PLR02 - Review of A Proposed Adjunct Treatment of Postoperative Arthrofibrosis in Total Knee Arthroplasty

Primary Presenter(s)

AS

Aaron Schmid, PharmD

Medical Student
Marian University College of Osteopathic Medicine
Indianapolis, Indiana, United States

Co-Presenter(s)

RH

Rachel Hicks, n/a

Medical Student
Marian University College of Osteopathic Medicine
Indianapolis, Indiana, United States

Introduction/Purpose: Leukotriene receptor antagonists (LTRA) are used clinically for the management of allergic rhinitis and asthma. Over the past decade a curiosity has come among researchers about the anti-inflammatory utility of LTRA in the management of non-pulmonary conditions.

Methods or Case Description: Leukotrienes are pro-inflammatory substances that can lead to accelerated wound contraction and scar formation, leading to hypertrophy, disorganized collagen formation and deposition, adhesions, and wound contracture. Capsular contracture, an inflammatory reaction of fibrotic tissue, is a common problem after silicone implant surgery. Capsule formation involves a foreign body response, inflammation cascades, coagulation cascades, granulation tissue formation, and protein adsorption and deposition. Arthrofibrosis, or joint stiffness, is a common complication following total knee arthroplast (TKA). Arthrofibrosis is partly due to an exaggerated local inflammatory response leading to hypertrophic, noncompliant fibrosis and scar formation. Mechanisms of pathogenesis of postoperative fibrosis include inflammatory and immune cell activation and recruitment, and excessive collagen deposition. Over the last two decades, LTRA have been noted to improve capsular contracture, softening the fibrous capsule and avoiding the need for surgical correction. LTRA inhibit collagen maturation, decrease angiogenesis and vessel formation, thin capsules, and decrease capsule collagen density. The involvement of leukotrienes, granulocytes, protein and coagulation cascades, macrophages, myofibroblasts, and collagen in capsule formation and capsule contracture is thought to underlie the mechanism by which LTRA help prevent, treat, and resolve capsular contracture. Stemming from a common pathophysiology, LTRA may be beneficial in reducing fibrosis, scarring, and joint stiffness in TKA patients experiencing decreased range of motion, pain, and limited mobility.

Outcomes: N/A

Conclusion: Comparing the similarities in etiology and pathophysiology of arthrofibrosis and capsular contracture, the authors propose LTRA be further evaluated in TKA arthrofibrosis. LTRA have been found to treat breast implant capsular contracture. Evidence supporting LTRA use in capsular contracture hints at the possibility for use in prevention and treatment of TKA postoperative joint stiffness and arthrofibrosis.