Manipulation under anaesthesia post total knee replacement: long term follow up

Area of Science:

• Orthopedic Surgery
• Rehabilitation Medicine

Background:

• Reduced range of motion (ROM) is a common complication after total knee replacement (TKR).
• Manipulation under anesthesia (MUA) is a frequent intervention for stiff TKRs, but long-term outcomes are debated.

Purpose of the Study:

• To evaluate the long-term effectiveness and safety of MUA for improving ROM in stiff TKRs.
• To determine if the timing of MUA or pre-operative ROM affects long-term outcomes.

Main Methods:

• Retrospective review of prospectively collected data from 48 TKR patients undergoing MUA.
• Average follow-up of 7.5 years (range 1-10 years).
• Analysis of ROM changes before and after MUA, and at 1 and 10 years post-procedure.

Main Results:

• MUA significantly improved immediate passive flexion by an average of 44° (p<0.05).
• Mean flexion at 1 year was 87°, and at 10 years was 86°, indicating sustained improvement.
• No significant difference in ROM gain was observed based on the timing of MUA (before/after 12 weeks) or pre-TKR ROM (<90° vs. >90°).
• No complications directly resulted from MUA; one patient required revision for infection unrelated to MUA.

Conclusions:

• MUA is a safe and effective procedure for enhancing ROM in stiff TKRs.
• The benefits of MUA are maintained long-term, irrespective of the timing of intervention or the degree of pre-operative knee stiffness.