Irradiation, revision may maintain range of motion in severe idiopathic arthrofibrosis
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Key takeaways:
- Low-dose irradiation and revision with a rotating hinge for severe idiopathic arthrofibrosis yielded a 60° gain in total arc of motion.
- Results showed 98% of patients had a flexion contracture of less than 10°.
GRAPEVINE, Texas — Results showed severe idiopathic arthrofibrosis after total knee arthroplasty treated with irradiation and revision with a rotating hinge maintained a gain in range of motion with reliable flexion contracture correction.
“Future research is desperately needed in this area, more specifically in the form of multi-institutional collaboration and, ideally, a randomized controlled trial to determine the relative efficacy of irradiation vs. the rotating hinge in terms of the relative contribution to our results,” Andrew M. Schneider, MD, said in his presentation at the American Association of Hip and Knee Surgeons Annual Meeting.
Schneider and colleagues retrospectively identified 89 patients with arthrofibrosis after TKA who were treated surgically from 2007 to 2021.
“From those 89 patients, we excluded 29 of them if they had an identifiable cause of stiffness, such as infection; hardware, like a tibial plateau plate or an ACL screw; or if they had an identifiable implant issue, such as malrotation or malalignment of the components,” Schneider said.
He added patients with revision implants were also excluded, and patients had to be severely stiff to be included.
“For the purpose of this paper, we defined severely stiff as a total arc of motion less than 80° and a flexion contracture of at least 15°,” Schneider said.
Overall, 60 patients with severe, idiopathic arthrofibrosis underwent a standardized protocol of preoperative low-dose irradiation and revision with a rotating hinge, according to Schneider. He said patients had a 60° gain in total arc of motion at 6-year follow-up, from a presenting arc of motion of 50° to a final arc of motion of 110°. At final follow-up, Schneider said 98% of patients had a flexion contracture of less than 10°. He added 97% of patients had a 10-year survivorship free from revision for aseptic loosening, 87% of patients had a 10-year survivorship free from revision for any reason and 63% of patients had a 10-year survivorship free from reoperation or manipulation under anesthesia.
“The most common complication in our study was a slow recovery of range of motion in the early postoperative period, requiring manipulation under anesthesia. This occurred in approximately 26% of patients,” Schneider said.
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Schneider AM, et al. Paper 1. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 2-5, 2023; Grapevine, Texas.
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