Functional Problems and Arthrofibrosis Following Total Knee Arthroplasty

Abstract

Improved surgical techniques and multidisciplinary rehabilitation protocols that involve coordination among surgeons, physical therapists, anesthesiologists, and social services personnel have led to excellent knee function and range of motion in a large percentage of patients following total knee arthroplasty. Nevertheless, there remains a small number of patients with persistent dysfunction that is difficult to treat1-4. Functional problems following total knee arthroplasty may be incapacitating as a result of persistent pain5, instability6, and a limited range of motion7. It has been shown recently that there is a direct correlation between a decreased range of motion following surgery and a lower perceived quality of life as evaluated with use of the Short Form-36 health survey questionnaire8. Continued dysfunction for any reason ultimately leads to decreased patient satisfaction. There is controversy about treatment methods for patients for whom initial rehabilitation efforts are unsuccessful following total knee arthroplasty. The reported efficacy of both noninvasive and invasive treatment modalities has been variable, with the percentage of patients obtaining improvement ranging from 0% to 90%3,9-12. Patients who have continued dysfunction despite initial rehabilitation efforts may require revision surgery. However, patients who have well-aligned, well-fixed prosthetic components will likely not benefit from a complete revision. Treatment of arthrofibrosis, scarring, soft-tissue contractures, and/or other soft-tissue dysfunction should involve less invasive treatment protocols before surgical options are considered. Nonoperative treatment modalities for restoring the range of motion include intensive rehabilitation protocols, static or dynamic splinting, injections, and application of serial casts13. Manipulation with the patient under anesthesia and invasive procedures, including arthroscopic debridement, open debridement with or without polyethylene exchange, and complete component revision, have been utilized when initial nonoperative rehabilitation efforts have failed. As a result of the …