Who Benefits from Manipulation under Anesthesia Following Total Knee Arthroplasty?

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Arthrofibrosis, characterized by reduced knee range of motion (ROM), frequently complicates total knee arthroplasty (TKA).
• Manipulation under anesthesia (MUA) is a common intervention for post-TKA arthrofibrosis, but its efficacy compared to routine care lacks robust evidence.

Purpose of the Study:

• To evaluate the comparative effectiveness of MUA versus routine care for treating arthrofibrosis after primary TKA.
• To determine if MUA provides a significant advantage in restoring knee ROM.

Main Methods:

• Retrospective study of TKA patients (2010-2014) with early follow-up flexion ≤ 100 degrees.
• Patients were categorized into MUA or routine care groups.
• Knee flexion was measured pre-TKA, early post-TKA, and at 1-year follow-up to calculate ROM change.

Main Results:

• No significant difference in average 1-year knee flexion between MUA (106.3 ± 12.8 degrees) and routine care (106.1 ± 11.7 degrees) groups.
• A significantly higher proportion of patients in the MUA group achieved flexion gains > 20 degrees (56%) compared to the routine care group (8%, p < 0.0001).

Conclusions:

• MUA is associated with a greater likelihood of substantial ROM improvement in patients with post-TKA arthrofibrosis compared to routine care.
• MUA may be a beneficial treatment option for patients experiencing decreased knee ROM early after TKA.