Department of Orthopaedic Surgery, Singapore General Hospital, Singapore; Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York; Hospital for Special Surgery, New York, New York.
Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York.
J Arthroplasty. 2025 Jan;40(1):198-202. doi: 10.1016/j.arth.2024.06.056. Epub 2024 Aug 9.
Arthrofibrosis is a common postoperative total knee arthroplasty (TKA) complication that results in limited range of motion (ROM). There is limited literature on outcomes after revision TKA (rTKA) for arthrofibrosis based on preoperative ROM restriction. The aims of this study were to: (1) examine ROM trajectory after rTKA for arthrofibrosis patients who have severe versus nonsevere limitations; (2) compare ROM gains and final arc of motion (AOM) between severe and nonsevere cohorts; (2a) compare ROM gain in a severe cohort treated with a rotating hinge (RH) versus a non-RH (NRH) construct; and (3) assess the impact of arthrofibrosis severity on patient-reported outcome measures.
Patients were divided into 2 groups: group A had preoperative ROM < 70 (severe), and group B had preoperative ROM > 70 (non-severe). Patients were assessed clinically using AOM gain, absolute ROM, Knee injury and Osteoarthritis Outcomes Score for Joint Replacement, lower extremity activity scale, and pain scores. Postoperative gains in AOM were compared between both groups.
A total of 56 rTKAs (group A (severe): n = 36, group B (non-severe): n = 20) were performed for patients who have postoperative fibrosis. Group B had better ROM at the 1-year time point (group B: 95.9 ± 22.5 degrees versus group A: 83.2 ± 25.7 degrees). Group A had significantly better improvement in absolute AOM than group B (31.1 ± 20.9 versus 11.4 ± 25.0 degrees, P < 0.01). The RH group demonstrated significantly better absolute AOM gain than the NRH group (41.3 ± 19.4 versus 18.3 ± 15.2 degrees, P < 0.001). However, there were no significant differences in patient-reported outcome measures between groups A and B or between RH and NRH groups at the final follow-up.
Final ROM achieved between severe and nonsevere arthrofibrosis groups was similar, and patients who have severe arthrofibrosis can expect greater absolute ROM gains and similar functional outcomes than nonsevere arthrofibrosis patients. The RH rTKAs provided greater AOM gains for patients who have severe arthrofibrosis, with equivalent functional outcomes to non-RH implants. For severe arthrofibrosis patients, RH designs provided twice the overall ROM gain; however, longer follow-up is necessary to determine whether RH designs have inferior overall implant survivorship.
关节纤维性僵直是一种常见的全膝关节置换术后并发症，会导致活动范围（ROM）受限。目前，针对术前 ROM 受限的膝关节翻修术（rTKA）后关节纤维性僵直的研究结果有限。本研究旨在：（1）比较术前 ROM 严重受限与非严重受限的膝关节翻修术后患者的 ROM 轨迹；（2）比较严重与非严重两组患者的 ROM 获得量和最终运动弧（AOM）；（2a）比较严重组中使用旋转铰链（RH）与非-RH（NRH）结构的患者的 ROM 获得量；（3）评估关节纤维性僵直严重程度对患者报告的结局测量值的影响。
患者分为两组：A 组术前 ROM < 70（严重），B 组术前 ROM > 70（非严重）。通过 AOM 获得量、绝对 ROM、膝关节损伤和骨关节炎关节置换评分、下肢活动量表和疼痛评分对患者进行临床评估。比较两组术后 AOM 的获得量。
共有 56 例 rTKA（A 组（严重）：n = 36，B 组（非严重）：n = 20）用于治疗术后纤维化患者。B 组在 1 年时 ROM 更好（B 组：95.9 ± 22.5 度，A 组：83.2 ± 25.7 度）。A 组在绝对 AOM 方面的改善明显优于 B 组（31.1 ± 20.9 度，B 组：11.4 ± 25.0 度，P < 0.01）。与 NRH 组相比，RH 组的绝对 AOM 获得量明显更高（41.3 ± 19.4 度，B 组：18.3 ± 15.2 度，P < 0.001）。然而，在最终随访时，A、B 两组之间或 RH、NRH 两组之间的患者报告结局测量值均无显著差异。
严重与非严重关节纤维性僵直组的最终 ROM 相似，严重关节纤维性僵直患者的绝对 ROM 获得量更大，功能结局与非严重关节纤维性僵直患者相似。严重关节纤维性僵直患者使用 RH rTKA 可获得更大的 AOM 获得量，功能结局与非-RH 植入物相当。对于严重关节纤维性僵直患者，RH 设计可使总 ROM 获得量增加一倍；然而，需要更长时间的随访以确定 RH 设计是否会导致总体植入物存活率降低。
