Manipulation Under Anesthesia After Primary Total Knee Arthroplasty.

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Knee stiffness is a common complication following total knee arthroplasty (TKA), impacting patient outcomes.
• Manipulation under anesthesia (MUA) and arthroscopic lysis of adhesions (aLOA) are interventions used to address TKA stiffness.

Purpose of the Study:

• To evaluate and compare the outcomes of MUA with or without aLOA in patients experiencing stiffness after primary TKA.

Main Methods:

• A retrospective study analyzed 726 patients undergoing MUA or aLOA + MUA after primary TKA.
• Data collected included demographics, perioperative variables, and postoperative outcomes.
• Failure was defined as repeat procedures, revision for arthrofibrosis, or insufficient range of motion gain.

Main Results:

• MUA alone had a lower failure rate (40%) compared to aLOA + MUA (52.3%).
• MUA was performed earlier, had a lower revision rate, and achieved greater final knee flexion.
• Successful MUA gained 33° flexion; successful aLOA + MUA gained 27.6°.

Conclusions:

• Both MUA and aLOA + MUA are effective for TKA stiffness, yielding significant flexion gains.
• MUA demonstrated superior and more consistent improvements in knee motion with lower risks.
• Unsuccessful procedures typically manifest early and do not recover; MUA patients achieve greater flexion gains.