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Kinematic versus mechanically aligned total knee arthroplasty: no difference in frequency of arthroscopic lysis of adhesions for arthrofibrosis

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Arthrofibrosis is a condition that can cause excessive scar tissue formation, leading to painful restriction of joint motion. Following total knee arthroplasty (TKA), significant arthrofibrosis can result in permanent deficits in range of motion (ROM) if not treated. Although arthroscopic lysis of adhesions (ALOA) reliably improves post-TKA ROM if performed in a timely fashion, it exposes patients to additional anesthesia, heightens the risk of infection, and increases overall medical expenses. Kinematically aligned TKA has emerged as an alternative method to mechanically aligned, basing bony cuts off of the patient’s pre-arthritic anatomy while limiting need for soft tissue and ligamentous releases. This study aimed to determine whether there is a difference in the frequency of post-TKA arthrofibrosis requiring ALOA between kinematic and mechanically aligned TKA. Between 2012 and 2019, a retrospective analysis was conducted based on a single surgeon’s experience. Two cohorts were made based on alignment technique. Postoperatively, patients were diagnosed with arthrofibrosis and indicated for ALOA if they had functional pain with < 90 degrees of terminal flexion at 6 weeks postoperatively despite aggressive physical therapy. Frequency of ALOA was recorded for each cohort and was regressed using independent samples t-test. The results showed no significant difference between the mechanical and kinematic cohorts for frequency of ALOA following TKA (13.2% vs. 7.3%; p = 0.2659). However, the kinematic cohort demonstrated significantly greater post-ALOA ROM compared to the mechanical group (129° vs. 113°; p = 0.0097). Future higher-powered, prospective studies are needed to clarify whether a significant difference in rates of MUA/ALOA exists between the two alignment techniques.

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Acknowledgements

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, George Washington University Hospital, 2300 M St NW, 5th Floor, Washington, DC, 20037, USA

    Seth Stake, Safa Fassihi, Casey Gioia, Alex Gu, Amil Agarwal & Andrew Sparks

  2. Department of Orthopaedic Surgery, Georgetown University School of Medicine, 3800 Reservoir Rd NW, Washington, DC, 20007, USA

    Alex Akman & Evan Argintar

Authors
  1. Seth Stake
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  2. Safa Fassihi
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  3. Casey Gioia
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  4. Alex Gu
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  5. Amil Agarwal
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  6. Alex Akman
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  7. Andrew Sparks
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  8. Evan Argintar
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Contributions

All authors contributed to the study conception and design. Data collection, analysis, and authorship were performed by SS, SF, CG, AG, AA, AA, AS, and EA. The first draft of the manuscript was written by Seth Stake, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Seth Stake.

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Conflicts of Interest

The senior author of this manuscript reports personal fees from Arthrex, personal fees from KCI, and personal fees from OrthoAlign outside the submitted work.

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The authors confirm that the work is their own and the confidentially obtained data are presented in an unbiased manner.

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This study received IRB approval from the Human Research Protection Program at the Medstar Health Research Institute.

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Stake, S., Fassihi, S., Gioia, C. et al. Kinematic versus mechanically aligned total knee arthroplasty: no difference in frequency of arthroscopic lysis of adhesions for arthrofibrosis. Eur J Orthop Surg Traumatol 31, 763–768 (2021). https://doi.org/10.1007/s00590-020-02836-7

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  • DOI: https://doi.org/10.1007/s00590-020-02836-7

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