title: Hydraulic distension of the knee: a novel treatment for arthrofibrosis after total knee replacement (case series).
abstract: BACKGROUND
  Arthrofibrosis following total knee arthroplasty (TKA) is a common problem, which can be frustrating to both the patient and treating physician and can dramatically compromise post-operative function. Current treatment options for TKA arthrofibrosis include watchful waiting, injections, physical therapy, manipulation under anaesthesia, arthroscopic/open lysis of adhesions and revision surgery. We present a novel technique to treat acute and chronic stiffness following TKA, which we call hydraulic distension.
  
  
  METHODS
  A retrospective pre- and post-operative inpatient and outpatient record review of three patients treated with hydraulic distension for arthrofibrosis following TKA at a single institution.
  
  
  RESULTS
  Three patients with a mean age of 74 years (68-78) underwent hydraulic distension of the knee at a mean of 23.4 ± 18.4 months (9 weeks to 36 months) following primary TKA. The mean pre-distension maximum flexion was 86.7 ± 10.4°, and the mean post-distension flexion was 110 ± 13.2° (23.3° increase). The patients maintained a mean 110 ± 20° flexion (23.3° increase) at a mean follow-up of 11.7 months (1 week to 29 months). There were no complications.
  
  
  CONCLUSIONS
  We present a novel technique for managing arthrofibrosis following TKA that has not been previously reported. This is an effective, safe procedure, with our patients experiencing a mean 23° increased knee flexion at the most recent follow-up.
authors.affiliation: Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Formby
authors.affiliation: Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Donohue
authors.affiliation: Washington Joint Institute, OrthoBethesda, Bethesda, MD, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Cannova
authors.affiliation: Washington Joint Institute, OrthoBethesda, Bethesda, MD, USA.
authors.forename: J Patrick
authors.initials: JP
authors.lastname: Caulfield
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005355:Fibrosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D007719:Knee Joint / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies
keywords: arthrofibrosis; arthroplasty; knee; knee manipulation; manipulation