Risk factors for manipulation under anaesthesia after total knee arthroplasty

Abstract

Aims Postoperative range of movement (ROM) is an important measure of successful and satisfying total knee arthroplasty (TKA). Reduced postoperative ROM may be evident in up to 20% of all TKAs and negatively affects satisfaction. To improve ROM, manipulation under anaesthesia (MUA) may be performed. Historically, a limited ROM preoperatively was used as the key harbinger of the postoperative ROM. However, comorbidities may also be useful in predicting postoperative stiffness. The goal was to assess preoperative comorbidities in patients undergoing TKA relative to incidence of postoperative MUA. The hope is to forecast those who may be at increased risk and determine if MUA is an effective form of treatment. Methods Prospectively collected data of TKAs performed at our institution’s two hospitals from August 2014 to August 2018 were evaluated for incidence of MUA. Comorbid conditions, risk factors, implant component design and fixation method (cemented vs cementless), and discharge disposition were analyzed. Overall, 3,556 TKAs met the inclusion criteria. Of those, 164 underwent MUA. Results Patients with increased age and body mass index (BMI) had decreased likelihood of MUA. For every one-year increase in age, the likelihood of MUA decreased by 4%. Similarly, for every one-unit increase in BMI the likelihood of MUA decreased by 6%. There were no differences in incidence of MUA between component type/design or fixation method. Current or former smokers were more likely to have no MUA. Surprisingly, patients discharged to home health service or skilled nursing facility were approximately 40% and 70% less likely than those discharged home with outpatient therapy to be in the MUA group. MUA was effective, with a mean increased ROM of 32.81° (SD 19.85°; -15° to 90°). Conclusion Younger, thinner patients had highest incidence of MUA. Effect of discharge disposition on rate of MUA was an important finding and may influence surgeons’ decisions. Interestingly, use of cement and component design (constraint) did not impact incidence of MUA. Level of Evidence II: Prospective cohort study. Cite this article: Bone Joint J 2020;102-B(6 Supple A):66–72.

Complications of Bicruciate-Retaining Total Knee Arthroplasty: The Importance of Alignment and Balance

“…Stiffness or arthrofibrosis after TKA ranges from 1.3% to 5.8% 19 , concurring with our results, but a previous paper suggested it might be more common for BCR TKA 20 . Stiffness was also more frequent in younger patients, which has been suggested in the literature before 21 . Our cohort had a higher rate of MUA than what is described, usually ranging from 1.5% to 4.8% of knees after TKA 19, [21][22][23] , which would be in line with that finding that stiffness might be a bigger issue in BCR TKA.…”

Excellent and Good Results Treating Stiffness with Early and Late Manipulation after Unrestricted Caliper-Verified Kinematically Aligned TKA

“…The 2.3% (82 of 3558) of patients that underwent an MUA after unrestricted caliperverified KA TKA is comparable to or lower than the incidence of 6.5% (182 of 2783), 4.6% (164 of 3556), 3.6% (62 of 1729) reported after MA TKA performed in a single institution [4,6,9]. Because 2 to 6 out of a 100 TKAs undergo an MUA, the long-term risk of further surgery is of interest to the patient and surgeon [1,2] A registry study of 664,604 primary MA TKAs in which 3918 (0.6%) underwent MUA after a median of 2.0 +/− 1.0 months reported that revision surgery occurred in 131 (3.4%) MUA patients after a median of 9.0 months [1].…”

“…The reported incidence of MUA for stiffness after mechanically aligned (MA) TKA ranges from 1 to 12% [2][3][4]. Factors contributing to the risk of stiffness include component malposition, patients being younger, smoking, prior knee surgery, diabetes, use of anticoagulation drugs (i.e., warfarin), limited preoperative ROM, and a long tourniquet time [4][5][6][7][8].…”

Factors affecting range of motion following two-stage revision arthroplasty for chronic periprosthetic knee infection

“…Therefore, we deemed it necessary to evaluate the factors affecting ROM after two-stage revision arthroplasty as a treatment for PJI. Previous studies reported that patient factors, such as causative diseases, degree of deformity, age, BMI, and pre-operative ROM, surgery-related factors, such as surgical approach and technique and component position and alignment, and other various factors, such as rehabilitation, may affect ROM after primary or revision TKA [ 19 , 20 , 31 – 33 ]. However, factors affecting ROM in two-stage revision arthroplasty for PJI may differ from those affecting ROM in conventional primary TKA.…”

“…In particular, post-operative ROM is considered to be an important factor that can affect the satisfaction rate after TKA [ 14 – 18 ]. It has been reported that various factors, such as age, pre-operative ROM, and body mass index (BMI), are factors that can affect ROM after primary TKA [ 19 ], and Ritter et al [ 20 ] reported that these factors can also affect the postoperative ROM after revision TKA. However, Ritter et al [ 20 ] did not mention the exact reason why the revision TKA was done and just how many surgeries was performed, which is a weakness of their study.…”