When physical therapy, manipulation under anesthesia, arthroscopic lysis of adhesions and open lysis of adhesions fail, revision knee replacement is considered.
Revision knee replacement is usually performed 1 year after the knee replacement.
Preoperative Evaluation
Every knee with stiffness following knee replacement should not be assumed to have arthrofibrosis. In addition to arthrofibrosis, there are many other causes for knee stiffness following knee replacement.
These include history of injury, surgery or stiffness in the knee before knee replacement, technical errors during knee replacement (like inadequate bone resection, improper bone cuts, improper component sizing, mal-positioning of components, and improper soft tissue balancing), inadequate physical therapy or prolonged immobilization after knee replacement, infection in knee after knee replacement, painful knee conditions causing muscle spasm, component loosening or failure, knee instability, and patients with psychiatric issues. The knee should be thoroughly evaluated to indentify the exact cause of stiffness following knee replacement for the treatment to be successful.
Surgical Technique
In this procedure, the existing prosthetic components are removed and replaced with new prosthetic components to improve flexion contracture and range of flexion. The revision knee replacement procedures described for arthrofibrosis following knee replacement include various partial revision knee replacement procedures as well as complete revision knee replacement. Various designs of prosthesis are available with different levels of constraint (freedom of movement between prosthetic components) for revision knee replacement for arthrofibrosis. The type of prosthesis utilized depends on the circumstances of an individual patient.
Revision knee replacement for arthrofibrosis is complex and technically demanding. It should ideally be done by a “Hip and Knee Joint Replacement Fellowship” trained orthopaedic surgeon having special expertise in arthrofibrosis after knee replacement.
Postoperative Management:
The following measures might be taken to minimize the risk of recurrence of AF after revision knee replacement:
Immediate postoperative physical therapy is prescribed to prevent flexion contracture and decreased range of flexion. Mechanical devices like flexionator / extensionator or CPM (continuous passive motion) can be used additionally. If the flexion and extension are not progressively improving as expected, manipulation under anesthesia (MUA) is utilized and it can be repeated as needed. In addition, splints or braces can be used. Patients may need serial manipulation and casting. We do not have enough literature evidence to suggest arthroscopic lysis of adhesions or open lysis of adhesions for recurrence of stiffness after revision knee replacement. For patients who develop stiffness despite all these measures, a second revision knee replacement can be considered.