Epidemiology and Risk Factors for Arthrofibrosis Following Total Knee Arthroplasty: Toward Effective Prevention.

Abstract

Arthrofibrosis is a debilitating complication following total knee arthroplasty (TKA), resulting in limited knee range of motion (ROM) and functional impairment. This review explores the (1) epidemiology, (2) risk factors, and (3) prevention strategies associated with arthrofibrosis. The incidence of arthrofibrosis ranges from 3 to 10% in primary TKA cases, with up to 13% in some series, and it contributes to up to 10% of revision surgeries within 5 years. Genetic and molecular factors may play a role in predisposition. Other risk factors include younger age, preoperative limited ROM, and surgical factors like prosthetic malpositioning. Prevention strategies focus on patient education, rehabilitation, and pharmacological interventions, with emerging evidence supporting the use of celecoxib, dexamethasone, COX-2 inhibitors, and losartan in reducing the risk of arthrofibrosis. Despite progress, gaps remain, particularly regarding standardized definitions and high-quality randomized controlled trials to assess the optimal treatment methods.