Manipulation under anesthesia after TKA may lead to persistent stiffness, revision
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Despite literature reporting that manipulation under anesthesia restores range of motion after total knee arthroplasty, published results showed this technique could also increase the risk of revision and persistent stiffness after TKA.
Michael J. DeFrance, DO, and colleagues analyzed 49,310 patients within a single institution who underwent primary TKA between 1999 and 2019. Researchers compared 2-year outcomes from two matched cohorts at a 1:3 ratio based on age, sex and BMI. The groups consisted of 575 patients who received manipulation under anesthesia (MUA) within 12 weeks of TKA and 1,725 patients who did not receive MUA after TKA.
Researchers found a statistically significant increase in the rate of noninfectious etiology revision TKA in the MUA cohort (7.3%) compared with the no MUA cohort (4.9%). According to the study, the most common reasons for revision TKA in the MUA cohort were persistent stiffness, arthrofibrosis and ankylosis. However, DeFrance and colleagues noted aseptic loosening, ligamentous instability and periprosthetic fracture were responsible for 21.4% of revisions. After excluding severe arthrofibrosis or severe ankylosis for the two cohorts, there was not a significant difference in the revision rates, researchers wrote in the study.
“Most cases of revision TKA after MUA were secondary to persistent stiffness, likely because of a failure of MUA to achieve functional range of motion (ROM),” DeFrance and colleagues wrote. “We believe that MUA is a safe procedure that may prevent the need for additional surgery for some patients with diminished ROM. However, the orthopedic surgeon must counsel patients that MUA does not guarantee success and that failure may lead to revision TKA,” they added.
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