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Manipulation under anesthesia for stiffness after total knee arthroplasty: A French multicenter study with 5 years'
Claude-Alain Roullet1, Stéphane Descamps2, Shirin Monadjemi1
1Université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
Introduction:
knee stiffness is a common complication following total knee replacement (TKA), causing important morbidity. Although manipulation under anesthesia (MUA) is a safe method for the treatment of stiffness, its benefits over long-term and for large cohorts are not precisely known. The aim of this retrospective study was to assess clinical and functional outcomes and patients satisfaction after MUA over 5 years of follow-up.
Hypothesis:
Our hypothesis was that range of motion (ROM) improvement would be superior to 30° and would be sustained at 5 years follow-up leading to a patient satisfaction rate exceeding 70%.
Material And Methods:
This was an observational retrospective study organized with 14 French centers implied in the SOFCOT. Three hundred and forty four patients who underwent MUA following TKA were reviewed between January 2023 and June 2024. Among the cohort, patients who underwent a second MUA were analyzed separately. The collected data included patient demographics, Devane activity, ASA score, functional scores, knee amplitudes and satisfaction rates. Statistical analysis was performed with EasyMedStat.
Results:
The mean time between TKA and MUA was 2.9 ± 6.9 months and the mean follow-up was 5.5 ± 2.5 years. In comparison with the ROM at stiffness diagnosis (66.6°± 21.0°), at 5 years post-MUA, the ROM was improved by 36.0° ± 26.1 (p < 0.001), at a mean of 102.2° ± 22.6°. The subgroup of patients having a second MUA had a ROM gain of 16.8° ± 12.3° at 5-years post-MUA. The global complication rate after MUA was 2.3% (n = 8) including hematoma, wound dehiscence, infection, tibial tubercle fracture and patellar tendon rupture. At last follow-up, OKS was 35.4 ± 9.6. The KOOS for all subscales ranged from 38.5 ± 30.9 to 57.5 ± 33.8 and the mean FJS was 35.0 ± 14.3. A high satisfaction rate was recorded (77.5%).
Conclusion:
The improvement in ROM was substantial throughout the 5-year follow-up period. MUA was associated with low complication rates and high patient satisfaction, suggesting that it is an effective treatment for knee stiffness.
Level Of Evidence:
III; multicenter retrospective cohort study.
