Do Various Factors Affect the Frequency of Manipulation Under Anesthesia After Primary Total Knee Arthroplasty?

Abstract

Background One of the most important goals of primary total knee arthroplasty (TKA) is to achieve a functional range of motion (ROM). However, up to 20% of patients fail to do so, which can impair activities of daily living. Questions/purposes The purpose of this study was to evaluate the effect of various (1) demographic factors;(2) comorbidities; and (3) knee-specific factors on the frequency of manipulation under anesthesia, which was used as an indicator of knee stiffness after a primary TKA. Methods We evaluated the registries of two high-volume centers and reviewed all 3182 TKAs that were performed between 2005 and 2011 to identify all patients who had undergone manipulation under anesthesia (MUA). A total of 156 knees in 133 patients underwent MUA after an index arthroplasty. These patients were compared in a one-to-four ratio with a group of patients with satisfactory ROM drawn from the same database who met prespecified criteria and who had not undergone MUA. Effects of various factors, including age, sex, body mass index, race, comorbidities, and the underlying cause of knee arthritis, were compared between these two cohorts using multivariable logistic regressions. Results After controlling for various confounding, nonwhite race was associated with an increase (odds ratio [OR], 2.01; p = 0.03), and age C 65 years (OR, 0.17; 95% confidence interval [CI], 0.04-0.74; p = 0.0179) was associated with a reduction in the incidence of MUA. In comorbidities, diabetes (OR, 1.72; 95% CI, 1.02-2.32; p = 0.03), high cholesterol levels (OR, 2.70; p = 0.03), and tobacco smoking (OR, 1.59; 95% CI, 1.03-2.47; p = 0.03) were associated with an increase in frequency of MUA. In knee-specific factors, preoperative knee ROM of less than 100°(OR, 0.80; p \ 0.0001) and knee osteonecrosis (p = 3.61; 95% CI, 1.29-10.1; p = 0.014) were associated with increased frequency of MUA. Conclusions We identified several demographic, medical, and knee-specific factors that were associated with poor

Manipulation under Anesthesia after Knee Arthroplasty Is Associated with Worse Long-Term Clinical Outcomes and Survivorship

“…This study found that patients who undergo manipulation after primary TKA have a significantly higher risk of revision, lower survivorship, as well as worse long-term ROM and 5,[10][11][12][13][14][15]27 Of all these factors, preoperative ROM is the best predictor of postoperative ROM. [10][11][12]27 Patients in this study who required a manipulation were significantly younger, had less preoperative knee ROM, and higher incidence of posttraumatic arthritis.…”

Manipulation under Anesthesia: Does Polyethylene Thickness Matter?

“…Persistent knee stiffness occurs in 1.3 to 5.3% of patients undergoing TKA, which may result in a decreased range of motion (ROM) and impede activities of daily living. [3][4][5][6][7] While no validated criteria or consensus defining postoperative subjective knee stiffness exists, studies have defined it as a flexion contracture between 15 to 90 degrees. 3,5 Several intraoperative risk factors that contribute to knee stiffness after TKA have been identified, including improper flexionextension gap balancing, component malpositioning, inadequate femoral or tibial resection, excessive joint line elevation, creation of an anterior tibial slope, and incomplete resection of posterior osteophytes.…”

“…6,7 A previous study by Issa et al, reviewing 3,182 TKAs of which 156 knees subsequently underwent MUA, found nonwhite race (odds ratio [OR]: 2.01), age less than 65, diabetes (OR: 1.72), high cholesterol (OR 2.70), tobacco smoking (OR: 1.59), knee osteonecrosis (OR: 3.61), and pre-TKA ROM less than 100 degrees (OR: 0.80) to be correlated to an increased risk of MUA. No difference was observed when comparing cruciate-retaining versus posterior-stabilized TKAs liner…”

Innovative Multimodal Physical Therapy Reduces Incidence of Repeat Manipulation under Anesthesia in Post–Total Knee Arthroplasty Patients Who Had an Initial Manipulation under Anesthesia

“…Knee stiffness following TKA is a potentially debilitating complication that can affect up to 20% of patients. [1][2][3] This complications may impair the patient's ability to perform frequent activities of daily living such as rising from the seated position, ascending and descending stairwells, as well as many others. 4 Additionally, range of motion (ROM) is one of the most important factors for quality of life and satisfaction in post TKA patients.…”