Treatment of Acquired Idiopathic Stiffness in Revision Total Knee Arthroplasty With Hinged Knee Prosthesis With or Without Low Dose Irradiation: A Multicentre Prospective Randomized Controlled Trial
Mount Sinai Hospital, Canada
Summary
Acquired idiopathic stiffness (AIS) is a common complication following total knee arthroplasty (TKA). It is caused by excessive scar formation, which leads to pain, loss of motion, and functional impairment. When early noninvasive treatments fail, some patients require more surgery. In these cases, surgeons often use a special type of replacement called a hinged prosthesis, which allows more thorough removal of scar tissue and stiffened ligaments. Unfortunately, even after more surgery, many patients continue to struggle with stiffness, pain, and impaired function. Low-dose irradiation (LDI) is a safe, established therapy for conditions with abnormal scar formation. Its role in the setting of AIS has not been defined. The goal of this study is to compare outcomes of revision TKA with or without the addition of LDI. The primary outcome is range of motion at one year following surgery. Secondary outcomes include patient-reported functional scores, repeat surgeries, and complications like wound breakdown or infection. This project has the potential to address a common, debilitating complication after TKA, improve outcomes, reduce repeat interventions and healthcare costs, and broader implementation and standardization of care.
Description
Acquired idiopathic stiffness (AIS), or arthrofibrosis, is a rare but potentially devastating complication after total knee arthroplasty (TKA), occurring in approximately 1-6% of cases. It is characterized by pathological fibroblast and myofibroblast proliferation leading to excessive scar tissue deposition within and around the knee joint, resulting in restricted range of motion (ROM), pain, and functional impairment. When conservative management (physiotherapy, manipulation under anesthesia) fails, operative intervention is required. Full component revision to a hinged prosthesis - which pe…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Adults (≥18 years) undergoing revision TKA with a hinged prosthesis for AIS after primary TKA * Patient with a ROM arc \<70 degrees or flexion contracture of \>20 degrees without any identifiable cause for stiffness (e.g. component oversizing, malrotation, infection, or periprosthetic fracture). Exclusion Criteria: * Revision for causes other than AIS (e.g., component malposition, infection, periprosthetic fracture) * Prior ipsilateral knee infection * Revision to non-hinged prosthesis * Medical contraindications to surgery * Medical contraindications to irradiation *…
Interventions
- RadiationLow-Dose External Beam Irradiation
A single session of external beam irradiation (800 cGy) delivered to the operative knee on post-operative day 1 (or post-operative day 2 if medically necessary). At Mount Sinai Hospital and Humber River Hospital, LDI is delivered at Princess Margaret Cancer Centre. US sites coordinate through local radiation oncology departments.
- ProcedureHinged Revision Total Knee Arthroplasty
Full component revision to a rotating hinge knee prosthesis, including synovectomy, posterior capsule debridement, and release of fibrosed collateral ligaments, performed by the treating orthopaedic surgeon at each participating site.
Locations (4)
- University of Southern CaliforniaLos Angeles, California
- University of UtahSalt Lake City, Utah
- Humber River HospitalToronto, Ontario
- Mount Sinai HospitalToronto, Ontario