Related Experiment Video
Updated: Sep 15, 2025
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Which Medications Are Effective in Reducing the Risk of Arthrofibrosis After Total Knee Arthroplasty?
Rigel P Hall1, Jens T Verhey2, David G Deckey3
1Creighton University School of Medicine, Phoenix, Arizona.
Background:
Arthrofibrosis is a common complication following total knee arthroplasty (TKA). Administration of medications that inhibit inflammation and fibrosis may reduce the risk of stiffness. The purpose of this study was to determine the isolated and combined effects of montelukast, celecoxib, meloxicam, and dexamethasone on rates of arthrofibrosis in patients after primary TKA.
Methods:
A retrospective cohort analysis of a health care database was performed by querying all patients who underwent primary TKA between 2004 and 2024. The treatment cohort consisted of patients who underwent TKA and were concurrently prescribed either as monotherapy or as a combined (dual or triple therapy): montelukast, dexamethasone, celecoxib, or meloxicam. Propensity scoring was used to match the treatment and control cohorts 1:1. The primary outcome was the incidence of manipulation under anesthesia (MUA) or arthroscopic lysis of adhesions (aLOAs) over a 1-year follow-up period.
Results:
Monotherapy of dexamethasone and celecoxib, and dual therapy of celecoxib/dexamethasone and dexamethasone/meloxicam significantly reduced rates of MUA or aLOA following primary TKA (P < 0.05). Patients prescribed other combinations of medication therapies did not experience improvement. Patient counts were insufficient to evaluate outcomes for meloxicam/montelukast and dexamethasone/meloxicam/montelukast cohorts.
Conclusions:
This investigation found that postoperative monotherapy of dexamethasone and celecoxib and dual therapy of celecoxib/dexamethasone and dexamethasone/meloxicam were associated with reduced rates of MUA or aLOA following primary TKA.
Insights
Certain medications like dexamethasone and celecoxib, when used alone or together, can reduce stiffness after total knee arthroplasty (TKA). These treatments help lower the need for manipulation under anesthesia (MUA) or arthroscopic lysis of adhesions (aLOAs).
Area of Science:
- Orthopedic Surgery
- Pharmacology
- Biomedical Engineering
Background:
- Arthrofibrosis is a frequent complication after total knee arthroplasty (TKA), leading to joint stiffness.
- Medications targeting inflammation and fibrosis are potential strategies to mitigate TKA-related stiffness.
- Understanding the efficacy of specific anti-inflammatory and anti-fibrotic agents is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the individual and combined effects of montelukast, celecoxib, meloxicam, and dexamethasone on arthrofibrosis rates post-TKA.
- To determine if specific medication regimens can reduce the incidence of manipulation under anesthesia (MUA) or arthroscopic lysis of adhesions (aLOAs).
Main Methods:
- Retrospective cohort analysis of a healthcare database from 2004-2024, including patients undergoing primary TKA.
- Treatment cohort received monotherapy or combined therapy (dual/triple) of montelukast, dexamethasone, celecoxib, or meloxicam.
- Propensity score matching was used to create a 1:1 ratio between treatment and control groups; primary outcome was MUA or aLOA within 1 year.
Main Results:
- Monotherapy with dexamethasone or celecoxib significantly lowered MUA/aLOA rates.
- Dual therapy combining celecoxib/dexamethasone or dexamethasone/meloxicam also demonstrated significant reductions in MUA/aLOA.
- Other medication combinations did not show significant improvements; insufficient data for meloxicam/montelukast and triple therapy cohorts.
Conclusions:
- Postoperative monotherapy with dexamethasone and celecoxib is associated with reduced rates of MUA or aLOA after primary TKA.
- Combined therapy of celecoxib/dexamethasone and dexamethasone/meloxicam also effectively decreased the incidence of MUA or aLOA.
- These findings suggest specific pharmacologic interventions can mitigate arthrofibrosis complications following total knee replacement.
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