KEY POINTS
- This single-institution retrospective series included 13 patients undergoing revision total knee arthroplasty for severe recurrent arthrofibrosis between 2023 and 2025. Mean follow-up was only 19 weeks.
- Every patient received 8 Gy in one fraction within 24 hours before surgery, using CT-based three-dimensional conformal planning and opposed anterior-posterior/posterior-anterior high-energy photon fields.
- Surgery involved radical removal of arthrofibrotic scar tissue and implantation of a rotating-hinge knee prosthesis, followed by standardized postoperative rehabilitation. Patients had undergone a mean of two previous operations, with some undergoing as many as six.
- Mean total range of motion improved from 69.5° before treatment to 94.5° at six weeks and 98.3° at final follow-up, corresponding to a mean improvement of 28.8°.
- PROMIS Physical Function improved by 7.8 points (p = 0.013) and PROMIS Pain Interference improved by 10.1 points (p = 0.017). KOOS Joint Replacement scores improved by 25.3 points (p = 0.004).
- PROMIS Global Physical Health improved by 5.8 points but did not reach statistical significance (p = 0.194).
- No radiation-related adverse events or reoperations occurred during follow-up. However, without a revision-surgery-alone control group, the substantial improvements cannot be separated from the effect of radical surgical release and rehabilitation.
CLINICAL TAKEAWAY
Single-fraction preoperative radiotherapy is an interesting antifibrotic adjunct for exceptionally refractory knee arthrofibrosis, but this series does not establish efficacy. Controlled prospective data with substantially longer follow-up are needed before this becomes a routine benign indication.