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Related Experiment Video

Updated: Jun 30, 2026

A Mini-Invasive Internal Fixation Technique for Studying Immobilization-Induced Knee Flexion Contracture in Rats

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Manipulation Under Anesthesia After Primary Total Knee Arthroplasty.

Justin M Walsh¹, Thomas C Sullivan¹, Blesson Varghese¹

¹Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, Texas.

The Journal of Arthroplasty

|May 17, 2025

Summary

Manipulation under anesthesia (MUA) offers better outcomes for knee stiffness after total knee arthroplasty (TKA) compared to arthroscopic lysis of adhesions (aLOA) plus MUA. MUA provides greater, more consistent knee motion improvement with reduced risks.

Keywords:

arthrofibrosis lysis of adhesions manipulation under anesthesia range of motion total knee arthroplasty

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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.