Manipulation and Injection after Total Knee Arthroplasty: Incidence and Outcomes

Area of Science:

• Orthopaedic Surgery
• Arthroplasty
• Infection Control

Background:

• Post-total knee arthroplasty (TKA) stiffness can negatively impact patient outcomes.
• Manipulation under anesthesia (MUA) is a treatment option for TKA stiffness.
• Corticosteroid injection (CSI) is sometimes administered concurrently with MUA.

Purpose of the Study:

• To determine the incidence of CSI performed with MUA after TKA.
• To evaluate the association between CSI with MUA and the risk of prosthetic joint infection (PJI).

Main Methods:

• A retrospective analysis of a large database of primary TKA procedures (n=754,421).
• Investigation of the incidence rates of MUA, CSI with MUA, revision surgery, and PJI.
• Patient characteristics were analyzed before and after propensity score matching.

Main Results:

• The incidence of MUA within 90 days of TKA was 2.9%.
• CSI was performed in 14.9% of MUA procedures.
• No significant increase in the odds of all-cause revision (OR 1.0, p=1.0) or revision with PJI (OR 1.1, p=0.83) was observed with CSI during MUA.
• Matching did not alter these findings (OR 0.9, p=0.29 for revision; OR 0.9, p=0.77 for PJI revision).

Conclusions:

• The incidence of MUA following TKA is relatively low.
• Corticosteroid injection during MUA after TKA does not elevate the risk of prosthetic joint infection.
• Combining CSI with MUA appears to be a safe adjunctive treatment for TKA stiffness regarding infection risk.