Arthrofibrosis After Total Knee Arthroplasty Managed with Manipulation Under Anesthesia

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Rheumatology

Background:

• Arthrofibrosis post-total knee arthroplasty (TKA) results from excessive scar tissue due to surgical inflammation.
• This complication causes significant loss of motion, pain, and functional deficits, often requiring further intervention.
• Despite research, definitive diagnostic tests for arthrofibrosis remain elusive, leading to diverse treatment strategies.

Purpose of the Study:

• To review the pathophysiology, diagnosis, and treatment of arthrofibrosis following TKA.
• To highlight the challenges in diagnosing arthrofibrosis due to the lack of specific tests.
• To focus on the role of manipulation under anesthesia as a treatment option.

Main Methods:

• Pathophysiology involves myofibroblast over-activation, collagen deposition, and scar formation, linked to TGF-beta pathways.
• Diagnosis is clinical and by exclusion, requiring patient history, examination, and ruling out other causes of stiffness.
• Treatment options range from conservative (physical therapy, medication) to operative (manipulation, lysis of adhesions, revision TKA).

Main Results:

• Arthrofibrosis pathogenesis is linked to myofibroblast proliferation and excessive collagen I deposition.
• Diagnosis relies on clinical assessment and excluding other etiologies, as no specific biomarker or imaging exists.
• Treatment strategies are varied, with manipulation under anesthesia being a key focus for restoring range of motion.

Conclusions:

• Arthrofibrosis is a complex complication of TKA characterized by scar tissue formation and functional loss.
• Accurate diagnosis is challenging due to the absence of definitive diagnostic tools.
• A range of treatments exist, with this review emphasizing manipulation under anesthesia for managing TKA arthrofibrosis.