Effect of Repeated Manipulation on Range of Motion in Patients With Stiff Total Knee Arthroplasty

Abstract

Although manipulation under anesthesia (MUA) has been considered effective first-line treatment for stiff total knee arthroplasty (TKA), there is no consensus regarding the usefulness of repeated MUA. The purpose of this study was to investigate the usefulness of repeated MUA performed for patients in whom satisfactory range of motion (ROM) was not achieved by MUA. The authors retrospectively reviewed 15 patients who underwent repeated MUA after failure of initial MUA for stiff TKA. Demographic and ROM data were collected. A final ROM of less than 90° was considered a failed manipulation (failure group) and a final ROM of 90° or more was considered a successful manipulation (success group). Average pre-repeated MUA ROM (72.3°±19.5°) immediately improved to 112.3°±9.7° (P<.001) in the operating room, and final ROM was 89.6°±23.9°, an overall gain of 17.3° (P=.04). However, despite this overall ROM increase, a successful final ROM (90° or more) was achieved in approximately half of patients (7 of 13; 54%). There were no significant differences in demographics between the success and failure groups, except that there was significantly less pre-TKA ROM in the failure group (P=.02). There were no complications related to either the first or the repeated MUA procedures. The findings of this study suggest that repeated MUA can improve overall ROM for stiff TKA. The success rate of repeated MUA was less than that of primary MUA; however, it is a useful treatment modality for stiff TKA. Decreased pre-TKA ROM appeared to be associated with poor outcomes after repeated MUA.

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

“…7,28 Repeat manipulations have demonstrated success in some studies with improvements in knee ROM of 17-29 degrees. [29][30][31] Nineteen patients (10%) in this study underwent a repeat MUA, and a significant increase in risk of revision was found with each subsequent MUA. Patients who underwent three or more MUAs had a relative risk of 27.02 for revision.…”

Acquired Idiopathic Stiffness After Total Knee Arthroplasty

“…The definition(s) of "arthrofibrosis," "stiffness," and/or "flexion contracture" utilized as inclusion criteria in each study were assessed. Of the 35 studies included in our review, 2 used the clinical term "arthrofibrosis," 20,41 29 used "stiffness," 1,12,[16][17][18][19][20][28][29][30][31][32][33][34][35][38][39][40][41][42][43][44][45][46][47][48][49][50][51] and 11 used "flexion contracture." 4,16,20,[36][37][38][50][51][52][53][54] Five studies used a combination of the aforementioned clinical terminology as inclusion criteria 16,20,38,41,51 .…”

“…4,16,20,[36][37][38][50][51][52][53][54] Five studies used a combination of the aforementioned clinical terminology as inclusion criteria 16,20,38,41,51 . For 12 studies 12,18,19,28,29,33,35,[44][45][46][47][48] that did not explicitly define inclusion criteria, but instead listed rangeof-motion criteria for manipulation under anesthesia, definitive criteria for manipulation under anesthesia were used as surrogate definitions.…”

Medical stretching devices are effective in the treatment of knee arthrofibrosis: A systematic review

“…However at week 6 the mean function sub-score results were better in the CPM group than the MUA group (p ​= ​0.065). Other research has shown substantial decreases in ROM following MUA over time with some requiring repeat MUA or further surgery [ [44] , [45] , [46] , [47] , [48] , [49] ]. This initial gain then deterioration in ROM may be explained by an abnormal inflammatory response caused or exacerbated by the sudden breakdown of scar tissue, lack of physiotherapy and or the opportunity to complete stretching exercises independently at home.…”