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ANZ J Surg. 2016 Jun;86(6):480-2. doi: 10.1111/ans.13540. Epub 2016 Apr 12.

Hydraulic distension of the knee: a novel treatment for arthrofibrosis after total knee replacement (case series).

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Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Washington Joint Institute, OrthoBethesda, Bethesda, MD, USA.



Arthrofibrosis following total knee arthroplasty (TKA) is a common problem, which can be frustrating to both the patient and treating physician and can dramatically compromise post-operative function. Current treatment options for TKA arthrofibrosis include watchful waiting, injections, physical therapy, manipulation under anaesthesia, arthroscopic/open lysis of adhesions and revision surgery. We present a novel technique to treat acute and chronic stiffness following TKA, which we call hydraulic distension.


A retrospective pre- and post-operative inpatient and outpatient record review of three patients treated with hydraulic distension for arthrofibrosis following TKA at a single institution.


Three patients with a mean age of 74 years (68-78) underwent hydraulic distension of the knee at a mean of 23.4 ± 18.4 months (9 weeks to 36 months) following primary TKA. The mean pre-distension maximum flexion was 86.7 ± 10.4°, and the mean post-distension flexion was 110 ± 13.2° (23.3° increase). The patients maintained a mean 110 ± 20° flexion (23.3° increase) at a mean follow-up of 11.7 months (1 week to 29 months). There were no complications.


We present a novel technique for managing arthrofibrosis following TKA that has not been previously reported. This is an effective, safe procedure, with our patients experiencing a mean 23° increased knee flexion at the most recent follow-up.


arthrofibrosis; arthroplasty; knee; knee manipulation; manipulation

[Indexed for MEDLINE]

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