Arthroscopic treatment of symptomatic total knee arthroplasty

Abstract

This paper reports experience with arthroscopic treatment of 53 patients with symptomatic total knee replacements since October 1983. There were no postoperative complications. Eighteen patients were diagnosed with the tethered patella syndrome--a patellofemoral dysfunction manifested by painful popping, catching, grinding, and jumping of the patellar component. Three distinct types of bands were identified that prevented the patella from seating into the femoral sulcus and/or tethered the patellar laterally. Complete resolution of preoperative symptoms followed arthroscopic removal of the fibrous bands. Of the seven patients with arthrofibrosis, two patients had knee fusions, two are awaiting that procedure, and three patients maintained increased motion, although one remains symptomatic with pain. Two patients demonstrated patellar malalignment treated by arthroscopic lateral retinacular release. Of the 24 patients who had arthroscopic evaluation as a diagnostic procedure, five patients had retained foreign matter or soft tissue, two patients had traumatic hemarthroses, nine patients had undefined pain syndromes, one patient demonstrated posterior instability, four patients were infected, two patients demonstrated loose tibial components, and two experienced dissociation of the metal tibial component from its polyethylene-articulating surface. In the authors' experience, operative arthroscopy of the prosthetic knee was reliable, safe, and effective.