Arthroscopy of symptomatic total knee replacements.

Between December 1983 and August 1992, 21 knees in 19 patients with symptomatic total knee replacements were arthroscopically diagnosed. The average time between total knee replacement and arthroscopy was 20 months (ranging from 4 to 84 months). All patients were primary total knee replacements. Metal bars, 5 and 8 mm in diameter and 40 cm in length, were made for arthroscopic treatment of fibroarthrosis. Thirteen knees of 11 patients with a diagnosis of arthrofibrosis had an average improvement of 42 degrees arc of motion 1 year after arthroscopic surgery. Three knees with an average of 15 degrees increase of motion were determined to be failures. Another two patients had arthroscopic resection of fibrous bands with complete relief of patella pain. Among six patients who had revision of total knee replacements after arthroscopic diagnosis, four had wear in the metal backed patella components, and two had wear in the tibial insert and loosening of cementless patella component. An early diagnosis of implant failure under arthroscopic control was made, which easily allowed revision of the metal-backed patellar button before the development of metallosis and massive osteolysis caused by the marked wear of polyethylene. With the use of our specially made metal bars for treating arthrofibrosis, we could release the adhesion more easily and avoid damage of valuable arthroscopic instruments.