Postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia

Abstract

Background and purpose: Manipulation under anesthesia (MUA) is the first-choice treatment for stiffness following total knee arthroplasty (TKA) unresponsive to pain management and physiotherapy. Some of the predisposing factors and patient-reported outcome measures (PROMs) following MUA remain poorly studied. We retrospectively investigated the etiological risk factors and the outcomes of MUA.Patients and methods: 391 TKA patients from a randomized trial comparing the use of a tourniquet and anesthesia (spinal or general) were analyzed, and patients needing MUA were identified (MUA group). We evaluated in-hospital opioid consumption, Oxford Knee Score (OKS), range of motion (ROM), and pain assessed by the Brief Pain Inventory-short form with a 1-year follow-up.Results: 39 (10%) MUA patients were identified. The MUA patients were younger (60 years vs. 64 years, difference –4, 95% CI –6 to –1) and had higher postoperative oxycodone consumption (66 mg vs. 51 mg, median difference 11, CI 1–22) than the no-MUA patients. The proportion of MUA patients who contacted the emergency department within 3 months because of pain was larger than that of non-MUA patients (41% vs. 12%, OR 5, CI 3–10). At the 1-year follow-up, the ROM was improved by 39° following MUA, but the total ROM was worse in the MUA group (115° vs. 124°, p < 0.001). No difference was found in the OKS between the MUA and no-MUA patients.Interpretation: Higher postoperative pain seems to predict MUA risk. MUA performed 3 months postoperatively offers substantial ROM improvement and comparable PROMs to no-MUA patients 1 year after TKA.

Racial and ethnic differences in the use of lumbar imaging, opioid analgesics and spinal surgery for low back pain: A systematic review and meta‐analysis

“…We searched in three electronic databases from 1 January 2000 to 24 June 2021: MEDLINE via Ovid, EMBASE via Ovid and CINAHL via EBSCO, to determine care disparities in recent healthcare practice. We developed the search strategy based on three keywords: low back pain (Rantasalo et al, 2022), delivery of health care, and racial and ethnic background, using set medical terms, synonyms, and variations (Cochrane, 2021). The full search strategy is presented in Table S2.…”

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

“…However, the studies included different definitions of stiffness/flexion contractures ( 1 ). The incidence of MUA has been reported, mostly from single centers/surgeons, to vary between 0.5% ( 2 ) and 10% ( 3 ). This variation is more or less in line with the findings in a Swedish national study on the incidence of MUA, including all 75 hospitals performing knee arthroplasties between 2009 and 2016.…”

“…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.…”

“…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.…”