Manipulation under anesthesia after total knee arthroplasty: a retrospective study of 145 patients

Abstract

Background and purpose: Manipulation under anesthesia (MUA) is considered to be effective in treating stiffness after total knee arthroplasty (TKA). However, not all patients achieve a satisfactory range of motion (ROM) after MUA. This retrospective study determined the outcome of MUA and identified the factors affecting it.Patients and methods: The final sample consisted of 150 MUAs performed on 145 patients. The parameters of interest were ROM and Knee Society Score (KSS) or Oxford Knee Score (OKS). The associations of preoperative, perioperative, and postoperative risk factors with gain in flexion and flexion at post-MUA follow-up (an average of 2 months after MUA) were analyzed using multivariable regression model.Results: The mean of 26° (95% CI 23–29) gain in flexion and the mean of 3° (CI 2–4) gain in extension were noticed at post-MUA follow-up when compared with the ROM preceding MUA. The mean post-MUA-FU flexion was 99° (CI 97–102) and the mean post-MUA-FU extension deficit was 4° (CI 2–5). KSS (121 vs. 129) and OKS (29 vs. 28) were similar before and after MUA. The early timing of MUA was associated with better gain in flexion –0.04 (CI –0.08 to –0.01), while we found no association between the timing of MUA and flexion after MUA –0.004 (CI –0.03 to 0.03). High BMI was associated with better gain in flexion 0.8 (CI 0.2–1.5).Interpretation: We found that ROM improved substantially after MUA. The gain in flexion decreased as the time between TKA and MUA increased.

Factors Influencing Knee Flexion Range of Movement after Primary Total Knee Arthroplasty : Study of a Consecutive Series over Ten Years

“…Authors still claim that high knee flexion is not necessary for patient satisfation [22]. But, knees are still manipulated for stiffness after total knee replacement [14,23]. The posterior tibial slope does not influence knee flexion [24], the pre anesthetic flexion is the best [25] and thus, pre operative physiotherapy is to be proposed from these observations in our study, like in the recomandiations formulated by Diane UJ and al.…”

Manipulation under anesthesia: to do or not to do, that is the question

“…Acta Orthopaedica has recently published 2 studies evaluating MUA after primary total knee arthroplasty, both from single centers in Finland ( 3 , 15 ). The 2 studies have different purposes.…”

“…The 2 studies have different purposes. Rantasalo et al ( 3 ) evaluated preoperative factors associated with postoperative stiffness of the knee in 39 patients needing MUA and the outcome 1 year postoperatively while Sala et al ( 15 ) evaluated the outcome of MUA and tried to identify factors affecting the outcome in 145 patients 2 months after MUA. Rantasalo et al ( 3 ) used a randomized study consisting of 391 patients that aimed to evaluate the use of tourniquet and anesthesia, and identified 39 patients who underwent MUA (10%) and compared those with patients without MUA 1 year postoperatively.…”

“…They found that postoperative pain was associated with stiffness, and that MUA performed 3 months after TKA is effective, with a 39° mean improvement in the ROM in the MUA group and similar PROMs compared with the no-MUA group at 1 year. Sala et al ( 15 ) retrospectively identified MUAs after primary TKA in a university hospital during the period 2009 to 2019. They found 168 MUAs performed in 163 patients (2.7%) and were able to evaluate 150 MUAs in 145 patients to assess which pre-, peri-, and postoperative factors affected the outcome of MUA.…”

“…However, most published studies considering knee stiffness after TKA and subsequent MUA have in common that they include few patients, are single-center studies and have short follow-up after MUA and may not have the possibility to show small differences that may exist. As an example, Sala et al ( 15 ) included 145 patients, which is considered to be one of the largest studies evaluating the factors associated with the outcome of MUA. There are few studies evaluating the risk of revision after MUA.…”