Poor Outcome of Arthrolysis, Synovectomy and Liner Change for Stiffness after Primary Total Knee Arthroplasty

Introduction: Knee limited range of motion after TKR causes reduced patient-reported quality of life, and dissatisfaction. The purpose of this study is to specifically describe the patient-reported outcomes and range of motion associated with knee revision surgery involving arthrolysis, synovectomy and liner downsizing.

Methods: A retrospective study of patients with knee revision for stiffness who obtained arthrolysis, synovectomy and liner change (no femoral or tibial component revision) and reviewed these patients to evaluate quality of life, satisfaction, and range of motion outcomes. Patients were a minimum of 2 years after revision surgery at the time of their most recent review.

Results: Out of 583 revision knee procedures which were performed between the years 2007-2014, 42 patients met inclusion criterion. Twenty five of these patients completed the study. Mean follow-up time was 4.8 years (SD=2.1) and mean time from TKR to revision surgery of 1.9 years (SD=2.4). Range of motion improvement occurred across the cohort with a mean extension and flexion improvement of 6 degrees (SD=16.3) and 20.9 degrees (SD=32.8), respectively. Mean pre-revision and post-revision range of flexion (ROM) were 56.6 (SD=25.6) and 75.6 (SD=35.16) degrees, respectively. Mean improvement in the overall arc of motion was 26.9 degrees (SD=29.8).

Patient reported quality of life was as follows: mean SF-12 Physical and mental score were 43.23 (SD=20.66) and 62.66 (SD=19.21), respectively. Oxford knee score mean 24.5 (SD=9), WOMAC overall score 47.9 (SD=17.4), and WOMAC pain, stiffness, and function domain scores were: 45.3 (SD=19.4), 53.3 (SD=22.1) and 48.6 (SD=18.4), respectively. Mean satisfaction score was 45.2 (SD=37.5). Better was seen in patients with final flexion greater than 90 degrees.

Conclusion: Surgical arthrolysis, synovectomy, and liner change results in an improvement in observed and recorded knee range of motion however quality of life scores demonstrate significant residual disability and the majority of patients are dissatisfied.