Our Summary

This research paper discusses a condition called arthrofibrosis that can occur after knee replacement surgery (also known as total knee arthroplasty or TKA). Arthrofibrosis is the formation of too much scar tissue, which can lead to a limited range of motion, pain, and difficulty functioning normally.

Doctors diagnose arthrofibrosis based on the patient’s medical history, a physical examination, and the results of any tests or procedures. Images from scans can help rule out other causes of stiffness after knee replacement surgery. However, a biopsy is not recommended, and there are currently no biomarkers (substances used as indicators of a particular disease state) for arthrofibrosis.

Arthrofibrosis is linked to the abnormal activation and growth of cells called myofibroblasts, which deposit a protein called type I collagen in response to inflammation in the body. The most significant pathway involved in arthrofibrosis after knee replacement surgery is the transforming growth factor-beta signaling pathway.

Treatment methods can involve non-surgical and surgical options. Physical therapy is often the first choice, while a second knee replacement surgery is typically only considered as a final option. Further research into the specific causes of arthrofibrosis could lead to better treatment options.

FAQs

  1. What is arthrofibrosis after total knee arthroplasty (TKA)?
  2. How is arthrofibrosis diagnosed after a TKA?
  3. What are the treatment options for arthrofibrosis after TKA?

Doctor’s Tip

Tip: Following your knee replacement surgery, it is important to adhere to your physical therapy regimen to prevent the formation of excessive scar tissue (arthrofibrosis). Be sure to communicate any concerns about limited range of motion, pain, or functional deficits to your doctor for proper evaluation and management.

Suitable For

Typically, patients who are recommended for knee replacement surgery are those who have severe knee pain and disability that is not relieved by other treatments such as medications, physical therapy, or injections. These patients may have conditions such as osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis. Patients who have limited range of motion, difficulty performing daily activities, and significant joint deformity may also be candidates for knee replacement surgery. It is important for patients to undergo a thorough evaluation by a healthcare provider to determine if knee replacement surgery is the best option for their individual situation.

Timeline

Before knee replacement:

  • Patient experiences chronic pain, stiffness, and limited range of motion in the affected knee
  • Patient undergoes a thorough evaluation by a healthcare provider to determine if knee replacement surgery is necessary
  • Patient and healthcare provider discuss the risks and benefits of knee replacement surgery
  • Patient undergoes preoperative testing and preparation for surgery, including physical therapy to strengthen the surrounding muscles
  • Patient undergoes knee replacement surgery

After knee replacement:

  • Patient experiences postoperative pain and swelling, and begins a rehabilitation program to regain strength and range of motion in the knee
  • Patient may experience temporary stiffness and discomfort as the knee heals
  • Patient gradually resumes normal activities and physical therapy to continue strengthening the knee
  • Patient follows up with their healthcare provider for regular check-ups and monitoring of the knee’s progress
  • Patient experiences improved mobility and reduced pain in the affected knee as it fully heals and recovers from the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about knee replacement surgery include:

  1. What are the potential risks and complications associated with knee replacement surgery?
  2. What is the expected recovery time and rehabilitation process after knee replacement surgery?
  3. How long can I expect the knee replacement to last before potentially needing a revision surgery?
  4. Will I need physical therapy after the surgery, and for how long?
  5. What restrictions or limitations will I have after the surgery, and for how long?
  6. What type of pain management options will be available to me during and after the surgery?
  7. Will I need any assistive devices, such as a cane or walker, after the surgery?
  8. How will the surgery affect my daily activities, such as work, exercise, and hobbies?
  9. Are there any specific precautions or warning signs I should be aware of after the surgery?
  10. How often will I need follow-up appointments with my doctor after the surgery?

Reference

Authors: Ramos MS, Pasqualini I, Surace PA, Molloy RM, Deren ME, Piuzzi NS. Journal: JBJS Rev. 2023 Dec 11;11(12):e23.00140. doi: 10.2106/JBJS.RVW.23.00140. eCollection 2023 Dec 1. PMID: 38079496