title: Prolonged Epidural Infusion Improves Functional Outcomes Following Knee Arthroscopy in Patients with Arthrofibrosis after Total Knee Arthroplasty: A Retrospective Evaluation.
abstract: A total of 20 consecutive patients with knee stiffness post total knee arthroplasty (TKA) underwent arthroscopic lysis of adhesions and manipulation plus indwelling epidural were evaluated retrospectively. Epidural catheters were placed preoperatively for an intended 6 weeks of postoperative analgesia to facilitate intensive physical therapy. The mean loss of knee extension immediately before incision was 13.5 ± 9.1 degrees (range, 0-35 degrees) and flexion was 77.65 ± 19.2 degrees (range, 45-125 degrees). At the 6-week and final (mean, 0.47 years) follow-up, the loss of extension was 1.5 ± 5.1 degrees (range, -10 to +7 degrees) and 5.4 ± 4.7 degrees (range, 0-15 degrees), respectively, and flexion was 99.7 ± 12.3 degrees (range, 75-120 degrees) and 98.5 ± 16.1 degrees (range, 75-130 degrees), respectively. Of the 20 patients, 2 missed their 6-week clinic visit. Improvements in motion immediately preoperative to 6-week and final follow-up were each significant (p < 0.01). At examination 6 weeks postoperatively, 94.4% of patients met the definition for clinical motion success and 70% maintained success at final follow-up. Visual analog scale improved significantly from 5.4 to 2.0 (p < 0.01) at 6 weeks postoperative in the 12 patients with this data recorded. On the basis of this data, use of tunneled epidurals with arthroscopic lysis of adhesions for arthrofibrosis after TKA is correlated with a high likelihood of functional success postoperatively as measured by range of motion improvement.
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Saltzman
authors.affiliation: Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Ankur
authors.initials: A
authors.lastname: Dave
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Adam
authors.initials: A
authors.lastname: Young
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Mukesh
authors.initials: M
authors.lastname: Ahuja
authors.affiliation: Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Sandeep D
authors.initials: SD
authors.lastname: Amin
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Bush-Joseph
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000534:rehabilitation*; D001182:Arthroscopy; D005260:Female; D005355:Fibrosis; D006801:Humans; D007719:Knee Joint / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult