Arthrolysis: Treatment, Effects & Risks

Arthrolysis a surgical procedure to restore full range of motion to restricted movement of large joints. Typically, the procedure is performed on the knee or even shoulder joint.

What is procedure?

Arthrolysis a surgical procedure to restore full range of motion in cases of limited motion of large joints. Typically, the procedure is performed on the knee or even shoulder joint. Arthrolysis, also referred to as surgical joint mobilization, is intended to restore full range of motion to larger joints. This requires certain orthopedic surgical techniques, which usually do not require a so-called wide joint opening. In the vast majority of cases, the surgical procedure can be minimally invasive. This surgical technique is associated with several advantages for patients. If the procedure is successful and no further complications are expected, then the patient can be discharged on the day of the minimally invasive procedure. Thus, arthrolysis does not necessarily have to be performed under full inpatient conditions, but can also be performed on an outpatient basis. Joint motion disorders can have many causes, all of which, however, can be remedied by surgical joint mobilization. The definitions in the medical guidelines for this type of surgery dictate that a surgeon should use as little force as possible to restore and fix a joint to its proper starting position. However, it is often not possible to avoid some use of force when there is a rigid restriction of motion, such as a knee joint.

Function, effect and goals

Movement disorders of large joints can be acute or chronic. The most common indication for arthrolysis of the knee joint involves older people in whom the mobility of a joint is impaired by adhesions. Over time, these scarring adhesions of the connective tissue of a joint provide greater restriction of motion, so that at a certain point of immobility, there is an indication for surgery. Other common causes of restricted joint movement are shrinkage of the joint capsule as part of degenerative changes in old age or in osteoporosis. In the case of osteoporosis, or bone atrophy, the surgeon must be particularly careful not to further damage the usually very soft bone structure during arthrolysis. Another clinical picture that occurs particularly in advanced age is arthrosis, which can also affect the large joints of the body. Up to a certain mild degree of arthrosis, however, many patients experience no discomfort at all, but as the disease progresses, so-called osteophytes may form. These are bone attachments, superfluous bone parts without function, which permanently endanger the ability to move a large joint. Therefore, osteophytes are also a typical indication for performing minimally invasive joint mobilization. However, the procedure can also be performed under general anesthesia. Before any arthrolysis, all conservative measures for joint mobilization should have been exhausted. However, it is known from studies that this is not the case for all patients. One reason for this is that the suffering pressure of many patients due to chronic pain is so high that they urge their treating physician to perform this treatment. Scarred changes or shortened capsule parts of a joint are removed or separated during the procedure. In medical parlance, extended arthrolysis is always referred to when osteophytes are removed in addition to other factors that restrict movement. The improvement or full restoration of the mobility of a joint is still checked intraoperatively and corrected again if necessary. After such an operation, the newly established structures are initially considered unstable and vulnerable. Therefore, postoperative follow-up is of immense importance. Rehabilitation aims at long-term stabilization and may well take several months. Treatment is not considered to have been successfully completed until a joint can be fully loaded again. However, this unrestricted load-bearing capacity cannot be fully restored in many patients, especially older patients.

Risks, side effects and dangers

If the procedure is minimally invasive under local anesthesia, then the patient is told exactly how to move the joint during surgery. This is because hyperextension or flexion during the procedure could ruin the success of surgery. However, the use of force during surgery, which should be avoided as much as possible according to the guidelines, is unavoidable in the case of chronically strained or overstretched joint components or tendons. Weeks to months after arthrolysis, minimal weight can be placed on a joint. This often results in the atrophy of the important joint-stabilizing muscles. The resulting joint instability can, for example, require a new operation if only one wrong movement is made. Only targeted physiotherapy can counteract excessive muscle atrophy after arthrolysis. In addition, many patients complain of moderate to severe pain after such surgical joint mobilization, which may be caused by the internal surgical scar. Therefore, adequate pain therapy is standard after surgery and must be continued for a sufficient period of time to prevent chronicity. The term arthrolysis was introduced into medical terminology as early as 1944 by the German surgeon Hackenbroch. Since then, the procedure has been further refined and optimized. Arthrolysis is often confused by laypersons with the so-called arthroplasty. However, while arthroplasty involves the artificial replacement of parts or an entire joint, artholysis in all its variants always works to preserve the joint. Artholysis is performed by specially trained surgeons or orthopedists.