Efficacy of manipulation under anesthesia beyond three months following total knee arthroplasty

Abstract

Background: Stiffness after total knee arthroplasty (TKA) is often treated with manipulation under anesthesia (MUA) to improve range of motion (ROM). However, many authors recommend against MUA beyond 3 months after TKA. This study investigates the timing of MUA for stiffness after TKA, focusing on MUA performed at >12 weeks. Methods: In total, 142 MUAs were retrospectively reviewed. “Early” MUAs were at 12 weeks. MUAs were further subdivided into 4 groups: 83 “Group I” cases at 52 weeks. Gains in ROM were compared between groups. Results: Gains in flexion and overall ROM were statistically equivalent in Early vs Late MUA when controlling for pre-MUA ROM. ROM gains between the early Group I and the later Groups II-IV were also statistically comparable. Overall ROM gain in Group I was 24.1°, 17.9° in Group II, 20.8° in Group III, and 11.1° in Group IV. There were no significant complications. Conclusions: Early and late MUA resulted in statistically equivalent gains in ROM, regardless of timing after TKA. All groups showed an average improvement in ROM of ≥11°. MUA performed beyond 3 months, and even beyond 1 year, appears to be safe and may improve ROM and allow select patients to avoid revision surgery. Keywords: Total knee arthroplasty, Manipulation under anesthesia, Stiffness, Range of motion