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Factors predicting manipulation under anaesthesia after total knee replacement.

Aruni Areti1, Terrul Ratcliff2, Vinayak Perake3

  • 1Baylor College of Medicine, 1 Baylor Plz, Houston, TX, 77030, USA. aruni.areti@bcm.edu.

Archives of Orthopaedic and Trauma Surgery
|January 23, 2025
PubMed
Summary

Younger age, female sex, and Black race are key predictors for manipulation under anesthesia (MUA) after total knee arthroplasty (TKA). Sickle cell disease (SCD) also increases MUA likelihood, highlighting the need for targeted risk assessment in TKA patients.

Keywords:
Manipulation under anaesthesiaOrthopedic surgeryPostoperative complicationsPredictive factorsTotal knee replacement

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Area of Science:

  • Orthopedic surgery
  • Medical data analysis
  • Patient risk stratification

Background:

  • Manipulation under anesthesia (MUA) effectively treats stiffness after total knee arthroplasty (TKA).
  • Delayed MUA is linked to higher revision surgery and infection rates.
  • Early MUA significantly improves flexion gains compared to delayed interventions.

Purpose of the Study:

  • To identify risk factors associated with undergoing MUA after TKA.
  • To analyze demographic and comorbidity predictors of MUA.
  • To refine postoperative risk stratification for TKA patients.

Main Methods:

  • Utilized TriNetX database (1973-2023) with 245,567 TKA patients.
  • Identified TKA and MUA using CPT codes; comorbidities via ICD-9/10 codes.
  • Performed univariate and multivariate analyses to assess risk factor associations.

Main Results:

  • 2.8% of TKA patients (6,867) required MUA.
  • Younger age (<65), Black race, and sickle cell disease (SCD) were significant MUA predictors.
  • Female sex was also a significant predictor in multivariate analysis.

Conclusions:

  • Younger age, female sex, and Black race predict MUA post-TKA.
  • Sickle cell disease (SCD) is a novel, significant predictor of MUA.
  • Findings aid in refining risk stratification for MUA after TKA.