Surgical Management of Arthrofibrosis After Total Knee Arthroplasty: Open Lysis of Adhesions and Tibial Component Exchange

Arthrofibrosis is a common and debilitating complication after total knee arthroplasty (TKA), with an incidence ranging from 1.3 to 19.8%. It is associated with pain, restricted range of motion, and elevated revision rates, yet diagnostic definitions and management strategies remain inconsistent. This review examines surgical options for arthrofibrosis after TKA, focusing on open lysis of adhesions (LOA) and tibial component exchange, and summarizes evidence on indications, patient selection, techniques, outcomes, complications, and predictors of success. A narrative review of the literature was performed, including studies on nonoperative strategies, manipulation under anesthesia (MUA), arthroscopic LOA, open LOA, and revision TKA. Nonoperative treatment and MUA are most effective in the early postoperative period (<12 weeks). Arthroscopic LOA benefits localized adhesions but is limited in diffuse or posterior fibrosis. Open LOA allows broader release and produces average range-of-motion gains, although outcomes vary. Tibial component or polyethylene exchange can be successful in select patients with moderate stiffness, whereas full component revision is more effective in severe cases or when mechanical errors are present. Complications include persistent stiffness, infection, fracture, and extensor mechanism compromise. Predictors of favorable outcomes include early intervention, correctable technical factors, and adherence to rehabilitation. Arthrofibrosis remains a multifactorial complication without a universally effective treatment. Management should be individualized and stepwise, beginning conservatively and escalating to surgical intervention when appropriate. Open LOA and tibial component exchange are valuable tools in select patients, but recurrence and complications remain common. Further prospective studies with standardized definitions and outcomes are needed to improve care.