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FOTO Rehab Outcomes Blog

Arthrofibrosis and Total Knee Arthroplasty

 

Some of you will be immediately miffed at the image chosen for this blog post. The abstract tends to focus on the costs associated with arthrofibrosis post total knee arthroplasty.  Arthrofibrosis really affects patients and their ability to function. The first thought I had was continuous passive motion machines. I know, that's crazy.... then my next thought was who is at risk for arthrofibrosis? Is there an easy way for these individuals to be identified?

Quite a few of my patients will choose to receive services from me in my private practice day 4 after surgery. They are not interested in home health services because of the results they hear happen by bypassing that step and coming to me instead. I think the secret is 1) ditching all the exercises the surgeon provided and 2) doing what research suggests: moving the knee every 1-2 hours and 3) educating patients on time frames for expectations. For the individuals who come to me 3 weeks post-operatively after home health services, their motion is horrible. The focus of their rehabilitation was on all sorts of exercises versus being laser focused on achieving the required motion for typical life activities.

Physical therapists are a key component in ensuring a readmission does not occur due to arthrofibrosis.

Here's a quick view of the abstract. 

arthrofibrosis_knee_arthroplasty

Arthrofibrosis Associated With Total Knee Arthroplasty.

 

Abstract

The purpose of this article is to review the etiology, economic burden, treatment strategies, and future research directions of arthrofibrosis after total knee arthroplasty (TKA). Arthrofibrosis is a debilitating postoperative complication of TKA. This condition is one of the leading causes of hospital readmission and a predominant reason for TKA failure. The prevalence of arthrofibrosis will increase as the annual incidence of TKA in the United States rises into the millions. Characterized by the excessive proliferation of scar tissue during an impaired wound healing response, the resulting stiffness of arthrofibrosis causes functional deficits in activities of daily living, such as walking, stair climbing, and standing from a chair. Postoperative, supervised physiotherapy remains the first line of defense against the development of arthrofibrosis. Also, adjuncts to traditional physiotherapy such as splinting and augmented soft tissue mobilization can be beneficial. The effectiveness of rehabilitation on functional outcomes depends on the appropriate timing, intensity, and progression of the program, accounting for the patient's ability and level of pain. Invasive treatments such as manipulation under anesthesia, debridement, and revision arthroplasty improve range of motion, but can be traumatic and costly. Future studies investigating novel treatments, early diagnosis, and potential preoperative screening for risk of arthrofibrosis will help target those patients who will need additional attention and tailored rehabilitation to improve TKA outcomes.

2017 Feb 14. pii: S0883-5403(17)30104-3. doi: 10.1016/j.arth.2017.02.005. [Epub ahead of print]

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