Which Medications Are Effective in Reducing the Risk of Arthrofibrosis After Total Knee Arthroplasty?

Abstract

Arthrofibrosis is a common complication following total knee arthroplasty (TKA). Administration of medications that inhibit inflammation and fibrosis may reduce the risk of stiffness. The purpose of this study was to determine the isolated and combined effects of montelukast, celecoxib, meloxicam, and dexamethasone on rates of arthrofibrosis in patients after primary TKA. A retrospective cohort analysis of a health care database was performed by querying all patients who underwent primary TKA between 2004 and 2024. The treatment cohort consisted of patients who underwent TKA and were concurrently prescribed either as monotherapy or as a combined (dual or triple therapy): montelukast, dexamethasone, celecoxib, or meloxicam. Propensity scoring was used to match the treatment and control cohorts 1:1. The primary outcome was the incidence of manipulation under anesthesia (MUA) or arthroscopic lysis of adhesions (aLOAs) over a 1-year follow-up period. Monotherapy of dexamethasone and celecoxib, and dual therapy of celecoxib/dexamethasone and dexamethasone/meloxicam significantly reduced rates of MUA or aLOA following primary TKA (P < 0.05). Patients prescribed other combinations of medication therapies did not experience improvement. Patient counts were insufficient to evaluate outcomes for meloxicam/montelukast and dexamethasone/meloxicam/montelukast cohorts. This investigation found that postoperative monotherapy of dexamethasone and celecoxib and dual therapy of celecoxib/dexamethasone and dexamethasone/meloxicam were associated with reduced rates of MUA or aLOA following primary TKA.