Manipulation for stiffness following total knee arthroplasty: when and how often to do it?

Abstract

Stiffness following total knee arthroplasty is a disabling complication. One of the management options of stiffness includes manipulation under anaesthesia, but no real consensus exist on appropriate timing of intervention, and the timing and results of the manipulation under anaesthesia (MUA) are under debate in the literature. Our aim was to determine the efficacy of single and multiple manipulations under anaesthesia following total knee arthroplasty and to determine the most appropriate timing for manipulation. We retrospectively reviewed 86 patients who underwent manipulation for stiffness following primary total knee replacement with at least 1-year follow-up. Range of motion before surgery, at the time of the MUA, immediately after MUA and at 6 weeks and 1 year post-MUA were recorded. At the end of 1 year post-manipulation, manipulations performed at less than 20 weeks, following primary total knee arthroplasty, showed 31° of flexion gain as compared to only 1.5° of flexion gain when manipulation was undertaken after 20 weeks. Of the 86 patients, 21 had multiple manipulations with no significant difference in flexion gain after the second manipulation. Patients on warfarin (26%) had an increased incidence of stiffness and poor flexion gain. This study showed that better results were achieved when manipulation was performed at less than 20 weeks (particularly between 12 and 14 weeks) from primary surgery with no added benefit from re-manipulations.

Manipulation under anesthesia after primary knee arthroplasty in Sweden: incidence, patient characteristics and risk of revision

“…2016), warfarin treatment (Desai et al. 2014), history of previous knee surgery (Plate et al. 2016, Newman et al.…”

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

“…5,7,19 The literature is mixed on the fate of knees that undergo manipulation, with revision rates after MUA being reported between 3.2 and 14%. [21][22][23][24][25] Few studies have evaluated the long-term outcomes and revision risk of undergoing a MUA. 24,25 The purpose of this study is to evaluate the long-term outcomes and survivorship of patients who required a MUA after primary TKA compared with a cohort of patients who did not undergo a MUA.…”

Does Manipulation under Anesthesia Increase the Risk of Revision Total Knee Arthroplasty? A Matched Case Control Study

“…There are several small studies that, similar to this study, have reported a low incidence of revision arthroplasty following MUA in the short term (►Table 2). 11,13,14 Most recently, Desai et al evaluated the outcomes of a cohort of patients who underwent MUA following a failed course of physical therapy (n ¼ 86 patients). 11 After a 1-year follow-up, they were three (3.5%) patients who required revision TKA for persistent knee stiffness, which they believe was most likely due to an oversized femoral component.…”

“…11,13,14 Most recently, Desai et al evaluated the outcomes of a cohort of patients who underwent MUA following a failed course of physical therapy (n ¼ 86 patients). 11 After a 1-year follow-up, they were three (3.5%) patients who required revision TKA for persistent knee stiffness, which they believe was most likely due to an oversized femoral component. Similarly, Namba and Inacio evaluated the outcomes of a cohort of patients who required an MUA following their TKA (n ¼ 195 patients).…”