Knee Manipulation After Total Knee Arthroplasty: Comparison of Two Implant Designs

Abstract

Substantial postoperative stiffness requiring manipulation is a well-recognized complication of total knee replacement. This study sought to determine whether the Medial-Pivot (MP) knee (Wright Medical, Memphis, TN) or the Double-High (DH) knee (Wright Medical) is more often associated with manipulation under anesthesia (MUA) for post-total knee arthroplasty (TKA) knee stiffness. It was hypothesized that manipulation rates would be similar. Retrospective review of 755 TKA patients showed that 4.1% required MUA, which is comparable to the literature. Manipulation by MUA for DH and MP knees was generally successful, with an average overall improvement in knee flexion of nearly 30°. MP and DH knees appear to have a lower than average prevalence of post-TKA knee stiffness requiring manipulation when compared with the literature. The number of MP and DH knees requiring MUA did not appear to differ substantially.

Acquired Idiopathic Stiffness After Total Knee Arthroplasty

“…2). Its prevalence was significantly (p = 0.033) lower in studies with >24 months of follow-up 1,4,12,[16][17][18]20,28,30,31,36,38,39,44,54 (3%, I 2 = 96%) than in those with £24 months of followup 19,29,[32][33][34][35]37,40,41,43,[45][46][47][48][49][50][51]53 (4%, I 2 = 85%) (Fig. 3).…”

“…In the majority (63%) of the studies, a range of motion of <90°or a flexion contracture of >5°was used to define postoperative acquired idiopathic stiffness 1,12,[17][18][19][20]28,[32][33][34][35]38,[42][43][44][45][46][48][49][50][51] . Previous studies have demonstrated that 105°to 110°is the minimum knee flexion required to perform most activities of daily living (ADLs) in Western societies such as rising from a chair, walking, and ascending stairs 55,56 .…”

“…The severity of acquired idiopathic stiffness is a continuum; the authors of several studies have recognized that the time of follow-up as well as the extent of clinical intervention or rehabilitation play a large role in determining the reported prevalence of the disease. We found that the prevalence was significantly lower (p = 0.033) in studies with follow-up of >24 months 1,4,12,[16][17][18]20,28,30,31,36,38,39,44,54 (3%, I 2 = 96%) than in those with £24 months of follow-up 19,29,[32][33][34][35]37,40,41,43,[45][46][47][48][49][50][51]53 (4%, I 2 = 85%). These data suggest that the disease process generates its most significant effects early; therefore, efforts to interrupt the process should be undertaken immediately postoperatively or in the perioperative period.…”

“…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 .…”

Low manipulation prevalence following fast-track total knee arthroplasty

“…We did not investigate component positioning, as there were no open manipulations, and no component changes were found to be necessary as the surgeons did not find any gross misplacement. Also, the choice of prosthesis was at the surgeons’ discretion, and could possibly influence the prevalence of MUA, as one recent study found different prevalences associated with different types of prostheses ( Berend et al 2013 ) whereas others did not ( Barnes et al 2013 ; Peters et al 2014 ). Although 1 study found that warfarin prophylaxis (compared to LMWH) resulted in more arthrofibrosis, necessitating manipulation in 26% as opposed to 6% of patients ( Walton et al 2005 ), we did not study this aspect as none of the patients received prolonged warfarin prophylaxis ( Jørgensen et al 2013c ).…”