Risk Factors for the Need for Manipulation Under Anesthesia Following total Knee Arthroplasty: A Systematic Review...

Area of Science:

• Orthopedic Surgery
• Arthroplasty Research
• Patient Outcomes Analysis

Background:

• Postoperative knee stiffness is a significant complication following total knee arthroplasty (TKA).
• This stiffness can lead to poor patient outcomes, decreased satisfaction, and may necessitate revision surgery.
• Manipulation under anesthesia (MUA) is a common intervention for TKA-related knee stiffness.

Purpose of the Study:

• To systematically review and identify risk factors for stiffness after primary TKA that leads to MUA.
• To evaluate the predictive value of various patient and procedural characteristics for MUA following TKA.

Main Methods:

• A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted.
• Six databases were searched from inception to October 1, 2023, screening 1,108 abstracts and 390 full-text articles.
• Meta-analysis using odds ratios was performed on data from 53 studies involving over 2.9 million patients, with risk of bias assessed using Quality in Prognostic Studies criteria.

Main Results:

• Significant risk factors for MUA following TKA included younger age (mean difference: -4.23 years), Black race (OR: 1.94), smoking (OR: 1.43), preoperative American Society of Anesthesiologists (ASA) score ≤ 2 (OR: 0.64), and prior knee procedures (OR: 2.00).
• Factors not found to be significant predictors were sex, obesity, and diabetes.
• Confidence intervals and p-values were reported for all significant and non-significant findings.

Conclusions:

• Younger age, Black race, smoking, lower preoperative ASA scores (≤ 2), and a history of prior knee surgery are identified as significant risk factors for requiring MUA after TKA.
• These findings highlight specific patient populations at higher risk for developing knee stiffness post-TKA.
• Understanding these risk factors can inform clinical practice and patient counseling regarding TKA outcomes.