Alternative technique for knee manipulation under anesthesia

Abstract

Total knee arthroplasty is a successful surgery for the majority of patients with osteoarthrosis of the knee. Approximately 5% of patients undergoing total knee arthroplasty experience loss of motion or arthrofibrosis. Manipulation under anesthesia (MUA) is generally indicated for patients who do not achieve >90° of flexion by 6-12 weeks postoperatively. Complications from MUA are rare but can be devastating. We describe a novel technique for MUA with no reported major complications in our review of 78 patients. The average flexion improved from 80.0 (±3.8) before manipulation to 115.4 (±2.1) after manipulation. There were no major complications including fracture or extensor mechanism injury.

Acute Femoropopliteal Bypass Graft Occlusion After Knee Manipulation Under Anesthesia: A Case Report and Review of Current Literature

“…33-35 For this patient, a short lever arm technique was done, as opposed to the long lever arm technique, which has been shown to have a higher rate of complications, which can include fracture and the need for revision surgery. 19 MUA for arthrofibrosis has been believed as a relatively benign, minimally invasive procedure to increase a patient's ROM, but here we show that there can be consequences for certain at-risk patients, and even potentially lead to limb loss. 19,20 Preparedness was a key driver of preventing limb loss in this patient; as a medical community, there is still room for improvement in understanding the contraindications and prevention of complications for knee MUA after femoropopliteal bypass grafting.…”

“…MUA for arthrofibrosis has been noted as a safe procedure that successfully increases patient's range of motion (ROM). 19,20 Acute femoropopliteal graft thrombosis after kneespanning ex-fix removal and MUA, to our knowledge, has not been described in the literature. Here, we describe successful recognition, reperfusion, and limb salvage in a single patient at a level 1 trauma center.…”

“…MUA for arthrofibrosis has been noted as a safe procedure that successfully increases patient's range of motion (ROM). 19,20…”

The STAK tool: evaluation of a new device to treat arthrofibrosis and poor range of movement following total knee arthroplasty and major knee surgery

“… 40 In clinical practice if 90° ROM is not attained an MUA is often performed. 41 66% of patients in the STAK intervention group achieved ROM over 90° (mean increase 30°). Patients in our study had very poor ROM (mean 65°) with 69% of the sample starting with 70° ROM or less.…”

“…Conventional treatment is aggressive physiotherapy, progressing to manipulation under anaesthetic (MUA) or arthroscopic debridement if 90° flexion is not attained within six to 12 weeks post-surgery. 17 MUA after primary TKA has been reported in up to 12% of patients and is a costly complication with some degree of risk attached to the procedure. 16 MUA can lead to impressive increases in ROM 18 ; however, initial gains may not be maintained 19 and further surgery to restore ROM may be required with only 37% of these reporting satisfactory results.…”