Non-surgical interventions for arthrofibrosis following knee joint replacement: A systematic review

Abstract

Objective

To evaluate the effectiveness of non-surgical interventions for knee stiffness or arthrofibrosis following knee replacement surgery.

Data sources

Ovid MEDLINE, Ovid Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL)were searched from database inception to October 2024.

Review methods

All studies of non-surgical interventions (versus any/no comparator) for adults who developed knee stiffness or a diagnosis of arthrofibrosis following knee replacement were included. Selection, quality appraisal and extraction were completed in duplicate. Results were synthesised narratively. The risk of bias was assessed, and GRADE criteria were used to evaluate evidence quality.

Results

Sixteen studies were included, comprising two randomised-controlled trials (n = 76), one non-randomised controlled trial (n = 35), seven cohort studies (n = 352) and six case studies (n = seven). Interventions varied widely including exercise, manual therapy, mechanical devices, and education. Improvements in knee range of movement were reported with some demonstrating functional gains >110° of knee flexion, but the evidence was of low quality. Limited reporting of intervention descriptions, patient-relevant outcomes including function and pain, and longer-term follow-up hindered comprehensive evaluation.

Conclusion

The review highlights the heterogeneity of interventions, emphasising the need for standardised reporting. While some studies showed promise, the lack of control groups, small sample sizes, and varied follow-up durations limit conclusive findings. There is insufficient evidence to support any specific non-surgical interventions for arthrofibrosis post-arthroplasty. Further research should be a priority.