were larger compared with the primary TKA cohort with no keloid diagnosis (South 43.1 versus 39.4%, p < 0.001; Northeast 20.1 versus 18.9%, p 0.006), and lower in the West and Midwest (West 11.4 versus 12.9%, p < 0.001; Midwest 25.2 versus 30.4%, p < 0.001)
Summary
Total knee arthroplasty (TKA) has emerged as one of the most frequently performed and successful surgeries in orthopedics today with over 95% survival at 15 years [1, 2]. The etiology of arthrofibrosis is multifactorial with known risk factors being previously identified which result in an excessive amount of fibrous scar tissue production in the joint, such as smoking, systemic disease, history of previous surgeries, limited preoperative range of motion, complexity of the TKA surgery, and poor postoperative rehabilitation [9, 13]. This complication can be debilitating to the patient as the excessive scar tissue restricts range of motion and causes pain, reducing the patient’s quality of life [14, 15]. The purpose of this study was to utilize a large nationwide database to identify and compare the rates of postoperative complications related to arthrofibrosis after primary TKA in patients with history of hypertrophic scar and keloid disorders versus those without
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