Arthroscopic arthrolysis for the treatment of stiffness after total knee replacement gives moderate improvements in range of motion and functional knee scores

  • J. E. ArbuthnotEmail author
  • R. B. Brink


Twenty-two total knee replacements (TKR’s) were treated for stiffness with arthroscopy and arthrolysis. The median follow-up was 38 months. No patients were lost to follow up. Extensive scarring was found and debrided in all of the knees. The mean Oxford Knee Score improved from 42.6 (±7.5) to 36.3 (±8.5) (P < 0.05) with TKR and from 36.3 (±8.5) to 29.3 (±9.0) (P < 0.05) with arthroscopic arthrolysis. The mean arc of motion improved from 8–69° post-TKR to 3–105° on table, but declined slightly to 4–93° (P < 0.05) at most recent review. Arthroscopic arthrolysis compares well with other methods of treatment for stiffness with regard to improvements in range of motion and functional knee scores.


Arthroscopy Total knee replacement Stiffness Arthrofibrosis Arthrolysis 


  1. 1.
    Babis GC, Trousdale RT, Pagnano MW, Morrey BF (2001) Poor outcomes of isolated tibial insert exchange and arthrolysis for the management of stiffness following total knee arthroplasty. J Bone Joint Surg Am 83-A:1534–1536PubMedGoogle Scholar
  2. 2.
    Bong MR, Di Cesare PE (2004) Stiffness after total knee arthroplasty. J Am Acad Orthop Surg 12:164–171PubMedGoogle Scholar
  3. 3.
    Court C, Gauliard C, Nordin JY (1999) Technical aspects of arthroscopic arthrolysis after total knee replacement. Rev Chir Orthop Reparatrice Appar Mot 85:404–410PubMedGoogle Scholar
  4. 4.
    Dalunga D, Lombardi AV Jr, Mallory TH, Vaughn BK (1991) Knee manipulation following total knee arthroplasty: analysis of prognostic variables. J Arthroplasty 6:119–128Google Scholar
  5. 5.
    Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg 80-B:63–69CrossRefGoogle Scholar
  6. 6.
    Diduch DR, Scuderi GR, Scott WN, Insall JN, Kelly MA (1997) The efficacy of arthroscopy following total knee replacement. Arthroscopy 13:166–171PubMedGoogle Scholar
  7. 7.
    Djian P, Christel P, Witvoet J (2002) Arthroscopic release for knee joint stiffness after total knee arthroplasty. Rev Chir Orthop Reparatrice Appar Mot 88:163–167PubMedGoogle Scholar
  8. 8.
    Fisher SE, Shelbourne KD (1993) Arthroscopic treatment of symptomatic extension block complicating anterior cruciate ligament reconstruction. Am J Sports Med 21:558–564CrossRefPubMedGoogle Scholar
  9. 9.
    Fox JL, Poss R (1981) The role of manipulation following total knee replacement. J Bone Joint Surg Am 63-A:357–362Google Scholar
  10. 10.
    Gollwitzer H, Burgkart R, Diehl P, Gradinger R, Bühren V (2006) Therapy of arthrofibrosis after total knee arthroplasty. Orthopäde 35:143–152CrossRefPubMedGoogle Scholar
  11. 11.
    Haidukewych GJ, Jacofsky DJ, Pagnano MW, Trousdale RT (2005) Functional results after revision of well-fixed components for stiffness after primary total knee arthroplasty. J Arthroplasty 20:133–138CrossRefPubMedGoogle Scholar
  12. 12.
    Hutchinson JRM, Parish EN, Cross MJ (2005) Results of open arthrolysis for the treatment of stiffness after total knee replacement. J Bone Joint Surg 87-B:1357–1360CrossRefGoogle Scholar
  13. 13.
    Jerosch J, Aldawoudy AM (2007) Arthroscopic treatment of patients with moderate arthrofibrosis after total knee replacement. Knee Surg Sports Traumatol Arthrosc 2007(15):71–77CrossRefGoogle Scholar
  14. 14.
    Kerr D, Kohan L (2008) Local infiltration analgesia: a technique for the control of acute post operative pain following knee and hip surgery. Acta Orthop 79:174–183CrossRefPubMedGoogle Scholar
  15. 15.
    Kim J, Nelson CL, Lotke PA (2004) Stiffness after total knee arthroplasty: prevalence of the complication and outcomes of revision. J Bone Joint Surg Am 86:1479–1484CrossRefPubMedGoogle Scholar
  16. 16.
    Klinger HM, Baums MH, Spahn G, Ernstberger T (2005) A study of effectiveness of knee arthroscopy after knee arthroplasty. Arthroscopy 21:731–738PubMedGoogle Scholar
  17. 17.
    Klinger HM, Otte S, Baums MH, Lorenz F (2003) Infection after arthroscopic treatment of symptomatic total knee arthroplasty. Arthroscopy 19:111–113Google Scholar
  18. 18.
    Laskin R, Beksac B (2004) Stiffness and total knee arthroplasty. J Arthroplasty 19(Suppl):41–46CrossRefPubMedGoogle Scholar
  19. 19.
    Lucas TS, DeLuca PF, Nazarian DG, Bartolozzi AR, Booth RE Jr (1999) Arthroscopic treatment of patellar clunk. Clin Orthop Relat Res 367:226–229CrossRefPubMedGoogle Scholar
  20. 20.
    Moreland JR (1988) Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res 226:49–64PubMedGoogle Scholar
  21. 21.
    Namba RS, Inacio M (2007) Early and late manipulation improve flexion after total knee arthroplasty. J Arthroplasty 6(Suppl 2):58–61CrossRefGoogle Scholar
  22. 22.
    Parsley BS, Engh GH, Dwyer KA (1992) Preoperative flexion: does it influence post-operative flexion after PCL-retaining total knee arthroplasty? Clin Orthop Relat Res 275:204–210PubMedGoogle Scholar
  23. 23.
    Ries MD, Badalamente M (2000) Arthrofibrosis after total knee arthroplasty. Clin Orthop Relat Res 380:177–183CrossRefPubMedGoogle Scholar
  24. 24.
    Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME (2003) Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression and regression tree analysis. J Bone Joint Surg 85-A:1278–1285PubMedGoogle Scholar
  25. 25.
    Ryu J, Saito S, Yamamoto K, Sano S (1993) Factors influencing the postoperative range of motion in total knee arthroplasty. Bull Hosp Joint Dis 53:35–40Google Scholar
  26. 26.
    Skutek M, Elsner HA, Slateva K, Mayr HO, Weig TG, van Griensven M, Krettek C, Bosch U (2004) Screening for arthrofibrosis after anterior cruciate ligament reconstruction: analysis of association with human leukocyte antigen. Arthroscopy 20:469–473PubMedCrossRefGoogle Scholar
  27. 27.
    Steadman RJ, Dragoo JL, Hines SL, Briggs KK (2008) Arthroscopic release for symptomatic scarring of the anterior interval of the knee. Am J Sports Med 36:1763–1769CrossRefPubMedGoogle Scholar
  28. 28.
    Stringer BW, Singhania AK, Sudhakar JE, Brink RB (2007) Serum and wound drain ropivacaine concentrations after wound infiltration in joint arthroplasty. J Arthroplasty 22:884–892CrossRefPubMedGoogle Scholar
  29. 29.
    Tirveilliot F, Migaud H, Gougeon F, Laffargue P, Maynou C, Fontaine C (2003) Management of stiffness after total knee arthroplasty: indication for different mobility management in 62 cases. Rev Chir Orthop Reparatrice Appar Mot 89:27–34PubMedGoogle Scholar
  30. 30.
    Walton NP, Jahromi I, Dobson PJ, Angel KR, Lewis PL, Campbell DG (2004) Arthrofibrosis following total knee replacement; does therapeutic warfarin make a difference. Knee 12:103–106CrossRefGoogle Scholar
  31. 31.
    Yercan HS, Sugun TS, Bussiere C, Ait Si Selmi T, Davies A, Neyret P (2006) Stiffness after total knee arthroplasty: prevalence, management and outcomes. Knee 13:111–117CrossRefPubMedGoogle Scholar
  32. 32.
    Zeichen J, van Griensven M, Albers I, Lobenhoffer P, Bosch U (1999) Immunohistochemical localisation of collagen VI in arthrofibrosis. Arch Orthop Traumatic Surg 119:315–318CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Geelong Private HospitalVictoriaAustralia
  2. 2.Warwick Specialist Registrar Training ProgrammeSolihull, West MidlandsUK

Personalised recommendations