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

Abstract

Manipulation under anesthesia (MUA) is performed for knee stiffness following a total knee arthroplasty (TKA) when nonoperative treatments fail. It is important to develop an optimal outpatient physical therapy protocol following an MUA, to avoid a repeat procedure. The purpose of this study was to evaluate and compare: (1) range of motion and (2) the rate of repeat MUA in patients who either underwent innovative multimodal physical therapy (IMMPT) or standard-of-care physical therapy (standard) following an MUA after a TKA. We performed a retrospective database study of patients who underwent an MUA following a TKA between January 2013 to December 2014 ( = 57). There were 16 (28%) men and 41 (72%) women who had a mean age of 59 years (range, 32-81 years). The patients were stratified into those who underwent IMMPT ( = 22) and those who underwent standard physical therapy ( = 35). The 6-month range of motion and rate of repeat manipulation between the two cohorts was analyzed by using Student t-test and Chi-square tests. In addition, we performed a Kaplan-Meier analysis of time to repeat MUA. The IMMPT cohort had a statistically significant higher proportion of TKAs with an optimal range of motion as compared with the standard cohort. There was statistically significant lower proportion of patients who underwent a repeat MUA in the IMMPT as compared with the standard cohort. There was also a significantly lower incidence and longer time to MUA in the IMMPT cohort as compared with the standard cohort in the Kaplan-Meier analysis. The group who underwent IMMPT utilizing Astym therapy had a significantly higher proportion of patients with optimal range of motion, which implies the potential efficacy of this regimen to improve range of motion. Furthermore, the IMMPT cohort had a significantly lower proportion of repeat manipulations as compared with the standard cohort, which implies that an IMMPT approach could potentially reduce the need for a repeat MUA. These findings warrant further investigation into outcomes of different rehab approaches.

ASTYM® versus massage in the treatment of chronic exertional anterior compartment syndrome of the lower leg: a randomized controlled trial

“…The study results are consistent with the conclusion of Mc Cormack [27] who revealed significant pain reduction with the improvement of the lower limb function in the patient with high hamstring tendinopathy. The finding of Chughtai [28] proved a significant gain in knee joint ROM in patient who underwent Astym therapy compared with standardized physical therapy program following total knee arthroplasty. Chughtai [28] and Paker [29] proved that the joint pain and ROM might be related to effects of Astym on the biomechanical properties of the injured tissues with enhancement of blood flow and possible angiogenesis in the vicinity of these tissues Patients with Ant-CECS might have transient or permanent lowgrade foot drop as a result of the weakness of dorsiflexors with or without paresthesia on the dorsum of the foot.…”

Astym® therapy: a systematic review

“…After undergoing treatment with Astym therapy for a mean of 17 sessions, there were improvements in flexion deficit (70º to 105º, P≤0.001), flexion contracture (15º to 3º, P≤0.001), and the Knee Society objective (57 to 80 points, P<0.0001) and function scores (54 to 80 points, P=0.0003). In another study (24), they evaluated 57 patients (57 knees) who had a mean age of 59 years (range, 32 to 81 years) who underwent TKA followed by MUA either underwent standard of care physical therapy (n=35) or innovative multimodal physical therapy (IMMPT), which included Astym therapy (n=22). At the 6-month evaluation, the IMMPT group did not have any repeat MUAs, but the standard of care group had 7 repeat MUAs (P=0.025), and the IMMPT group had better knee flexion compared to the standard of care group (116º vs. 106º, P=0.005).…”