Comparison of outcomes and revision free survival of early arthrofibrosis management after total knee replacement: a national cohort analysis.

PURPOSE: This study examined three common treatment options for arthrofibrosis treatment after total knee arthroplasty (TKA)-manipulation under anesthesia (MUA), arthroscopic lysis of adhesions (LOA), and revision TKA (rTKA)-and evaluated differences in medical outcomes, orthopedic outcomes, and revision free survivorship.

METHODS

The TriNetX platform was queried to identify patients with arthrofibrosis after TKA. Cohorts were stratified by treatment and matched based on demographics and comorbidities. Differences in short-term medical complications, long-term orthopedic complications, and revision free survivorship were assessed. Odds ratios were used to compare outcomes, and Kaplan-Meier analysis was conducted to determine survivorship.

RESULTS

30,142 patients were identified with arthrofibrosis after TKA (3.61%). Within one year of diagnoses, 3,617 patients were treated with MUA, 2,022 with rTKA, 489 with LOA, and 635 patients with rTKA after MUA/LOA. At 90 days, rTKA had a higher risk of acute kidney injury, pulmonary embolism, wound dehiscence, emergency department visits, and readmission compared to MUA, and lower risk of readmission compared to patients with prior MUA/LOA (P < 0.05). At 2 years, rTKA had a higher risk of periprosthetic fracture, prosthetic dislocation, periprosthetic joint infection, and aseptic loosening compared to MUA but a lower risk of prosthetic dislocation and periprosthetic joint infection compared to patients with prior MUA/LOA (P < 0.05). Survivorship with rTKA was markedly lower than with MUA at 2-and 10-years but was comparable with prior MUA/LOA.

CONCLUSION

This study found that manipulation under anesthesia may be preferred as the first-line treatment in the management of early postoperative arthrofibrosis over rTKA due to decreased short-term and long-term complication risk and increased survival rate.