Cheuy Victor A, Foran Jared R H, Paxton Roger J, Bade Michael J, Zeni Joseph A, Stevens-Lapsley Jennifer E
Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado.
Panorama Orthopaedics and Spine Center, Golden, Colorado.
J Arthroplasty. 2017 Aug;32(8):2604-2611. doi: 10.1016/j.arth.2017.02.005. Epub 2017 Feb 14.
Arthrofibrosis is a debilitating postoperative complication of total knee arthroplasty (TKA). It 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.
In a narrative review of the literature, the etiology, economic burden, treatment strategies, and future research directions of arthrofibrosis after TKA are examined.
Characterized by excessive proliferation of scar tissue during an impaired wound healing response, arthrofibrotic stiffness causes functional deficits in activities of daily living. 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.
Arthrofibrosis is a multi-faceted complication of TKA, and is difficult to treat without an early, tailored, comprehensive rehabilitation program. Understanding the risk factors for its development and the benefits and shortcomings of various interventions are essential to best restore mobility and function.
关节纤维化是全膝关节置换术（TKA）一种导致功能障碍的术后并发症。它是医院再入院的主要原因之一，也是TKA失败的主要原因。随着美国每年TKA发病率上升至数百万例，关节纤维化的患病率也将增加。
在一篇文献综述中，研究了TKA后关节纤维化的病因、经济负担、治疗策略和未来研究方向。
关节纤维化僵硬的特征是在伤口愈合反应受损期间瘢痕组织过度增生，导致日常生活活动出现功能缺陷。术后，在监督下进行物理治疗仍然是预防关节纤维化发展的第一道防线。此外，传统物理治疗的辅助手段，如夹板固定和增强软组织松动术可能有益。康复对功能结局的有效性取决于方案的适当时间、强度和进展情况，同时要考虑患者的能力和疼痛程度。麻醉下手法操作、清创术和翻修关节成形术等侵入性治疗可改善关节活动范围，但可能具有创伤性且成本高昂。未来研究新型治疗方法、早期诊断以及潜在的术前关节纤维化风险筛查，将有助于针对那些需要额外关注和量身定制康复方案以改善TKA结局的患者。
关节纤维化是TKA的一个多方面并发症，若无早期、量身定制的综合康复方案则难以治疗。了解其发生的风险因素以及各种干预措施的利弊对于最佳恢复活动能力和功能至关重要。
