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DOI: 10.1055/a-2315-7955
Specific Preoperative Factors Increase Manipulations under Anesthesia Following Primary TKA
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Abstract
Arthrofibrosis following primary total knee arthroplasty (TKA) can result in pain and limit postoperative range of motion (ROM), jeopardizing clinical outcomes and patient satisfaction. This study aims to identify preoperative risk factors associated with necessitating a manipulation under anesthesia (MUA) following primary TKA.
We retrospectively reviewed 950 cases of consecutive primary TKAs performed at one institution by three arthroplasty surgeons between May 2017 and May 2019. Recorded preoperative variables included smoking status, race, preoperative ROM, presence of effusion or positive anterior drawer, and medical comorbidities. Demographic characteristics were compared with Student's t-tests or chi-square tests as appropriate. For each preoperative factor, we obtained an odds ratio (OR) for MUA risk using multivariate logistic regression.
Twenty (2.3%) patients underwent MUA following their index primary TKA surgery. History of ipsilateral knee surgery (OR: 2.727, p = 0.047) and diagnosed hypertension (OR: 4.764, p = 0.016) were identified as risk factors associated with significantly increased risk of MUA. The greater the preoperative ROM, the higher likelihood needed of MUA (OR: 1.031, p = 0.034).
Patients who had diagnosed hypertension or a history of prior ipsilateral knee surgery were associated with increased risk of necessitating an MUA following primary TKA. Additionally, a greater total arc of motion preoperatively increased the odds of needing MUA.
Level III of evidence was present.
Keywords
total knee arthroplasty - manipulation under anesthesia - preoperative risk factors - stiffness - arthrofibrosisNote
This work was performed in the Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.
Publication History
Received: 18 September 2023
Accepted: 23 April 2024
Accepted Manuscript online:
27 April 2024
Article published online:
24 May 2024
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References
- 1 Schiavone Panni A, Cerciello S, Vasso M, Tartarone M. Stiffness in total knee arthroplasty. J Orthop Traumatol 2009; 10 (03) 111-118
- 2 Kornuijt A, Das D, Sijbesma T, de Vries L, van der Weegen W. Manipulation under anesthesia following total knee arthroplasty: a comprehensive review of literature. Musculoskelet Surg 2018; 102 (03) 223-230
- 3 Yercan HS, Sugun TS, Bussiere C, Ait Si Selmi T, Davies A, Neyret P. Stiffness after total knee arthroplasty: prevalence, management and outcomes. Knee 2006; 13 (02) 111-117
- 4 Gu A, Michalak AJ, Cohen JS, Almeida ND, McLawhorn AS, Sculco PK. Efficacy of manipulation under anesthesia for stiffness following total knee arthroplasty: a systematic review. J Arthroplasty 2018; 33 (05) 1598-1605
- 5 Cheuy VA, Foran JRH, Paxton RJ, Bade MJ, Zeni JA, Stevens-Lapsley JE. Arthrofibrosis associated with total knee arthroplasty. J Arthroplasty 2017; 32 (08) 2604-2611
- 6 Gandhi R, de Beer J, Leone J, Petruccelli D, Winemaker M, Adili A. Predictive risk factors for stiff knees in total knee arthroplasty. J Arthroplasty 2006; 21 (01) 46-52
- 7 Kurosaka M, Yoshiya S, Mizuno K, Yamamoto T. Maximizing flexion after total knee arthroplasty: the need and the pitfalls. J Arthroplasty 2002; 17 (4 Suppl 1): 59-62
- 8 Laubenthal KN, Smidt GL, Kettelkamp DB. A quantitative analysis of knee motion during activities of daily living. Phys Ther 1972; 52 (01) 34-43
- 9 Rodríguez-Merchán EC. The stiff total knee arthroplasty: causes, treatment modalities and results. EFORT Open Rev 2019; 4 (10) 602-610
- 10 Kapoor A, Mishra SK, Dewangan SK, Mody BS. Range of movements of lower limb joints in cross-legged sitting posture. J Arthroplasty 2008; 23 (03) 451-453
- 11 Zachwieja E, Perez J, Hardaker WM, Levine B, Sheth N. Manipulation under anesthesia and stiffness after total knee arthroplasty. JBJS Rev 2018; 6 (04) e2
- 12 Pfefferle KJ, Shemory ST, Dilisio MF, Fening SD, Gradisar IM. Risk factors for manipulation after total knee arthroplasty: a pooled electronic health record database study. J Arthroplasty 2014; 29 (10) 2036-2038
- 13 Issa K, Rifai A, Boylan MR, Pourtaheri S, McInerney VK, Mont MA. Do various factors affect the frequency of manipulation under anesthesia after primary total knee arthroplasty?. Clin Orthop Relat Res 2015; 473 (01) 143-147
- 14 Newman ET, Herschmiller TA, Attarian DE, Vail TP, Bolognesi MP, Wellman SS. Risk factors, outcomes, and timing of manipulation under anesthesia after total knee arthroplasty. J Arthroplasty 2018; 33 (01) 245-249
- 15 Plate JF, Wohler AD, Brown ML, Sun D, Fino NF, Lang JE. Factors associated with range of motion recovery following manipulation under anesthesia. Surg Technol Int 2016; 29: 295-301
- 16 Livbjerg AE, Froekjaer S, Simonsen O, Rathleff MS. Pre-operative patient education is associated with decreased risk of arthrofibrosis after total knee arthroplasty: a case control study. J Arthroplasty 2013; 28 (08) 1282-1285
- 17 Gadinsky NE, Ehrhardt JK, Urband C, Westrich GH. Effect of body mass index on range of motion and manipulation after total knee arthroplasty. J Arthroplasty 2011; 26 (08) 1194-1197
- 18 Werner BC, Carr JB, Wiggins JC, Gwathmey FW, Browne JA. Manipulation under anesthesia after total knee arthroplasty is associated with an increased incidence of subsequent revision surgery. J Arthroplasty 2015; 30 (9 Suppl): 72-75
- 19 De Miguel C, Rudemiller NP, Abais JM, Mattson DL. Inflammation and hypertension: new understandings and potential therapeutic targets. Curr Hypertens Rep 2015; 17 (01) 507
- 20 Usher KM, Zhu S, Mavropalias G, Carrino JA, Zhao J, Xu J. Pathological mechanisms and therapeutic outlooks for arthrofibrosis. Bone Res 2019; 7: 9