From the Guidelines
Arthrofibrosis after Total Knee Arthroplasty (TKA)
Arthrofibrosis after TKA is primarily caused by intraoperative and postoperative factors that lead to the formation of excessive scar tissue, resulting in reduced knee mobility and function.
Key Factors Contributing to Arthrofibrosis
- Surgical technique: Improper surgical technique, such as inadequate soft tissue balancing or improper component positioning, can contribute to the development of arthrofibrosis 1.
- Postoperative rehabilitation: Inadequate or aggressive postoperative rehabilitation can also lead to the formation of scar tissue and arthrofibrosis 1.
- Patient-related factors: Patient-related factors, such as pre-existing conditions or comorbidities, can also increase the risk of developing arthrofibrosis after TKA 1.
Incidence of Arthrofibrosis
The incidence of arthrofibrosis after TKA is relatively low, accounting for 4.5% of failures in one series and 6.9% of failures in another series 1.
Importance of Identifying Causes
Identifying the cause of a painful TKA, including arthrofibrosis, is critically important before surgery, as reoperation without a clear diagnosis can lead to suboptimal results 1.
From the Research
Causes of Arthrofibrosis after Total Knee Arthroplasty (TKA)
- Arthrofibrosis is characterized by excessive proliferation of scar tissue during an impaired wound healing response, leading to functional deficits in activities of daily living 2
- The exact cause of arthrofibrosis is not fully understood, but it is believed to be related to an exaggerated inflammatory response and the formation of fibrous tissue in the joint 3
- Histopathology typically shows subsynovial fibrosis with synovial hyperplasia, chronic inflammatory infiltration, and excessive and unregulated proliferation of collagen and fibroblasts 4
Risk Factors for Arthrofibrosis
- Patient-related factors such as age, body mass index, and comorbidities may contribute to the development of arthrofibrosis 5
- Surgical technique and postoperative care may also play a role in the development of arthrofibrosis 6, 4
- The use of certain types of implants or surgical approaches may increase the risk of arthrofibrosis, although this is not fully understood 5
Pathophysiology of Arthrofibrosis
- Arthrofibrosis is a complex process involving the formation of fibrous tissue in the joint, which can lead to stiffness and limited range of motion 3
- The inflammatory response and the release of various cytokines and growth factors may contribute to the development of arthrofibrosis 2
- The formation of fibrous tissue can lead to the contraction of the joint capsule and the surrounding soft tissues, resulting in stiffness and limited mobility 4