Manipulation under anesthesia, lysis of adhesion after TKA may improve knee flexion
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Key takeaways:
- Manipulation under anesthesia with or without lysis of adhesion after total knee arthroplasty may intraoperatively improve knee flexion.
- However, this improvement declined at the first postoperative visit.
DALLAS —Successful manipulation under anesthesia with or without lysis of adhesion after total knee arthroplasty may provide a gain of 30° of knee flexion, according to data presented here.
“[Manipulation under anesthesia] does lose some effectiveness after 90 days of the index procedure; however, it demonstrates similar results to [lysis of adhesion] LOA, lower risk of loss of flexion and comparable complication profiles,” Kwan “Kevin” J. Park, MD, assistant professor of clinical orthopedic surgery in the department of orthopedic surgery and orthopedics & sports medicine at Houston Methodist Hospital, said in his presentation at the American Association of Hip and Knee Surgeons Annual Meeting.
Park and colleagues retrospectively collected patient characteristics, intraoperative variables and postoperative outcomes from patients who underwent manipulation under anesthesia (MUA) with or without arthroscopic LOA after primary total knee arthroplasty. Researchers defined failure as repeat MUA or LOA, revision TKA for arthrofibrosis and failure to gain more than 50° of flexion achieved intraoperatively.
Overall, 605 patients underwent primary MUA and 67 patients underwent primary LOA. Park said both groups experienced an intraoperative gain in knee flexion that declined at first postoperative visit before being regained.
“Looking at the intraoperative data, we were able to achieve more intraoperative flexion with primary LOA,” Park said.
Patients had an overall failure rate of 38%, with no differences between the MUA group and LOA group, according to Park.
In a subgroup analysis of patients who underwent primary MUA (n = 112) or LOA (n = 61) after 90 days, Park said both groups “were able to achieve some degree of knee flexion intraoperatively. However, they lost that postoperative in both groups.”
“Interestingly, for the MUA group, they were able to gain part of that knee flexion at first postoperative visit compared to the LOA group,” Park said. “However, the results were similar at the final follow-up.”
Park said patients who failed tended to have a higher Elixhauser Comorbidity Index and higher incidence of cancer.
“We also found the [cruciate retaining] CR type of bearing is likely to fail after manipulation compared to other bearings,” Park said. “Then when these patients do fail, we found that these patients tend to fail early.”
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