Arthrofibrosis in the artificial knee joint

What treatment options are available?

Many patients with an artificial knee joint describe that they are less and less able to bend the knee joint over time, which leads to restrictions in everyday life. Over time, movement- and load-dependent pain is also added. This painful restriction of movement is a common complication that can occur after knee surgery. The cause of these symptoms is arthrofibrosis: an adhesion of the joint due to excessive production of scar tissue. This often occurs after the insertion of an artificial knee joint or after reconstruction of the anterior cruciate ligament. This disrupted and excessive proliferation of connective tissue with the corresponding formation of scar strands in the knee joint leads to painful restriction of movement and noises in the joint. In the worst case, arthrofibrosis can stiffen the joint.

Why does osteoarthritis fibrosis develop?

The connective tissue cells, known as fibroblasts, are activated by mechanical and emotional stress (stress hormones), which can be the case after knee surgery. This stress can lead to increased activation of the connective tissue cells, which produce more connective tissue as a protective mechanism. The resulting impaired and hyperactive wound healing leads to restricted movement of the joint, which is also very painful for most people affected. This overactivation of the connective tissue cells varies from person to person.

There are many possible causes of arthrofibrosis following knee joint surgery:

• Instability of the knee prosthesis if the collateral ligaments are too loose (leads to buckling and gait instability)
• Malposition of the knee prosthesis
• Knee prosthesis selected too large
• Kneecaps not running optimally
• Osteoarthritis behind the kneecaps
• Bleeding into the joint
• Allergies to the artificial joint / cement
• Infections

What therapies are available?

A painful restriction of movement of the knee joint that worsens over time must be examined by a knee specialist. Imaging examinations must also be carried out, such as X-ray, MRI, whole-leg scan, etc. Based on these results, a personalised therapy can be determined.

A mechanical problem as the cause of arthrofibrosis (e.g. a misalignment) should be surgically repaired to eliminate the mechanical stress. Physiotherapy exercises should be gentle, according to the motto: less is more. Painful stretching or excessive exercises should be avoided at all costs, as this releases even more stress hormones (substance P), which promote a renewed tendency for the arthrofibrosis to stick together.

Emotional stress should also be avoided, as the operated knee joint can be like a mirror of the soul for certain people. In addition, all patients must take anti-inflammatory medication at the beginning.

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Dr Andreas L. Oberholzer is a recognised expert in knee problems and has extensive experience in the field of artificial knee joints and alternative treatment methods.

Book your appointment directly online here or call us on +41 44 388 16 16. You are also welcome to come to us for a second opinion.