Understanding rates, risk factors, and complications associated with manipulation under anesthesia after total knee arthroplasty (TKA): An analysis of 100,613 TKAs

Rullán, Pedro J.; Klika, Alison K.; Koroukian, Siran M.; Piuzzi, Nicolás S.

doi:10.1016/j.knee.2022.08.009

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…Ligament reconstruction or surgeries requiring prolonged immobilization have been shown to double the rate of arthrofibrosis 31-33 . Factors inconsistently reported to be associated with arthrofibrosis include younger age, female sex, Black or Hispanic races, increased body mass index, and smoking 7,8,10,13,16,18,23,34-37 .…”

Section: Risk Factorsmentioning

confidence: 99%

“…Other preventative measures may be robotic-assisted TKA, which has demonstrated superior soft-tissue protection that may ultimately minimize inflammation 121-123 . Both Malkani et al 124 and Rullan et al 34 found that patients who underwent robotic-assisted TKA were at less risk of needing a manipulation under anesthesia (MUA); however, Ali et al found that more robotic-assisted TKA patients required MUA compared with manual TKA patients 125 . More studies are needed to determine the role of robotic-assisted TKA in possibly preventing arthrofibrosis, but initial investigations are promising.…”

Section: Management Of Arthrofibrosismentioning

confidence: 99%

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Arthrofibrosis After Total Knee Arthroplasty

Ramos,

Pasqualini,

Surace

et al. 2023

JBJS Reviews

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» Arthrofibrosis after total knee arthroplasty (TKA) is the new formation of excessive scar tissue that results in limited ROM, pain, and functional deficits.» The diagnosis of arthrofibrosis is based on the patient's history, clinical examination, absence of alternative diagnoses from diagnostic testing, and operative findings. Imaging is helpful in ruling out specific causes of stiffness after TKA. A biopsy is not indicated, and no biomarkers of arthrofibrosis exist.» Arthrofibrosis pathophysiology is multifactorial and related to aberrant activation and proliferation of myofibroblasts that primarily deposit type I collagen in response to a proinflammatory environment. Transforming growth factor-beta signaling is the best established pathway involved in arthrofibrosis after TKA.» Management includes both nonoperative and operative modalities. Physical therapy is most used while revision arthroplasty is typically reserved as a last resort. Additional investigation into specific pathophysiologic mechanisms can better inform targeted therapeutics.

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Section: Risk Factorsmentioning

confidence: 99%

Section: Management Of Arthrofibrosismentioning

confidence: 99%

Arthrofibrosis After Total Knee Arthroplasty

Ramos,

Pasqualini,

Surace

et al. 2023

JBJS Reviews

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“…The use of robotic TKA in knee arthroplasties has increased significantly in recent years, with the possibility of representing 50% of all knee arthroplasties in the United States by 2030 [ 1 , 6 , 7 ]. Robotic assistance in TKA has been shown to have several advantages over conventional TKA, including improved accuracy and precision in implant placement as well as greater reliability in restoring a neutral mechanical axis [ 8 , 9 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Management of a Massive Solitary Femoral Condyle Bone Cyst at the Site of Knee Osteoarthritis with a Synthetic Bone Graft and Primary Robotic-assisted Cementless Total Knee Arthroplasty: A Case Report

Ibaseta,

Pasqualini,

Tidd

et al. 2023

jocr

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Introduction: Subarticular cystic lesions, also known as geodes, present a challenge in the management of patients undergoing primary total knee arthroplasty (TKA). Although multiple treatment options are available for addressing these lesions, uncertainty persists regarding the optimal approach. Case Report: A 58-year-old man with a history of rheumatoid arthritis presented with several years of left knee pain. Evaluation showed severe left knee degenerative osteoarthritis complicated by the presence of a large lateral femoral condyle cyst. After failing conservative management, a robotic-assisted cementless cruciate-retaining TKA was indicated. The large bone cyst was managed with augmentation using synthetic bone grafting. 1 year postoperatively, he showed excellent clinical outcomes and radiographic evidence of osteointegration. Conclusion: This case highlights the value of robotic-assisted technology to plan and execute bone grafting of a large femoral cystic lesion while performing TKA with primary components. A computed tomography-imaged robotic TKA offers the potential benefit of screening bone cysts and thus planning a surgical approach in which bone preservation can be maximized. Keywords: Robotic arthroplasty, geode, bone cyst, injectable regenerative graft, bone void filler.

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