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Matthew P. Abdel - One of the best experts on this subject based on the ideXlab platform.
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Absence of signature inflammatory markers in synovial fluid for total knee arthroplasties revised for Arthrofibrosis.
Orthopaedics & traumatology surgery & research : OTSR, 2021Co-Authors: Christopher G. Salib, Nicolas Reina, Andre J. Van Wijnen, Arlen D. Hanssen, Daniel J. Berry, Matthew P. AbdelAbstract:Abstract Introduction: Current diagnostic criteria for Arthrofibrosis are limited. Since many patients will be aspirated during their clinical course, synovial fluid analysis may supplement current diagnostic criteria for Arthrofibrosis. The goal of this study was to determine a unique synovial fluid and inflammatory marker profile for diagnosing Arthrofibrosis. Hypothesis: Patients with Arthrofibrosis following total knee arthroplasty will have a unique synovial fluid aspirate profile compared to control patients to aid in diagnosis. Materials and Methods: Between 2013 and 2017, 32 patients (32 total knee arthroplasties [TKAs]) underwent revision TKAs for Arthrofibrosis. Fourteen patients had pre-revision aspirations. They were 2:1 matched based on age, sex, body mass index (BMI), and year of revision to 28 patients who underwent aseptic revision TKAs for reasons other than Arthrofibrosis (control group). Mean age at revision was 66 years, with 64% males. Results: In TKAs revised for Arthrofibrosis, mean total cell count was 828 cells/uL. These aspirates contained a mean distribution of 46% macrophages (range, 4 – 76%), 31% lymphocytes (range, 11 – 68%), 21% neutrophils (range, 0 – 75%), 1% other cells (mainly synovial cells; range, 0 – 11%), and 1% eosinophils (range, 0 – 7%). There was no significant difference in mean total cell count (p=0.8) or mean distribution of macrophages (p=0.6), lymphocytes (p=0.1), neutrophils (p=0.2), eosinophils (p>0.9), or serum inflammatory markers (p>0.7) when compared to controls. All aspirations were culture negative for infection. Discussion: The profile of arthrofibrotic synovial fluid aspirates and serum inflammatory marker values were similar to patients revised for non-arthrofibrotic aseptic etiologies. This suggests synovial fluid and serum inflammatory markers in non-infected knees with Arthrofibrosis should expect to have characteristics similar to synovial fluid and inflammatory marker profiles in other aseptic diagnoses. Level of Evidence: III; Retrospective case-control study
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Rotating-Hinge Revision Total Knee Arthroplasty for Treatment of Severe Arthrofibrosis.
The Journal of arthroplasty, 2019Co-Authors: Joshua S. Bingham, Daniel J. Berry, Brandon R. Bukowski, Cody C. Wyles, Ayoosh Pareek, Matthew P. AbdelAbstract:Revision total knee arthroplasty (TKA) for Arthrofibrosis is fraught with challenges. Because rotating-hinge (RH) prostheses do not rely on ligaments for stability, a more aggressive soft-tissue release is possible. The goal of this study was to report arc of motion, Knee Society scores, and implant survivorship in patients with Arthrofibrosis revised with an RH. Thirty-four patients revised with an RH for Arthrofibrosis were matched to 68 patients revised without an RH. The mean age was 63 years, 62% were female, mean body mass index was 31 kg/m2, and mean follow-up was 6 years (range, 2-15 years). The mean arc of motion increased 20° (74°-94°) in the RH group versus 12° (87°-99°) in the non-RH group (P = .048). Two manipulations under anesthesia were performed in the RH group compared to 9 in the non-RH group (P = .2). Knee Society scores increased significantly in both groups (P = .01 and P < .001, respectively). Survivorship free of revision for aseptic loosening at 10 years was 83% in the RH group versus 96% in the non-RH group (P = .44). Survivorship free of any revision at 10 years was 54% in the RH group and 90% in the non-RH group (P = .03). Forty percent of the revisions in the RH group were related to insert and bushing exchanges. In this series, patients with Arthrofibrosis revised to an RH TKA had a 20° improvement in arc of motion and manipulations under anesthesia were half as common. However, there was a higher risk of re-revision in the RH group. III. Copyright © 2019 Elsevier Inc. All rights reserved.
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Rotating-Hinge Revision Total Knee Arthroplasty for Treatment of Severe Arthrofibrosis.
The Journal of Arthroplasty, 2019Co-Authors: Joshua S. Bingham, Daniel J. Berry, Brandon R. Bukowski, Cody C. Wyles, Ayoosh Pareek, Matthew P. AbdelAbstract:BACKGROUND Revision total knee arthroplasty (TKA) for Arthrofibrosis is fraught with challenges. Because rotating-hinge (RH) prostheses do not rely on ligaments for stability, a more aggressive soft-tissue release is possible. The goal of this study was to report arc of motion, Knee Society scores, and implant survivorship in patients with Arthrofibrosis revised with an RH. METHODS Thirty-four patients revised with an RH for Arthrofibrosis were matched to 68 patients revised without an RH. The mean age was 63 years, 62% were female, mean body mass index was 31 kg/m2, and mean follow-up was 6 years (range, 2-15 years). RESULTS The mean arc of motion increased 20° (74°-94°) in the RH group versus 12° (87°-99°) in the non-RH group (P = .048). Two manipulations under anesthesia were performed in the RH group compared to 9 in the non-RH group (P = .2). Knee Society scores increased significantly in both groups (P = .01 and P < .001, respectively). Survivorship free of revision for aseptic loosening at 10 years was 83% in the RH group versus 96% in the non-RH group (P = .44). Survivorship free of any revision at 10 years was 54% in the RH group and 90% in the non-RH group (P = .03). Forty percent of the revisions in the RH group were related to insert and bushing exchanges. CONCLUSION In this series, patients with Arthrofibrosis revised to an RH TKA had a 20° improvement in arc of motion and manipulations under anesthesia were half as common. However, there was a higher risk of re-revision in the RH group. LEVEL OF EVIDENCE III.
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A Drug Eluting Scaffold for the Treatment of Arthrofibrosis.
Tissue engineering. Part C Methods, 2018Co-Authors: William H. Trousdale, Mark E. Morrey, Joaquin Sanchez-sotelo, Christopher G. Salib, Nicolas Reina, Andre J. Van Wijnen, Daniel J. Berry, Eric A. Lewallen, Anthony Viste, Matthew P. AbdelAbstract:Introduction: The inflammatory cascade and production of prostaglandins may play a role in the pathogenesis of Arthrofibrosis, a debilitating condition after joint replacement and other orthopedic ...
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molecular landscape of Arthrofibrosis microarray and bioinformatic analysis of the temporal expression of 380 genes during contracture genesis
Gene, 2017Co-Authors: Mark E. Morrey, Amel Dudakovic, Andre J. Van Wijnen, Matthew P. Abdel, Scott M Riester, Bernard F Morrey, Joaquin SanchezsoteloAbstract:Abstract Purpose Inflammatory changes are suspected in the pathophysiology of Arthrofibrosis formation and require early molecular examination. Here, we assessed the hypothesis that early inflammatory genes are related to Arthrofibrosis by ascertaining gene expression during the early stages of contracture genesis in an animal model. Methods Joint trauma was incited surgically in a cohort of rabbits (n = 36) knees followed by immobilization in a model of contracture. Six groups of 6 rabbits were sacrificed at multiple time points (0, 6, 12, 24, 72 h and 2 weeks). Microarray expression and RT-qPCR profiling were performed to determine genes that are significantly up or downregulated. Bioinformatic analysis was carried out to understand which biological programs and functional groups of genes are modulated in Arthrofibrosis. Results Gene expression profiling revealed a large number biologically relevant genes (> 100) that are either upregulated or downregulated by at least a 1.5 fold (log2) during the first two weeks after joint injury during contracture development. Gene ontology analysis identified molecular pathways and programs that act during the course of fibrosis and joint contracture. Our main finding is that the development of contractures occur concomitant with modulation of genes mediating inflammatory responses, ECM remodeling and the epithelial-to-mesenchymal transition. Conclusion The genesis of joint contracture reflects an imbalance between pro- and anti-fibrotic expression. Our study indicates that inflammatory genes may be involved in the process of contracture genesis and initiated at relatively early stages. Our findings also may inform clinical practice in the future by suggesting potential therapeutic targets in preventing the long-term development of Arthrofibrosis.
Daniel J. Berry - One of the best experts on this subject based on the ideXlab platform.
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elevated expression of plasminogen activator inhibitor pai 1 serpine1 is independent from rs1799889 genotypes in Arthrofibrosis
Meta Gene, 2021Co-Authors: Banu Bayram, Aaron R. Owen, Amel Dudakovic, Jacob W. Bettencourt, Afton K. Limberg, Mark E. Morrey, Daniel J. Berry, Joaquin Sanchezsotelo, Jeanpierre A Kocher, Andre J. Van WijnenAbstract:Abstract Arthrofibrosis is characterized by excessive extracellular matrix deposition in patients with total knee arthroplasties (TKAs) and causes undesirable joint stiffness. The pathogenesis of Arthrofibrosis remains elusive and currently there are no diagnostic biomarkers for the pathological formation of this connective tissue. Fibrotic soft tissues are known to have elevated levels of plasminogen activator inhibitor-1 (PAI-1) (encoded by SERPINE1), a secreted serine protease inhibitor that moderates extracellular matrix remodeling and tissue homeostasis. The 4G/5G insertion/deletion (rs1799889) is a well-known SERPINE1 polymorphism that directly modulates PAI-1 levels. Homozygous 4G/4G allele carriers typically have higher PAI-1 levels and may predispose patients to soft tissue fibrosis (e.g., liver, lung, and kidney). Here, we examined the genetic contribution of the SERPINE1 rs1799889 polymorphism to musculoskeletal fibrosis in arthrofibrotic (n = 100) and non-arthrofibrotic (n = 100) patients using Sanger Sequencing. Statistical analyses revealed that the allele frequencies of the SERPINE1 rs1799889 polymorphism are similar in arthrofibrotic and non-arthrofibrotic patient cohorts. Because the fibrosis related SERPINE1 rs1799889 polymorphism is independent of Arthrofibrosis susceptibility in TKA patients, the possibility arises that fibrosis of joint connective tissues may involve unique genetic determinants distinct from those linked to classical soft tissue fibrosis.
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Absence of signature inflammatory markers in synovial fluid for total knee arthroplasties revised for Arthrofibrosis.
Orthopaedics & traumatology surgery & research : OTSR, 2021Co-Authors: Christopher G. Salib, Nicolas Reina, Andre J. Van Wijnen, Arlen D. Hanssen, Daniel J. Berry, Matthew P. AbdelAbstract:Abstract Introduction: Current diagnostic criteria for Arthrofibrosis are limited. Since many patients will be aspirated during their clinical course, synovial fluid analysis may supplement current diagnostic criteria for Arthrofibrosis. The goal of this study was to determine a unique synovial fluid and inflammatory marker profile for diagnosing Arthrofibrosis. Hypothesis: Patients with Arthrofibrosis following total knee arthroplasty will have a unique synovial fluid aspirate profile compared to control patients to aid in diagnosis. Materials and Methods: Between 2013 and 2017, 32 patients (32 total knee arthroplasties [TKAs]) underwent revision TKAs for Arthrofibrosis. Fourteen patients had pre-revision aspirations. They were 2:1 matched based on age, sex, body mass index (BMI), and year of revision to 28 patients who underwent aseptic revision TKAs for reasons other than Arthrofibrosis (control group). Mean age at revision was 66 years, with 64% males. Results: In TKAs revised for Arthrofibrosis, mean total cell count was 828 cells/uL. These aspirates contained a mean distribution of 46% macrophages (range, 4 – 76%), 31% lymphocytes (range, 11 – 68%), 21% neutrophils (range, 0 – 75%), 1% other cells (mainly synovial cells; range, 0 – 11%), and 1% eosinophils (range, 0 – 7%). There was no significant difference in mean total cell count (p=0.8) or mean distribution of macrophages (p=0.6), lymphocytes (p=0.1), neutrophils (p=0.2), eosinophils (p>0.9), or serum inflammatory markers (p>0.7) when compared to controls. All aspirations were culture negative for infection. Discussion: The profile of arthrofibrotic synovial fluid aspirates and serum inflammatory marker values were similar to patients revised for non-arthrofibrotic aseptic etiologies. This suggests synovial fluid and serum inflammatory markers in non-infected knees with Arthrofibrosis should expect to have characteristics similar to synovial fluid and inflammatory marker profiles in other aseptic diagnoses. Level of Evidence: III; Retrospective case-control study
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Anti-fibrotic effects of the antihistamine ketotifen in a rabbit model of Arthrofibrosis.
Bone & joint research, 2020Co-Authors: Meagan E. Tibbo, Travis W Turner, Jacob W. Bettencourt, Afton K. Limberg, Christopher G. Salib, Alex R Mclaury, Anthony G Jay, Jodi M Carter, Brad Bolon, Daniel J. BerryAbstract:Aims Arthrofibrosis is a relatively common complication after joint injuries and surgery, particularly in the knee. The present study used a previously described and validated rabbit model to asses...
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reduction of Arthrofibrosis utilizing a collagen membrane drug eluting scaffold with celecoxib and subcutaneous injections with ketotifen
Journal of Orthopaedic Research, 2020Co-Authors: Afton K. Limberg, Travis W Turner, Meagan E. Tibbo, Christopher G. Salib, Alex R Mclaury, Charlotte E Berry, Anthony G Jay, Jodi M Carter, Brad Bolon, Daniel J. BerryAbstract:The dense formation of abnormal scar tissue after total knee arthroplasty results in Arthrofibrosis, an unfortunate sequela of inflammation. The purpose of this study was to use a validated rabbit model to assess the effects on surgically-induced knee joint contractures of two combined pharmacological interventions: celecoxib (CXB) loaded on an implanted collagen membrane, and subcutaneously (SQ) injected ketotifen. Thirty rabbits were randomly divided into five groups. The first group received no intervention after the index surgery. The remaining four groups underwent intra-articular implantation of collagen membranes loaded with or without CXB at the time of the index surgery; two of which were also treated with SQ ketotifen. Biomechanical joint contracture data were collected at 8, 10, 16, and 24 weeks. At the time of necropsy (24 weeks), posterior capsule tissue was collected for messenger RNA and histopathologic analyses. At 24 weeks, there was a statistically significant increase in passive extension among rabbits in all groups treated with CXB and/or ketotifen compared to those in the contracture control group. There was a statistically significant decrease in COL3A1, COL6A1, and ACTA2 gene expression in the treatment groups compared to the contracture control group (P < .001). Histopathologic data also demonstrated a trend towards decreased fibrous tissue density in the CXB membrane group compared to the vehicle membrane group. The present data suggest that intra-articular placement of a treated collagen membrane blunts the severity of contracture development in a rabbit model of Arthrofibrosis, and that ketotifen and CXB may independently contribute to the prevention of Arthrofibrosis. Statement of clinical significance: Current literature has demonstrated that Arthrofibrosis may affect up to 5% of primary total knee arthroplasty patients. For that reason, novel pharmacologic prophylaxis and treatment modalities are critical to mitigating reoperations and revisions while improving the quality of life for patients with this debilitating condition.
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Rotating-Hinge Revision Total Knee Arthroplasty for Treatment of Severe Arthrofibrosis.
The Journal of arthroplasty, 2019Co-Authors: Joshua S. Bingham, Daniel J. Berry, Brandon R. Bukowski, Cody C. Wyles, Ayoosh Pareek, Matthew P. AbdelAbstract:Revision total knee arthroplasty (TKA) for Arthrofibrosis is fraught with challenges. Because rotating-hinge (RH) prostheses do not rely on ligaments for stability, a more aggressive soft-tissue release is possible. The goal of this study was to report arc of motion, Knee Society scores, and implant survivorship in patients with Arthrofibrosis revised with an RH. Thirty-four patients revised with an RH for Arthrofibrosis were matched to 68 patients revised without an RH. The mean age was 63 years, 62% were female, mean body mass index was 31 kg/m2, and mean follow-up was 6 years (range, 2-15 years). The mean arc of motion increased 20° (74°-94°) in the RH group versus 12° (87°-99°) in the non-RH group (P = .048). Two manipulations under anesthesia were performed in the RH group compared to 9 in the non-RH group (P = .2). Knee Society scores increased significantly in both groups (P = .01 and P < .001, respectively). Survivorship free of revision for aseptic loosening at 10 years was 83% in the RH group versus 96% in the non-RH group (P = .44). Survivorship free of any revision at 10 years was 54% in the RH group and 90% in the non-RH group (P = .03). Forty percent of the revisions in the RH group were related to insert and bushing exchanges. In this series, patients with Arthrofibrosis revised to an RH TKA had a 20° improvement in arc of motion and manipulations under anesthesia were half as common. However, there was a higher risk of re-revision in the RH group. III. Copyright © 2019 Elsevier Inc. All rights reserved.
R Jay Lee - One of the best experts on this subject based on the ideXlab platform.
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Four Risk Factors for Arthrofibrosis in Tibial Spine Fractures: A National 10-Site Multicenter Study
The American journal of sports medicine, 2020Co-Authors: Joshua T Bram, Julien T Aoyama, R Justin Mistovich, Yi-meng Yen, Henry B Ellis, Peter D Fabricant, Daniel W Green, Gregory Schmale, Scott D. Mckay, R Jay LeeAbstract:Background:Tibial spine fractures (TSFs) are relatively rare pediatric injuries. Postoperative Arthrofibrosis remains the most common complication, with few studies having examined factors associat...
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RISK FACTORS FOR Arthrofibrosis IN TIBIAL SPINE FRACTURES: A NATIONAL 10-SITE MULTICENTER STUDY
Orthopaedic Journal of Sports Medicine, 2020Co-Authors: Joshua T Bram, Julien T Aoyama, R Justin Mistovich, Yi-meng Yen, Henry B Ellis, R Jay Lee, Peter D Fabricant, Daniel W Green, Aristides I Cruz, Scott MckayAbstract:Background: Tibial spine fractures are common pediatric injuries with similar mechanism of injury to anterior cruciate ligament tears. Post-operative Arthrofibrosis remains the most common complication following treatment of this injury, and many patients require subsequent manipulation under anesthesia. Several prior studies have examined risk factors for the development of Arthrofibrosis, but with small patient populations and varying reported predictors. Therefore, our objective was to identify risk factors for Arthrofibrosis in the largest known cohort of pediatric tibial spine patients. Hypothesis/Purpose: Identify risk factors for developing Arthrofibrosis after TSF treatment. Methods: This was a retrospective, multi-center study across ten institutions of 448 patients <25 years old who presented to care with a tibial spine fracture between 1/2000 and 2/2019. Patient records were reviewed for a multitude of pre-operative, intra-operative, and post-operative characteristics. Patients were then separated into two cohorts based on if they suffered from post-treatment Arthrofibrosis. Results: Chart review demonstrated that 43 (9.6%) of the patients suffered from post-treatment Arthrofibrosis. There were no demographic differences observed between the two groups. However, based on MRIs at the time of injury, distal femoral and proximal tibial growth plates were more frequently closed in the Arthrofibrosis group (17.6% vs 4.4%, p=0.023 for both comparisons). Additionally, there was no difference in Meyers & McKeever (MM) classification (p=0.597). All Arthrofibrosis patients received operative treatment (p=0.003), though there was no difference in fixation technique (p=0.734). Intraoperatively, a higher number of screws were used in the Arthrofibrosis group (p=0.002) with the placement of hardware more likely to be epiphyseal (p=0.007). Other operative parameters including number of sutures were not different. Post-operatively, Arthrofibrosis patients were more likely to have been immobilized in a cast (p<0.001) with no difference observed for weight-bearing status. After multivariate regression, screw number (OR 8.9, CI 1.9-41.7, p=0.005) and immobilization in a cast (OR 7.8, CI 1.0-60.4, p=0.049) remained significant predictors of post-treatment Arthrofibrosis. Conclusion: This serves as the largest study of tibial spine fractures to analyze risk factors for the development of post-treatment Arthrofibrosis. Our study demonstrates that pre-operative factors were largely similar between groups, but that intra-operative decisions, including the number of screws used for fixation and placement of hardware in relation to the physis, were significant predictors of post-treatment Arthrofibrosis. These findings may influence operative decision-making in tibial spine fracture patients. Additionally, post-operative immobilization in a cast should be avoided given the high risk of Arthrofibrosis. [Table: see text]
Olufemi R Ayeni - One of the best experts on this subject based on the ideXlab platform.
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Arthrofibrosis after acl reconstruction is best treated in a step wise approach with early recognition and intervention a systematic review
Knee Surgery Sports Traumatology Arthroscopy, 2017Co-Authors: Seper Ekhtiari, Nolan S Horner, Nicole Simunovic, Michael T Hirschmann, Rick Ogilvie, Rebecca L Berardelli, Danny Whelan, Olufemi R AyeniAbstract:Arthrofibrosis is the most common post-operative complication of anterior cruciate ligament (ACL) reconstruction. Risk factors and management strategies for Arthrofibrosis remain unclear. The purpose of this review was to: (a) describe existing definitions of Arthrofibrosis, and (b) characterize the management strategies and outcomes of Arthrofibrosis treatment. MEDLINE, EMBASE, and PubMed were searched from database inception to search date (March 21, 2016) and screened in duplicate for relevant studies. Data regarding patient demographics, indications, index surgery, management strategy, and outcomes were collected. Twenty-five studies of primarily level IV evidence (88%) were included. A total of 647 patients (648 knees) with a mean age of 28.2 ± 1.8 years (range 14–62 years) were treated for Arthrofibrosis following ACL reconstruction and followed for a mean 30.1 ± 16.9 months (range 2 months–9.6 years). Definitions of Arthrofibrosis varied widely and included subjective definitions and the Shelbourne classification system. Patients were treated by one or more of: arthroscopic arthrolysis (570 patients), manipulation under anaesthesia (MUA) (153 patients), oral corticosteroids (31 patients), physiotherapy (81 patients), drop-casting (17 patients), epidural therapy combined with inpatient physiotherapy (six patients), and intra-articular interleukin-1 antagonist injection (four patients). All studies reported improvement in range of motion post-operatively, with statistically significant improvement reported for 306 patients (six studies, p range <0.001 to =0.05), and one study (18 patients) reporting significantly better results if Arthrofibrosis was treated within 8 months of reconstruction (p < 0.03). The greatest improvements for extension loss were seen with drop-casting (mean 6.2° ± 0.6° improvement), whereas MUA produced the greatest improvement for flexion deficit (mean 47.8° ± 3.3° improvement). Arthrofibrosis is poorly defined and outcome measures range varies widely. Amongst the studies included in this review, Arthrofibrosis was most commonly managed surgically by arthroscopic arthrolysis, and most patients showed at least some improvement, including six studies that reported statistically significant change in ROM. In studies that used a step-wise approach to treating Arthrofibrosis, more than half of patients were successfully treated without an operation. A more well-defined concept of Arthrofibrosis, along with large, prospective studies will provide a clearer understanding of how to describe and manage this complication. The issue of Arthrofibrosis following ACL reconstruction is clinically relevant as it represents a common complication of a commonly performed operation that nonetheless remains poorly defined and without clear treatment guidelines. Systematic Review of Level III and IV Studies, Level IV.
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Arthrofibrosis after ACL reconstruction is best treated in a step-wise approach with early recognition and intervention: a systematic review.
Knee surgery sports traumatology arthroscopy : official journal of the ESSKA, 2017Co-Authors: Seper Ekhtiari, Nolan S Horner, Nicole Simunovic, Michael T Hirschmann, Rick Ogilvie, Rebecca L Berardelli, Danny B Whelan, Olufemi R AyeniAbstract:Arthrofibrosis is the most common post-operative complication of anterior cruciate ligament (ACL) reconstruction. Risk factors and management strategies for Arthrofibrosis remain unclear. The purpose of this review was to: (a) describe existing definitions of Arthrofibrosis, and (b) characterize the management strategies and outcomes of Arthrofibrosis treatment. MEDLINE, EMBASE, and PubMed were searched from database inception to search date (March 21, 2016) and screened in duplicate for relevant studies. Data regarding patient demographics, indications, index surgery, management strategy, and outcomes were collected. Twenty-five studies of primarily level IV evidence (88%) were included. A total of 647 patients (648 knees) with a mean age of 28.2 ± 1.8 years (range 14–62 years) were treated for Arthrofibrosis following ACL reconstruction and followed for a mean 30.1 ± 16.9 months (range 2 months–9.6 years). Definitions of Arthrofibrosis varied widely and included subjective definitions and the Shelbourne classification system. Patients were treated by one or more of: arthroscopic arthrolysis (570 patients), manipulation under anaesthesia (MUA) (153 patients), oral corticosteroids (31 patients), physiotherapy (81 patients), drop-casting (17 patients), epidural therapy combined with inpatient physiotherapy (six patients), and intra-articular interleukin-1 antagonist injection (four patients). All studies reported improvement in range of motion post-operatively, with statistically significant improvement reported for 306 patients (six studies, p range
David G. Campbell - One of the best experts on this subject based on the ideXlab platform.
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Arthrofibrosis following total knee replacement does therapeutic warfarin make a difference
Knee, 2005Co-Authors: N. P. Walton, I. Jahromi, Peter J. Dobson, Kevin R Angel, Peter L. Lewis, David G. CampbellAbstract:Arthrofibrosis following total knee replacement (TKR) is a relatively common complication which results in a reduction in knee range of movement and patient dissatisfaction. A retrospective study examined the relationship between anticoagulation with therapeutic warfarin and rates of Arthrofibrosis following TKR. Arthrofibrosis was defined as less than 80 degrees of knee flexion 6-8 weeks post-TKR. Patients were warfarinised if they had a history of thrombophilic tendencies or medical conditions necessitating anti-coagulation, rather than as routine thromboprophylaxis. All other patients received thromboprophylaxis using low molecular weight heparin. A total of 728 patients underwent 874 primary TKR between 1993 and 2002 in one centre, performed by four surgeons. Mean age was 68 years (range 48-89 years) and there were 483 female and 391 male knees. Eighty cases were warfarinised post-operatively (53 female, 27 male). Overall, 83 of 874 TKRs (9%) had Arthrofibrosis (57 female, 26 male) requiring manipulation under anaesthetic (MUA). In the warfarinised group, 21 knees (26%) had an MUA (15 female, 6 male). This compared to 62 cases (8%) requiring MUA in the non-warfarinised group (42 female, 20 male). There was a statistically significant difference on Fisher's exact testing (P<0.0001) between groups. Following MUA, knee flexion improved in 95% cases to a minimum 95 degrees but 8 cases had a fixed flexion deformity of 5-10 degrees . In conclusion, therapeutic warfarinisation post-TKR leads to a statistically greater chance of the patient developing Arthrofibrosis compared to prophylactic low molecular weight heparin and that patients should be counseled appropriately.
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Arthrofibrosis following total knee replacement; does therapeutic warfarin make a difference?
The Knee, 2005Co-Authors: N. P. Walton, I. Jahromi, Peter J. Dobson, Kevin R Angel, Peter L. Lewis, David G. CampbellAbstract:Arthrofibrosis following total knee replacement (TKR) is a relatively common complication which results in a reduction in knee range of movement and patient dissatisfaction. A retrospective study examined the relationship between anticoagulation with therapeutic warfarin and rates of Arthrofibrosis following TKR. Arthrofibrosis was defined as less than 80 degrees of knee flexion 6-8 weeks post-TKR. Patients were warfarinised if they had a history of thrombophilic tendencies or medical conditions necessitating anti-coagulation, rather than as routine thromboprophylaxis. All other patients received thromboprophylaxis using low molecular weight heparin. A total of 728 patients underwent 874 primary TKR between 1993 and 2002 in one centre, performed by four surgeons. Mean age was 68 years (range 48-89 years) and there were 483 female and 391 male knees. Eighty cases were warfarinised post-operatively (53 female, 27 male). Overall, 83 of 874 TKRs (9%) had Arthrofibrosis (57 female, 26 male) requiring manipulation under anaesthetic (MUA). In the warfarinised group, 21 knees (26%) had an MUA (15 female, 6 male). This compared to 62 cases (8%) requiring MUA in the non-warfarinised group (42 female, 20 male). There was a statistically significant difference on Fisher's exact testing (P
