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Arthrofibrosis following primary total hip arthroplasty: a distinct clinical entity

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Arthrofibrosis is a relatively frequent complication after total knee arthroplasty. Although stiffness after total hip arthroplasty (THA), because of formation of heterotopic ossification or other causes, is not uncommon, to the authors’ best knowledge, arthrofibrosis after THA has not been described. The aim of this study is to describe the arthrofibrosis of the hip after primary THA using an established clinical and histological classification of arthrofibrosis.

Materials and methods

We retrospectively examined all patients who were histologically confirmed to have arthrofibrosis after primary THA during revision surgery by examination of tissue samples in our clinic. Arthrofibrosis was diagnosed according to the histopathological SLIM-consensus classification, which defines seven different SLIM types of the periimplant synovial membrane. The SLIM type V determines the diagnosis of endoprosthesis-associated arthrofibrosis.

Results

The study population consists of 66 patients who were revised due to arthrofibrosis after primary THA. All patients had a limitation in range of motion prior to revision with a mean flexion of 90° (range from 40 to 125), mean internal rotation of 10° (range from 0 to 40) and mean external rotation of 20° (range from 0 to 50). All patients had histological SLIM type V arthrofibrosis, corresponding to endoprosthesis-associated arthrofibrosis. Histological examination revealed that seven patients (10.6%) had particle-induced and 59 patients (89.4%) had non-particle-induced arthrofibrosis.

Conclusion

This is the first description of endoprosthetic-associated arthrofibrosis after primary THA on the basis of a well-established histological classification. Our study results could enable new therapeutic and diagnostic opportunities in patients with such an arthrofibrosis. Surgeons should keep arthrofibrosis as a possible cause for stiffness and pain after primary THA in mind.

Level of evidence

Diagnostic study, Level of Evidence IV.

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Data availability

Where plausible reasons for disclosure of the data are given, the data used may be explained to promote transparency.

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Author notes

  1. Thorsten Gehrke and Lara Althaus contributed equally to the writing of this manuscript.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany

    Thorsten Gehrke, Lara Althaus, Philip Linke & Mustafa Citak

  2. Department of Surgery, Ruhr-University Bochum, Bochum, Germany

    Jochen Salber

  3. MVZ-Center for Histology, Cytology and Molecular Diagnostics, Trier, Germany

    Veit Krenn

Authors
  1. Thorsten Gehrke
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  2. Lara Althaus
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  3. Philip Linke
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  4. Jochen Salber
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  5. Veit Krenn
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  6. Mustafa Citak
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Contributions

TG: supervision, writing, editing, analysis. LA: data collection, analysis, statistics, writing. PL: data collection, analysis, writing, proof reading. JS: analysis, writing, proof reading. VK: data collection, writing, editing, analysis. MC: supervision, writing, editing, analysis.

Corresponding author

Correspondence to Mustafa Citak.

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Conflict of interest

The authors declare that they have no conflict of interest regarding this manuscript. Independent from the submitted manuscript, received royalties/payments of all authors are listed: Payments for presentations from Waldemar Link, Zimmer Biomet, Heraeus, and Ceramtec.

Ethical approval

Ethical approval was performed and has following number: WF-080/20.

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Gehrke, T., Althaus, L., Linke, P. et al. Arthrofibrosis following primary total hip arthroplasty: a distinct clinical entity. Arch Orthop Trauma Surg 142, 511–515 (2022). https://doi.org/10.1007/s00402-021-03922-z

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  • DOI: https://doi.org/10.1007/s00402-021-03922-z

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