3476 - Perioperative Radiation Therapy for Prevention of Recurrent Arthrofibrosis after Revision Total Knee Arthroplasty
Presenter(s)
J. Liu1, C. Green2, P. Kelly3, A. P. Shah3, G. Haidukewych2, and J. M. Rineer3; 1University of Central Florida Medical School, Orlando, FL, 2Orlando Health Jewett Orthopedic Institute, Orlando, FL, 3Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
Purpose/Objective(s): Severe idiopathic arthrofibrosis is an uncommon but debilitating complication following total knee arthroplasty (TKA). It is characterized by excessive scar tissue formation and is often refractory to treatment. Low dose perioperative radiation therapy (RT) is widely used to reduce scar and fibro-osseous proliferation, as in keloid formation and heterotopic ossification. Limited case series have demonstrated a role for perioperative RT to prevent recurrent arthrofibrosis. Here, we present results of our analysis of patients treated with perioperative RT undergoing revision TKA to demonstrate favorable safety and functional outcomes.
Materials/Methods: Patients undergoing revision TKA and perioperative RT at a single institution between 2023 and 2025 were included in this retrospective analysis. Patients had a preoperative diagnosis of severe arthrofibrosis with planned revision surgery. Patients were treated preoperatively (< 24 hours prior to surgery) or postoperatively (< 72 hours after surgery) in a single fraction of 7.5-8.0Gy using AP/PA fields and high energy photons. Safety was assessed by the incidence of perioperative complications. Functional outcome assessment included full arc range of motion (ROM) compared preoperatively, at 6 week follow up and at last follow up. Comparisons were made by paired t-test.
Results: A total of 11 patients were eligible for analysis. See Table 1 for pretreatment characteristics. Five patients had flexion contracture > 10° at baseline. Five had ROM 80° or less pretreatment. Median follow up was 10 weeks (range 3-52). Two patients were treated with RT postoperatively and 9 preoperatively. Four patients were treated with 7.5Gy and 7 with 8.0Gy. There were no acute sequelae of RT observed. One patient treated postoperatively developed deep vein thrombosis requiring hospitalization and anticoagulation. There were no other significant complications. Functional improvement was noted in ROM versus baseline at 6 weeks: median 88° (range 75-115°; p = 0.08). ROM improvement was statistically significant at last follow up: median 89° (range 75-120°; p = 0.05).
Conclusion: Preliminary findings suggest that preoperative low-dose RT is safe and may contribute to improved ROM following revision TKA, with decreased recurrent arthrofibrosis. The data support further investigation into low dose RT as a potential adjunctive therapy to reduce arthrofibrosis in revision TKA for arthrofibrosis. In clinical practice, surgeons may consider selective use of perioperative RT to enhance post-TKA functional outcomes, particularly ROM as demonstrated in this series.
Abstract 3476 - Table 1
| Sex | Male - 3 | Female - 8 |
| Knee laterality | Right - 6 | Left - 5 |
| Prior manipulation under anesthesia | Yes - 5 | No - 5 |
| Median | Range | |
| Age | 64 | 54-79 |
| Prior surgeries | 2 | 1-6 |
| Preoperative flexion contracture | 5° | 0-45° |
| Preoperative ROM | 80° | 40-105° |