Summary

Open lysis of adhesions for post-TKA arthrofibrosis offers adequate ROM outcomes immediately post-op and at 6 month follow up.

Abstract

Introduction

Arthrofibrosis following total knee arthroplasty (TKA) is a significant postoperative complication. Surgical treatments include manipulation under anesthesia (MUA), arthroscopic lysis of adhesions (aLOA), or open lysis of adhesion (oLOA). While more patients receive aLOA with or without MUA, some surgeons opt for oLOA to exchange poly-liners or perform posterior capsular releases. Few studies have focused specifically on outcomes following oLOA. Our study aims to contribute to the fund of knowledge by investigating range of motion (ROM) outcomes following oLOA

Methods

28 consecutive patients undergoing oLOA for arthrofibrosis after TKA at a single large urban academic center by a single fellowship trained reconstructive surgeon were retrospectively evaluated. Demographic and clinical data including age, gender, BMI, preoperative and postoperative ROM, and rationale for surgery was collected. The difference between preoperative ROM and 6-month postoperative ROM was utilized as the primary outcome and compared using two sample t-tests.

Results

The mean age of all patients was 60 (8.7). 19/28 (67.9%) patients had a poly exchange and 16/28 (57.1%) had a posterior capsule release. Overall, the average ROM prior to oLOA was 52° (19°). The average gain of ROM post oLOA was 14°, increasing the average ROM to 66° (17°) post oLOA. Our data showed an oLOA increased intraoperative ROM by 58° (SD 19°) (p < 0.001), and oLOA increased immediate postoperative ROM by 14° (SD 25°) (p = 0.01). ROM gain 6 months post oLOA was 33° (SD 21°). There was no statistically significant difference in ROM gain at 6 months for oLOA with or without poly exchange.

Conclusion

Our results suggest that surgeons contemplating oLOA for their patients can anticipate non-inferior improvements to ROM relative to previously reported gains in ROM after aLOA. Open procedures may offer surgeons the ability to confidently perform a more thorough lysis and assess appropriateness of hardware and liner size. oLOA provides a knee surgeon an opportunity for a definitive, singular procedure addressing arthrofibrosis as opposed to subjecting patients to multiple procedures. While there may be an increased risk of infection following oLOA, future work can aim to assess post-lysis rates of complications between aLOA and oLOA.