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
