**1. Introduction**

236 Modern Arthroscopy

Tscherne H, Lobenhoffer P: Tibial plateau fractures: management and expected results, Clin

Williams S., Hulstyn M., Fadale P., Lindy P., Ehrlich M., Coran J., Dorfman G. : Incidence of

deep vein thrombosis after arthroscopic knee surgery, a prospective study,

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Arthroscopy, 1995, 11:701-705, 1995

Total Knee replacement although an extremely successful procedure is occasionally complicated by conditions such as pain of unknown etiology, clunk and stiffness. Diagnosing and managing the patients with pain and dysfunction following joint replacement is difficult and can be challenging. The underlying cause could be impinging soft tissue under the patella with the clunk syndrome, impinging hypertrophic synovitis elsewhere in the knee, impinging PCL stump, prosthesis loosening and wear, arthrofibrosis and subclinical infections.

c. Hypertrophied

Synovium d. Poly Insert with Cam e. Suprapatellar pouch

a. Medial Aspect of knee b. Patella with femoral Component.

Fig. 1a. Normal Arthroscopic appearance after TKR

Arthroscopy Following Total Knee Replacement 239

Fig. 2. Ceramic Knee – Arthroscopic appearance

Fig. 3. Unicompartmental Knee Replacement – Arthroscopy Appearance.

Fig. 1b. Sequence of arthroscopic examination of Knee post TKR is usually same as normal Knee – Patellofemoral joint, Medial compartment, Intercondylar notch, lateral compartment. Extra precaution needs to be taken while handling scope so as not to damage or scratch the metal surface. It could also be technically challenging in tight knees and due to scarring around knee.

Many of the problems can be diagnosed after clinical examination, radiography, bone scan and aspiration. Most of the remaining conditions can be resolved (except infection) using arthroscopic techniques. The chapter describes the indications and surgical techniques for arthroscopy following the knee replacement, along with a description of the various conditions that can be encountered. Arthroscopic images of arthroscopy after knee replacement are also included for teaching purposes.

Fig. 1b. Sequence of arthroscopic examination of Knee post TKR is usually same as normal Knee – Patellofemoral joint, Medial compartment, Intercondylar notch, lateral compartment. Extra precaution needs to be taken while handling scope so as not to damage or scratch the metal surface. It could also be technically challenging in tight knees and due to scarring

Many of the problems can be diagnosed after clinical examination, radiography, bone scan and aspiration. Most of the remaining conditions can be resolved (except infection) using arthroscopic techniques. The chapter describes the indications and surgical techniques for arthroscopy following the knee replacement, along with a description of the various conditions that can be encountered. Arthroscopic images of arthroscopy after knee

replacement are also included for teaching purposes.

around knee.

Fig. 2. Ceramic Knee – Arthroscopic appearance

Fig. 3. Unicompartmental Knee Replacement – Arthroscopy Appearance.

Arthroscopy Following Total Knee Replacement 241

The incidence of arthrofibrosis or stiffness following TKR varies considerably and has been cited to be between 1 and 11%. Arthrofibrosis or knee stiffness is clinically defined as an inadequate range of movement that results in functional limitations affecting activities of daily living. The cutoff range of motion (ROM) for which stiffness requires surgical treatment is defined as having a flexion contracture of 15 degrees or flexion of less than 75 degrees. This decreased range of movement can severely affect the patient's ability to perform tasks of daily living such as walking, climbing stairs, or getting up from a seated position. Biomechanical studies and gait analysis have shown that patients required 67 degrees of knee flexion during the swing phase of gait, 83 degrees of flexion to climb stairs, 90- 100 degrees of flexion to

Arthrofibrosis may be secondary to numerous factors, including limited preoperative range of motion, faulty surgical technique, incorrect sizing, inappropriate implant placement, or inadequate postoperative rehabilitation and limiting motion until wound healing occurs. It could be also due to a biological predilection as some patients may be predisposed to

descend stairs, and 93 degrees of flexion to stand from a seated position

Fig. 5. Adhesion in suprapatellar pouch.

**2.1** 

**2. Arthrofibrosis** 

Fig. 4.1. Painful TKR without any clinically identifiable cause. O Arthroscopy synovium showed signs of metallosis.

Fig. 4.2. Note the scratches on the metal surface of the same knee.

Fig. 4.3. Same knee implant at the time of revision. The knee was a part of global recall. Note the scratches on the tibial base plates
