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Objectives and questions: To evaluate the efficacy of different treatment modalities on range of motion (ROM) and functional outcomes in patients with histologically proven knee arthrofibrosis following total knee arthroplasty (TKA) in a prospective study with operative patients from March 15, 2020, to March 15, 2022.

Material and methods: A total of 30 patients with knee arthrofibrosis were prospectively enrolled and nonrandomly divided into three groups based on treatment:Group A (ASK: Arthroscopic Surgery of the Knee, n=16),Group B (Tub: Tuberosity transfer and total knee arthroplasty revision , n=8), andGroup C (Konservativ: Conservative treatment, n=6). Pre- and post-operative ROM (extension and flexion) and Oxford scores were compared. Statistical analyses included intra-group and intergroup comparisons using t-tests, ANOVA, and Wilcoxon tests.

Results: Pre-operative ROM averaged 12.2° (SD=12.1) for extension and 69.7° (SD=20.1) for flexion in Group A (ASK), 12.5° (SD=12.5) for extension and 59.4° (SD=40.8) for flexion in Group B (Tub), and 1.7° (SD=4.1) for extension and 87.5° (SD=20.9) for flexion in Group C (Konservativ). Post-operatively, ROM improved significantly in Groups A and B, with extension increasing to 4.4° (SD=5.7) and 3.4° (SD=3.9), and flexion to 90.9° (SD=11.9) and 80.0° (SD=29.5), respectively (p < 0.05). Oxford scores improved from 45.19 (SD=6.8) to 32.5 (SD=7.6) in Group A (ASK) and from 49.0 (SD=6.9) to 35.1 (SD=10.7) in Group B (Tub) (p < 0.05). Group C (Konservativ) showed no significant improvement in ROM or Oxford scores (p > 0.05). Intergroup analysis revealed no significant difference between Groups A (ASK) and B (Tub) (p > 0.05), but both surgical groups showed superior outcomes compared to Group C (Konservativ) (p < 0.05).

Discussion and conclusions: Surgical interventions (ASK and Tub) significantly improve ROM and functional outcomes in patients with knee arthrofibrosis post-TKA, outperforming conservative treatment. These findings suggest that surgical approaches are effective in enhancing joint flexibility and quality of life, reducing the need for revision surgeries.