Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 21:93:583-587.
doi: 10.2340/17453674.2022.3167.

Manipulation under anesthesia after total knee arthroplasty: a retrospective study of 145 patients

Julius Sala  1 , Antti Jaroma  2 , Reijo Sund  3 , Jukka Huopio  2 , Heikki Kröger  2 , Joonas Sirola  2
Affiliations

Manipulation under anesthesia after total knee arthroplasty: a retrospective study of 145 patients

Julius Sala et al. Acta Orthop. .

Abstract

Background and purpose: Manipulation under anesthesia (MUA) is considered to be effective in treating stiffness after total knee arthroplasty (TKA). However, not all patients achieve a satisfactory range of motion (ROM) after MUA. This retrospective study determined the outcome of MUA and identified the factors affecting it.

Patients and methods: The final sample consisted of 150 MUAs performed on 145 patients. The parameters of interest were ROM and Knee Society Score (KSS) or Oxford Knee Score (OKS). The associations of preoperative, perioperative, and postoperative risk factors with gain in flexion and flexion at post-MUA follow-up (an average of 2 months after MUA) were analyzed using multivariable regression model.

Results: The mean of 26° (95% CI 23-29) gain in flexion and the mean of 3° (CI 2-4) gain in extension were noticed at post-MUA follow-up when compared with the ROM preceding MUA. The mean post-MUA-FU flexion was 99° (CI 97-102) and the mean post-MUA-FU extension deficit was 4° (CI 2-5). KSS (121 vs. 129) and OKS (29 vs. 28) were similar before and after MUA. The early timing of MUA was associated with better gain in flexion -0.04 (CI -0.08 to -0.01), while we found no association between the timing of MUA and flexion after MUA -0.004 (CI -0.03 to 0.03). High BMI was associated with better gain in flexion 0.8 (CI 0.2-1.5).

Interpretation: We found that ROM improved substantially after MUA. The gain in flexion decreased as the time between TKA and MUA increased.

PubMed Disclaimer

Figures

None
Association between the timing of MUA and the gain in flexion. Multivariable regression analysis showed that there was a statistically significant negative association between the timing of MUA and the gain in flexion –0.04 (CI –0.08 to –0.01). MUA = manipulation under anesthesia
See this image and copyright information in PMC

Comment in

References

    1. Yeoh D, Nicolaou N, Goddard R, Willmott H, Miles K, East D, et al. . Manipulation under anaesthesia post total knee replacement: long term follow up. Knee 2012; 19(4): 329-31. doi: 10.1016/j.knee.2011.05.009. - DOI - PubMed
    1. Rubinstein R A Jr, DeHaan A. The incidence and results of manipulation after primary total knee arthroplasty. Knee 2010; 17(1): 29-32. doi: 10.1016/j.knee.2009.07.001. - DOI - PubMed
    1. Cates H E, Schmidt J M. Closed manipulation after total knee arthroplasty: outcome and affecting variables. Orthopedics 2009; 32(6): 398. doi: 10.3928/01477447-20090511-10. - DOI - PubMed
    1. Keating E M, Ritter M A, Harty L D, Haas G, Meding J B, Faris P M, et al. . Manipulation after total knee arthroplasty. J Bone Joint Surg Am 2007; 89(2): 282-6. doi: 10.2106/JBJS.E.00205. - DOI - PubMed
    1. Ipach I, Schäfer R, Lahrmann J, Kluba T. Stiffness after knee arthrotomy: evaluation of prevalence and results after manipulation under anaesthesia. Orthop Traumatol Surg Res 2011; 97(3): 292-6. doi: 10.1016/j.otsr.2011.01.006. - DOI - PubMed