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MUA after TKA linked with increased risk of subsequent revision
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DALLAS — Results from a database study presented here showed 4.24% of patients had manipulation under anesthesia within 6 months following total knee arthroplasty and highlighted postoperative manipulation as a strong risk factor for subsequent early revision surgery.
“We have established some benchmark nationwide data looking at the incidence of manipulation under anesthesia. There are similar rates in the literature, but I think we were able to tighten our confidence interval a little bit with this study,” James A. Browne, MD, who presented the study results at the American Association of Hip and Knee Surgeons Annual Meeting, said. “We have confirmed that young age and smoking are risk factors for manipulation under anesthesia, and this is part of my preoperative discussion with these patients.”
Patients who required a manipulation within 6 months of their index primary had a two- to three-times higher rate of early revision compared with those who were not manipulated with an early revision rate, approaching 5% in this patient cohort, according to Browne.
Browne and colleagues used the PearlDiver database to identify 141,000 total knee arthroplasties (TKAs) performed in Medicare and private payer patients. The researchers found the incidence rates for manipulation under anesthesia (MUA) within 1 month, 3 months and 6 months of TKA were less than 0.5%, slightly more than 3% and 4.24%, respectively.
Although female sex was associated with risk for manipulation after TKA, the strongest risk factor the researchers found was young patient age, with patients younger than 50 years showing an odds ratio of 2.8 for requiring MUA.
A subgroup analysis of young patients indicated smoking was strongly associated with the need for MUA in patients younger than 65 years, with an odds ratio of 1.47, according to Browne.
“Interestingly, when we looked at a number of other patient factors, things like diabetes and obesity, we did not see any significant association, which is different than some of the other papers that have been published on this topic,” Browne said.
The researchers also discovered 4.8% of all patients who had a manipulation within 6 months of TKA went on to subsequent revision TKA within the following 6 years compared with 2% of patients who did not have MUA.
“If we look at the younger patients, the risk for subsequent revision was 4.6% [in the MUA group] compared to just 1.6% in those who were not manipulated, for an odds ratio of almost 3,” he said. — by Gina Brockenbrough, MA
Reference:
Browne JA. Paper #45. Presented at: American Association of Hip and Knee Surgeons Annual Meeting. Nov. 7-9, 2014; Dallas.
Disclosure: Browne has no relevant financial disclosures.