Deep vein thrombosis, age and body mass index are significant risk factors for arthrofibrosis following total knee arthroplasty

IF 5 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-03-27 DOI:10.1002/ksa.12665

Maximilian Budin, T. David Luo, Thorsten Gehrke, Mustafa Citak

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Abstract

Purpose

Arthrofibrosis is a significant complication that occurs in 3.7%–10% of total knee arthroplasty (TKA) cases, causing pain and limiting the range of motion. Addressing arthrofibrosis poses a considerable challenge, given its intricate and time-consuming treatment. The aim of this study was to identify patient-related risk factors that contribute to the formation of arthrofibrosis following primary TKA.

Methods

This retrospective case–control study encompassed 1033 cases in which arthrofibrosis was identified as a cause for failure following primary TKA between 1996 and 2021. These patients were compared to a cohort of 39,572 patients from the same time frame who did not undergo any revision following primary TKA, with a minimum follow-up of 3 years. Both bivariate analysis and binary logistic regression analysis, adjusting for age, gender, body mass index (BMI) and age-adjusted Charlson comorbidity index (CCI) were conducted. The odds ratio (OR) and 95% confidence interval (CI) were presented.

Results

Patients with arthrofibrosis were significantly younger (p < 0.001), had lower BMIs (p = 0.044) and exhibited significantly lower CCI scores (p < 0.001). No significant difference in gender was observed between patients with and without arthrofibrosis. Binary logistic regression indicated that a deep vein thrombosis (DVT) following primary TKA (p < 0.001; OR = 2.21; 95% CI = 1.64–2.98) was linked to an increased risk, while rheumatoid arthritis (RA) (p = 0.016; OR = 0.25; 95% CI = 0.08–0.77) was associated with a decreased risk for developing arthrofibrosis following primary TKA.

Conclusions

In conclusion, a DVT following primary TKA increased the risk of arthrofibrosis after primary TKA, while RA decreased it. Patients with arthrofibrosis tended to be younger, have a lower BMI, and have fewer comorbidities, with no gender differences observed. Preventing DVT is crucial, and TKA should be approached cautiously in young, thin patients with few comorbidities.

Level of Evidence

Level III.

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深静脉血栓形成、年龄和体重指数是全膝关节置换术后发生关节纤维化的重要危险因素。

目的：关节纤维化是一个重要的并发症，发生在3.7%-10%的全膝关节置换术（TKA）病例中，引起疼痛并限制活动范围。考虑到关节纤维化复杂且耗时的治疗，治疗关节纤维化带来了相当大的挑战。本研究的目的是确定原发性全膝关节置换术后导致关节纤维化的患者相关危险因素。方法：这项回顾性病例对照研究包括1033例，其中1996年至2021年间，关节纤维化被确定为原发性TKA后失败的原因。将这些患者与来自同一时间段的39,572例患者进行比较，这些患者在原发性TKA后未接受任何翻修，随访时间至少为3年。进行双变量分析和二元logistic回归分析，校正年龄、性别、体重指数（BMI）和年龄校正Charlson合并症指数（CCI）。给出比值比（OR）和95%置信区间（CI）。结论：原发性TKA后发生DVT增加了原发性TKA后发生关节纤维化的风险，而RA则降低了风险。关节纤维化患者往往较年轻，BMI较低，合并症较少，没有观察到性别差异。预防深静脉血栓是至关重要的，对于年轻、瘦弱且很少有合并症的患者，TKA应谨慎进行。证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).