Arthrolysis for Joint Stiffness: Arthroscopic Arthrolysis and Open Procedures, Preoperative Diagnosis, and Postoperative Care

Joints can function smoothly only when all their components work together perfectly. If parts become jammed or interfere with one another, this results in restricted range of motion.

Causes of such joint dysfunction often include

• scar tissue adhesions,
• adhesions, and
• osteophytes (bony spurs that can form over time).

Arthrolysis can provide relief to a certain extent. This is a surgical procedure that doctors use to restore mobility to a restricted joint.

The word “arthrolysis” is a neologism derived from Greek and combines

• “arthron” for “joint” and
• “lysis,” which means “dissolution.”

In most cases, arthrolysis can be performed minimally invasively using arthroscopy. The incisions required are very small, and significantly less force is needed. This protects the joint and surrounding structures and leads to faster healing.

Open joint procedures are rather uncommon in the context of mobilization via arthrolysis and occur only very rarely.

Arthrolysis is used when

• conservative,
• physical therapy, and
• medication-based

treatments fail to produce improvement.

Arthrolysis should be distinguished from arthroplasty. In arthroplasty, the existing joint is not restored but is instead replaced with an artificial joint.

In certain situations or under specific conditions, arthrolysis is not possible, such as in cases of

• acute inflammation in the area of the joint to be restored,

• blood clotting disorders

  and
• general contraindications to general anesthesia (such as allergies to anesthetics).

Arthroscopic procedures are primarily performed on the large joints. Procedures on

• knees,
• shoulders, or
• the hips

are the most common applications of this procedure. These joints bear the heaviest load in everyday life.

The elbow and the ankle joint are also frequently treated arthroscopically.

Thanks to technological advances in medicine, surgeons are increasingly able to perform arthroscopic procedures on smaller joints as well. This includes, for example,

• the wrist and
• the lower ankle.

The procedure is often performed under general anesthesia. This means the patient is unconscious for the duration of the surgery.

Occasionally, local anesthesia may be used instead. In this case, the doctor numbs only the area around the joint being operated on. However, there is a risk that the patient might move inadvertently, which could interfere with the procedure and thus affect its success. Instructions from the attending physician on how to behave during the procedure should minimize this risk.

Prior to anesthesia, a consultation with the anesthesiologist also takes place. The anesthesiologist explains the risks and the procedure involved in anesthesia to the patient. There are two types of arthrolysis.

Simple arthrolysis involves cutting or splitting shortened or fused sections of the joint capsule. The surgeon then removes adhesions that have formed, for example, due to scar tissue. In extended arthrolysis, any bone spurs are also removed.

The success of the procedure in terms of restoring mobility is assessed during the operation itself. If there is any doubt, minor adjustments can be made on the spot.

Compared to open surgery, the risks of an arthroscopic procedure are relatively low. Nevertheless, as with any procedure, there are some potential complications. These include

• joint effusion,
• irritation during wound healing, and
• joint infections, although these are very rare.

In addition, the procedure can cause cartilage damage and increase the risk of developing osteoarthritis.

In the case of knee arthroscopy, the procedure may result in

• thrombosis (probability of 1 in 400) or
• pulmonary embolisms (probability of 1 in 588)

. Therefore, discuss the risks and the exact procedure with a specialist before deciding to undergo surgical mobilization of your joint.

The length of the hospital stay depends on the extent of the procedure. In cases of minimally invasive arthrolysis without complications, the patient can be discharged on the day of the surgery. In such cases, inpatient admission is usually not necessary.

However, a hospital stay is necessary if complications arise or the procedure is unsuccessful. In such cases, the doctor will recommend observation in the hospital.

The focus of follow-up care is on

• stabilizing the joint and
• consolidating the changes made to the joint’s structure.

Healing takes a relatively long time. Patients must therefore be prepared for a longer and more extensive course of follow-up care (usually several months). This is the only way to ensure that the joint will continue to function reliably in the future.

Pain often occurs in the initial period following the procedure. Pain management is therefore usually necessary.

After surgery, you should rest the joint and put only minimal strain on it. However, this may also lead to muscle loss. Therefore, targeted physical therapy is used to gently and appropriately build up muscle strength.