Surgical treatment of the knee joint contractures after total knee arthoplasty

Background. The development of contractures after total knee replacement is most often associated with arthrofibrosis and constitutes up to 1.3-5.7% of the total number of cases of joint replacement. The conservative treatment is ineffective. Arthrolysis is pathogenetically substantiated (arthroscopic or open). Aim: assessment of the effectiveness of arthrolysis as a method of treating knee joint contractures after arthroplasty, comparison of the results of arthroscopic and open arthrolysis, analysis of complications. Methods. We compared two groups in a retrospective study. In group 1, 57 patients underwent arthroscopic arthrolysis. In group 2, 54 patients underwent open arthrolysis. The operations were performed from 2015 to 2019, the observation period ranged from one year to three years. As criteria for the result of the treatment, the KSS data were used (general and functional assessment of the knee joint), as well as, separately, the amplitude of movements in the joint before surgery and at different times after it. Results. One of the results of this work was the optimization of arthroscopic arthrolysis technique. The surgical access and the joint revision sequence were improved. According to the KSS scale and range of motion, the best results were obtained in group 1. Especially important is the lesser number of complications in comparison with the 2nd group requiring repeated interventions, including revision arthroplasty. In the 1st group, we observed 3 such cases (5.3%) , in the 2nd group - 7 (13.0%). Conclusions. Arthroscopic arthrolysis is a less traumatic and more effective treatment for arthritis of the knee. It seems appropriate to gradually replace open arthrolysis by the arthroscopic approach.