Rates of Periprosthetic Joint Infection and Revision Increase After Arthroscopic Lysis of Adhesions Subsequent to Primary TKA

Abstract

Background: Arthrofibrosis is a debilitating complication of total knee arthroplasty (TKA) and may benefit from arthroscopic lysis of adhesions (LOA) to improve range of motion and decrease pain. However, the rates of periprosthetic joint infection (PJI) and of the need for future revision TKA (rTKA) have only been studied in a limited capacity in the literature. In this study, we aimed to compare PJI and revision outcomes in patients who had undergone TKA between those who subsequently underwent arthroscopic LOA and those who did not undergo arthroscopic LOA. Methods: The PearlDiver database was utilized to identify patients who had undergone primary TKA between 2016 and 2021. ICD-10 (International Classification of Diseases, Tenth Revision) and CPT (Current Procedural Terminology) codes were then used to identify patients who underwent LOA for arthrofibrosis. The rates of PJI and rTKA were compared between patients who did and did not undergo LOA. Multivariable logistic and Cox regressions, controlling for age, sex, Charlson Comorbidity Index, tobacco use, and a body mass index of >30 kg/m2, were performed to compare the rates of PJI and revision between the LOA and no-LOA groups. Results: A total of 383,143 patients were identified, of whom 703 had undergone arthroscopic LOA. Patients who underwent LOA had higher overall rates of PJI (2.7% versus 1.3%; p = 0.001) and all-cause revision (9.8% versus 1.8%; p < 0.001) than those who did not. Patients who underwent LOA had significantly higher odds of PJI (odds ratio [OR], 2.00; p < 0.014), aseptic loosening-related revision (OR, 3.31; p = 0.002), and all-cause revision (OR, 5.32; p < 0.001) within 1 year after the initial TKA. There was no significant difference in 1-year PJI-related revisions between the groups (OR, 1.71; p = 0.193). In a time-to-event analysis, patients undergoing LOA had significantly higher risks of PJI (p = 0.003) and all-cause revision (p = 0.001) but not PJI-related revision (p = 0.322) or aseptic loosening-related revision (p = 0.111). Conclusions: Arthroscopic LOA after primary TKA was associated with higher rates of PJI and subsequent revision surgery. Surgeons should consider the results of these studies when counseling patients on the importance of early rehabilitation and improving modifiable risk factors after TKA. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.