Long-Term Outcomes of MUA for Stiffness in Primary TKA

Abstract

Knee stiffness following primary total knee arthroplasty (TKA) is a well-recognized problem which leads to poor patient outcomes and may limit patient activities of daily living. Manipulation under anesthesia (MUA) is one option for the treatment of knee stiffness. However, there has been controversy regarding the safety and long-term efficacy of this procedure. A systematic review of the literature was performed to identify studies that reported the clinical outcomes and measured range of motion for patients undergoing MUA. Fourteen studies (913 patients) reported range of motion results following MUA at up to 10-year follow-up. The mean premanipulation and final range of motion were 66 and 99 degrees, respectively. Compared with preoperative range of motion, the gain in the range-of-motion arc at 1-, 5-, and 10-year follow-up was 30, 33, and 33 degrees, respectively. Complications were rare with only two reported periprosthetic fractures, resulting in an incidence of 0.2%. MUA for a stiff primary TKA is an efficacious procedure to restore range of motion. Early gains in motion appear to be maintained at long term, and in some cases patients may gradually improve further at mid-term follow-up. The risk of periprosthetic fracture is low, making MUA a safe option for improving knee range of motion.

Keywords

knee stiffness - manipulation under anesthesia (MUA) - TKA

• References

• 1 Nelson CL, Kim J, Lotke PA. Stiffness after total knee arthroplasty. J Bone Joint Surg Am 2005; 87 (Pt 2, Suppl 1): 264-270
• 2 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 (2) 111-117
• 3 Bong MR, Di Cesare PE. Stiffness after total knee arthroplasty. J Am Acad Orthop Surg 2004; 12 (3) 164-171
• 4 Kotani A, Yonekura A, Bourne RB. Factors influencing range of motion after contemporary total knee arthroplasty. J Arthroplasty 2005; 20 (7) 850-856
• 5 Ritter MA, Berend ME, Harty LD, Davis KE, Meding JB, Keating EM. Predicting range of motion after revision total knee arthroplasty: clustering and log-linear regression analyses. J Arthroplasty 2004; 19 (3) 338-343
• 6 Scott WN, Clarke HD. The stiff knee: causes and cures. Orthopedics 2000; 23 (9) 987-988
• 7 Demura T, Demura SI. Influence of restricted vision and knee joint range of motion on gait properties during level walking and stair ascent and descent. J Mot Behav 2011; 43 (6) 445-450
• 8 Zeni Jr JA, Snyder-Mackler L. Preoperative predictors of persistent impairments during stair ascent and descent after total knee arthroplasty. J Bone Joint Surg Am 2010; 92 (5) 1130-1136
• 9 Ritter MA, Lutgring JD, Davis KE, Berend ME. The effect of postoperative range of motion on functional activities after posterior cruciate-retaining total knee arthroplasty. J Bone Joint Surg Am 2008; 90 (4) 777-784
• 10 Laubenthal KN, Smidt GL, Kettelkamp DB. A quantitative analysis of knee motion during activities of daily living. Phys Ther 1972; 52 (1) 34-43
• 11 McElroy MJ, Johnson AJ, Zywiel MG, Mont MA. Devices for the prevention and treatment of knee stiffness after total knee arthroplasty. Expert Rev Med Devices 2011; 8 (1) 57-65
• 12 Bonutti PM, McGrath MS, Ulrich SD, McKenzie SA, Seyler TM, Mont MA. Static progressive stretch for the treatment of knee stiffness. Knee 2008; 15 (4) 272-276
• 13 Fitzsimmons SE, Vazquez EA, Bronson MJ. How to treat the stiff total knee arthroplasty?: a systematic review. Clin Orthop Relat Res 2010; 468 (4) 1096-1106
• 14 Scranton Jr PE. Management of knee pain and stiffness after total knee arthroplasty. J Arthroplasty 2001; 16 (4) 428-435
• 15 Wasilewski SA, Frankl U. Arthroscopy of the painful dysfunctional total knee replacement. Arthroscopy 1989; 5 (4) 294-297
• 16 Williams III RJ, Westrich GH, Siegel J, Windsor RE. Arthroscopic release of the posterior cruciate ligament for stiff total knee arthroplasty. Clin Orthop Relat Res 1996; (331) 185-191
• 17 Esler CN, Lock K, Harper WM, Gregg PJ. Manipulation of total knee replacements. Is the flexion gained retained?. J Bone Joint Surg Br 1999; 81 (1) 27-29
• 18 Fox JL, Poss R. The role of manipulation following total knee replacement. J Bone Joint Surg Am 1981; 63 (3) 357-362
• 19 Smith EL, Banerjee SB, Bono JV. Supracondylar femur fracture after knee manipulation: a report of 3 cases. Orthopedics 2009; 32 (1) 18
• 20 Yeoh D, Nicolaou N, Goddard R , et al. Manipulation under anaesthesia post total knee replacement: long term follow up. Knee 2012; 19 (4) 329-331
• 21 Ipach I, Mittag F, Lahrmann J, Kunze B, Kluba T. Arthrofibrosis after TKA – Influence factors on the absolute flexion and gain in flexion after manipulation under anaesthesia. BMC Musculoskelet Disord 2011; 12: 184
• 22 Mohammed R, Syed S, Ahmed N. Manipulation under anaesthesia for stiffness following knee arthroplasty. Ann R Coll Surg Engl 2009; 91 (3) 220-223
• 23 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) 292-296
• 24 Keating EM, Ritter MA, Harty LD , et al. Manipulation after total knee arthroplasty. J Bone Joint Surg Am 2007; 89 (2) 282-286
• 25 Namba RS, Inacio M. Early and late manipulation improve flexion after total knee arthroplasty. J Arthroplasty 2007; 22 (6) (Suppl. 02) 58-61
• 26 Rubinstein Jr RA, DeHaan A. The incidence and results of manipulation after primary total knee arthroplasty. Knee 2010; 17 (1) 29-32
• 27 Sharma V, Maheshwari AV, Tsailas PG, Ranawat AS, Ranawat CS. The results of knee manipulation for stiffness after total knee arthroplasty with or without an intra-articular steroid injection. Indian J Orthop 2008; 42 (3) 314-318
• 28 Cates HE, Schmidt JM. Closed manipulation after total knee arthroplasty: outcome and affecting variables. Orthopedics 2009; 32 (6) 398
• 29 Maloney WJ. The stiff total knee arthroplasty: evaluation and management. J Arthroplasty 2002; 17 (4) (Suppl. 01) 71-73
• 30 Daluga D, Lombardi Jr AV, Mallory TH, Vaughn BK. Knee manipulation following total knee arthroplasty. Analysis of prognostic variables. J Arthroplasty 1991; 6 (2) 119-128
• 31 Sambaziotis C, Plymale M, Lovy A, O'Halloran K, McCulloch K, Geller DS. Pseudoaneurysm of the distal thigh after manipulation of a total knee arthroplasty. J Arthroplasty 2012; 27 (7) e5-e7
• 32 Stecker MS, Ries MD. Fatal pulmonary embolism during manipulation after total knee arthroplasty. A case report. J Bone Joint Surg Am 1996; 78 (1) 111-113
• 33 Khaw FM, Moran CG, Pinder IM, Smith SR. The incidence of fatal pulmonary embolism after knee replacement with no prophylactic anticoagulation. J Bone Joint Surg Br 1993; 75 (6) 940-941