Comparison of outcomes and revision free survival of early arthrofibrosis management after total knee replacement: a national cohort analysis.

Abstract

Purpose: This study examined three common treatment options for arthrofibrosis treatment after total knee arthroplasty (TKA)-manipulation under anesthesia (MUA), arthroscopic lysis of adhesions (LOA), and revision TKA (rTKA)-and evaluated differences in medical outcomes, orthopedic outcomes, and revision free survivorship.

Methods: The TriNetX platform was queried to identify patients with arthrofibrosis after TKA. Cohorts were stratified by treatment and matched based on demographics and comorbidities. Differences in short-term medical complications, long-term orthopedic complications, and revision free survivorship were assessed. Odds ratios were used to compare outcomes, and Kaplan-Meier analysis was conducted to determine survivorship.

Results: 30,142 patients were identified with arthrofibrosis after TKA (3.61%). Within one year of diagnoses, 3,617 patients were treated with MUA, 2,022 with rTKA, 489 with LOA, and 635 patients with rTKA after MUA/LOA. At 90 days, rTKA had a higher risk of acute kidney injury, pulmonary embolism, wound dehiscence, emergency department visits, and readmission compared to MUA, and lower risk of readmission compared to patients with prior MUA/LOA (P < 0.05). At 2 years, rTKA had a higher risk of periprosthetic fracture, prosthetic dislocation, periprosthetic joint infection, and aseptic loosening compared to MUA but a lower risk of prosthetic dislocation and periprosthetic joint infection compared to patients with prior MUA/LOA (P < 0.05). Survivorship with rTKA was markedly lower than with MUA at 2-and 10-years but was comparable with prior MUA/LOA.

Conclusion: This study found that manipulation under anesthesia may be preferred as the first-line treatment in the management of early postoperative arthrofibrosis over rTKA due to decreased short-term and long-term complication risk and increased survival rate.