Arthrofibrosis is a complication that can arise after knee replacement surgery, characterized by the formation of excessive scar tissue. This condition leads to significant stiffness and pain, severely limiting the knee’s ability to move and affecting daily activities.
What Arthrofibrosis Is
Arthrofibrosis involves an overactive healing response, resulting in dense, inelastic scar tissue. This tissue can form within the joint capsule, surrounding muscles, and ligaments of the knee. Its accumulation restricts normal joint motion, leading to a noticeable loss of range of motion.
Unlike typical healing, where scar tissue is minimal and remodels over time, arthrofibrosis involves an exaggerated inflammatory response that produces excessive connective tissue. This abnormal growth of scar tissue becomes thick and fibrous, interfering with the knee joint’s ability to operate smoothly.
Identifying Arthrofibrosis After Knee Replacement
Arthrofibrosis is identified by specific symptoms emerging after knee replacement. Patients commonly experience persistent pain, a significant reduction in knee range of motion, particularly in bending (flexion) and straightening (extension), and a consistent feeling of tightness. These symptoms can make routine activities such as walking or climbing stairs difficult.
Diagnosis involves a thorough physical examination where a healthcare professional assesses the knee’s range of motion and observes the patient’s gait, as walking with a bent knee can be a sign of stiffness. Imaging studies, such as X-rays, are performed to exclude other potential issues like infection or improper placement of the knee replacement components. An MRI may also be used to provide a more detailed view of the soft tissues within the joint.
Why Arthrofibrosis Develops
Several factors can contribute to the development of arthrofibrosis following knee replacement surgery. Patient-specific elements play a role, including pre-existing health conditions like diabetes or inflammatory arthritis, or a history of previous knee injuries or surgeries. These conditions can influence the body’s healing response and inflammatory processes.
Surgical factors also influence the risk of developing arthrofibrosis. These include the specific surgical technique used, the duration of tourniquet application during the procedure, and the effectiveness of blood clot prevention (hemostasis).
Post-operative elements are equally important. Longer periods of immobility after surgery also increase the risk. Inadequate pain control after surgery can lead to reduced early mobilization, preventing the patient from moving the knee sufficiently to prevent stiffness. Complications such as infection or a delay in starting rehabilitation exercises can also disrupt the normal healing process and contribute to scar tissue formation.
Treatment Approaches for Arthrofibrosis
Treatment for arthrofibrosis begins with conservative management aimed at improving knee function and reducing pain. Physical therapy is a primary focus, involving stretching exercises to increase flexibility, strengthening exercises to support the joint, and manual therapy techniques to improve range of motion. Pain management techniques, which may include medications or injections, are used in conjunction with therapy.
If conservative approaches do not achieve sufficient improvement, surgical interventions may be considered. One common procedure is manipulation under anesthesia (MUA), where a surgeon moves the knee through its full range of motion to break up scar tissue. Another surgical option is arthroscopic lysis of adhesions, a minimally invasive procedure where small incisions are made to insert a camera and instruments to remove scar tissue. In severe cases, open surgery may be necessary to remove the fibrous tissue.
Reducing the Risk of Arthrofibrosis
Minimizing the risk of arthrofibrosis after knee replacement involves several proactive measures. Optimizing physical condition before surgery is important, as patients with limited pre-operative range of motion are more susceptible to post-operative stiffness. Meticulous surgical technique during the procedure also helps reduce the chances of complications.
Early post-operative rehabilitation is important, including consistent adherence to prescribed exercises to maintain and improve knee movement. Effective pain management after surgery allows patients to participate fully in rehabilitation, facilitating early movement and preventing stiffness. Prompt identification and treatment of any complications, such as infection, are also important steps in preventing arthrofibrosis.