title: Fibrosis is a common outcome following total knee arthroplasty.
abstract: Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures that alleviates pain and restores function in patients with degenerative knee joint diseases. Arthrofibrosis, abnormal scarring in which dense fibrous tissue prevents normal range of motion, develops in ~3-10% of TKA patients. No prophylactic intervention is available and treatment is restricted to aggressive physiotherapy or revision surgery. Tissue was collected from patients undergoing primary (n = 30) or revision (n = 27) TKA. Revision patients were stratified as non-arthrofibrotic and arthrofibrotic. Tissue was macroscopically and histologically compared to improve our understanding of the pathophysiology of arthrofibrosis. Macroscopically, tissue from primary TKA presents as homogenous, fatty tissue whereas tissue from revision TKA presents as dense, pigmented tissue. Histologically, there was dramatic tissue remodelling, increased collagen deposition and increased (myo)fibroblast staining in tissue from revision TKA. Significantly, tissue architecture was similar between revision patients regardless of clinically diagnosis. There are significant differences in architecture and composition of tissue from revision TKA over primary TKA. Surprisingly, whether revision TKA were clinically diagnosed as arthrofibrotic or non-arthrofibrotic there were still significant differences in fibrotic markers compared to primary TKA suggesting an ongoing fibrotic process in all revision knees.
authors.affiliation: Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
authors.forename: Nicole
authors.initials: N
authors.lastname: Abdul
authors.affiliation: Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
authors.forename: David
authors.initials: D
authors.lastname: Dixon
authors.affiliation: Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Walker
authors.affiliation: Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Horabin
authors.affiliation: Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Smith
authors.affiliation: Musculoskeletal Unit, Freeman Hospital, Newcastle Hospitals, NHS Trust, High Heaton, Newcastle upon Tyne, NE7 7DN, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Weir
authors.affiliation: Musculoskeletal Unit, Freeman Hospital, Newcastle Hospitals, NHS Trust, High Heaton, Newcastle upon Tyne, NE7 7DN, UK.
authors.forename: Nigel T
authors.initials: NT
authors.lastname: Brewster
authors.affiliation: Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.|Musculoskeletal Unit, Freeman Hospital, Newcastle Hospitals, NHS Trust, High Heaton, Newcastle upon Tyne, NE7 7DN, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Deehan
authors.affiliation: Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
authors.forename: Derek A
authors.initials: DA
authors.lastname: Mann
authors.affiliation: Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Borthwick
mesh_terms: D000199:Actins / Q000235:genetics / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D020679:Arthroscopes; D001706:Biopsy; D003094:Collagen / Q000378:metabolism; D005260:Female; D005355:Fibrosis; D015870:Gene Expression; D006801:Humans; D006909:Hydroxyproline / Q000378:metabolism; D007150:Immunohistochemistry; D007592:Joint Diseases / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D007719:Knee Joint / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013583:Synovial Membrane / Q000378:metabolism / Q000473:pathology
chemical_list: D000199:Actins; D003094:Collagen; D006909:Hydroxyproline