Speaker calls manipulation under anesthesia effective for stiffness after TKA
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LAS VEGAS — Manipulation under anesthesia is an effective option to use for patients with a stiff knee after total knee arthroplasty and can be used 4 to 6 months postoperatively, a speaker said, but results are less favorable.
During the Knee Society Specialty Day Meeting at the American Academy of Orthopaedic Surgeons Annual Meeting, here, Thomas P. Sculco, MD, said he performs manipulation under anesthesia (MUA) in about 2% to 3% of cases.
Stiff knees are a biologic and mechanical problem, he said.
“The ideal indication is a patient that has less than 90° of flexion within the immediate perioperative period, which I consider out to 12 weeks, and those patients generally, on exam, have a soft endpoint. And, if you break those adhesions with a manipulation, you can significantly improve that range of motion,” Sculco said.
In discussing his MUA protocol, Sculco said to manipulate the patient first. “Then, go on to arthroscopic debridement and, in a bad one, an open debridement and changing the poly[ethylene], and in the severe ones, revision of the knee,” he said.
Post-acute MUA may be an option in some cases, according to Sculco.
“On occasion, you can improve the range of motion 15° to 20°. Not as much with a more acute manipulation, but it is something you can do if it is done carefully,” he said.
Sculco concluded, regarding the stiff knee after TKA, “Manipulate it early, you get good success as a rule. Scope it in that small group that are still stiff, and I think that’s a reasonable way to go.”
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Sculco TP. Stiff knee – lack of flexion and extension: What do I do and when do I do it? Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 7-11, 2023; Las Vegas.
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