Manipulation under Anesthesia for Stiffness after Total Knee Arthroplasty

Abstract

PurposeThis study evaluated the incidence of manipulation under anesthesia (MUA) for stiffness after total knee arthroplasty (TKA) and the degree of joint motion recovery after MUA.Materials and MethodsA total of 4,449 TKAs (2,973 patients) were performed between March 2000 and August 2014. Cases that underwent MUA for stiffness after TKA were reviewed. TKAs were performed using the conventional procedure in 329 cases and using the minimally invasive procedure in 4,120 cases. The preoperative range of joint motion, timing of manipulation, diagnosis and the range of joint motion before and after MUA were retrospectively investigated.ResultsMUA was carried out in 22 cases (16 patients), resulting in the incidence of 0.5%. The incidence after the conventional procedure was 1.2% and 0.4% after the minimally invasive procedure. In the manipulated knees, the preoperative range of motion (ROM) was 102.5°±26.7°, and the preoperative diagnosis was osteoarthritis in 19 cases, rheumatoid arthritis in two, and infection sequela in one. MUA was performed 4.7±3.0 weeks after TKA. The average ROM was 64.5°±13.5° before manipulation. At an average of 64.3±41.3 months after manipulation, the ROM was recovered to 113.4°±31.2°, which was an additional 49.9° improvement in flexion.ConclusionsThe satisfactory recovery of joint movement was achieved when MUA for stiffness was performed relatively early after TKA.

Late Evaluation of Patients Undergoing Manipulation of the Knee After Total Arthroplasty

“…A series of studies have shown superior results when manipulation is performed early. 3 , 5 , 6 , 9 Many authors consider 12 weeks post-TKA to be the deadline for manipulation, since a more invasive procedure is necessary after this time because of maturation of the scar tissue. 5 , 9 - 11 However, some studies found no significant differences in gains in range of motion between early and late groups (undergoing manipulation before and after twelve weeks).…”

“…All the patients in our study received guidance via booklets given to them by our team physiotherapists, and the institute’s rehabilitation service was also available for post-procedure follow-up. Yoo et al 3 emphasized the need for aggressive physical therapy after manipulation to achieve good outcomes.…”

“… 1 , 2 Despite good results and constant advances in implant characteristics, surgical techniques, and postoperative recovery protocols, some patients have poor functional outcomes, which restrict their activities of daily living. 3 , 4 …”

The effect of a preoperative education class on the rate of manipulation under anesthesia after total knee arthroplasty in a veterans population

“…This procedure, however, is not without its own risks, including exposure to anesthetic agents and possible extensor mechanism rupture or periprosthetic fractures [13]. Patients requiring MUA may also have an increased risk of early revision TKA [14].…”

“…Multiple studies have confirmed that patients undergoing MUA have good clinical outcomes in terms of patients recovering the range of motion required for activities of daily living and performing similar to TKA patients not needing MUA [2] , [11] , [12] . This procedure, however, is not without its own risks, including exposure to anesthetic agents and possible extensor mechanism rupture or periprosthetic fractures [13] . Patients requiring MUA may also have an increased risk of early revision TKA [14] .…”