Clinical and Patient-Reported Outcomes Following Total Knee Revision for Arthrofibrosis Using Modern Rotating Hinged Knee Arthroplasty and Preoperative Radiation Therapy: A Single-Institution Retrospective Analysis.

PURPOSE: Arthrofibrosis is a debilitating complication following total knee arthroplasty (TKA) characterized by excessive fibroproliferation leading to restricted range of motion (ROM) and impaired function. Radiation therapy (RT) has demonstrated efficacy in modulating fibroblast activity in benign conditions, yet patient-reported outcomes following RT-assisted management of arthrofibrosis remain poorly defined. This study evaluates clinical and patient-reported outcomes in patients undergoing revision TKA for severe arthrofibrosis augmented with preoperative RT. METHODS AND MATERIALS: In this retrospective study, patients undergoing revision TKA for severe arthrofibrosis with adjunctive preoperative RT between 2023 and 2025 were identified. All patients received a single fraction of 8.0 Gy external beam RT within 24 hours prior to surgery. Clinical outcomes included passive ROM measured preoperatively, at 6 weeks, and at final follow-up. Patient-reported outcomes were assessed using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, PROMIS Pain Interference, PROMIS Global Physical Health, and Knee injury and Osteoarthritis Outcome Score for Joint Replacement instruments. Paired t tests compared pre- and postoperative outcomes. RESULTS: Thirteen patients were included with a mean follow-up of 19 weeks. Mean total arc of motion improved from 69.5° preoperatively to 94.5° at 6 weeks and 98.3° at final follow-up (P < .01). PROMIS Physical Function improved by a mean of 7.8 points (P = .013), PROMIS Pain Interference decreased by 10.1 points (P = .017), and Knee injury and Osteoarthritis Outcome Score for Joint Replacement improved by 25.3 points (P = .004). Patient-reported outcome data were available for 12 patients. PROMIS Global Physical Health demonstrated a nonsignificant improvement. No radiation-related adverse events or reoperations were observed. CONCLUSIONS: Preoperative RT appears to be a safe and effective adjunct in the management of severe arthrofibrosis following TKA, resulting in meaningful improvements in ROM and patient-reported functional outcomes. These findings support an expanding role for RT in benign musculoskeletal fibroproliferative disorders.