title: Manipulation after total knee arthroplasty.
abstract: BACKGROUND
  Following total knee arthroplasty, some patients who fail to achieve >90 degrees of flexion in the early perioperative period may be considered candidates for manipulation of the knee under anesthesia. The purpose of this study was to assess the outcomes of manipulation following total knee arthroplasty.
  
  
  METHODS
  One hundred and thirteen knees in ninety patients underwent manipulation for postoperative flexion of < or =90 degrees at a mean of ten weeks after surgery. Flexion was measured with a goniometer prior to total knee arthroplasty, at the conclusion of the operative procedure, before manipulation, immediately after manipulation, at six months, and at one, three, and five years postoperatively.
  
  
  RESULTS
  Eighty-one (90%) of the ninety patients achieved improvement of ultimate knee flexion following manipulation. The average flexion was 102 degrees prior to total knee arthroplasty, 111 degrees following skin closure, and 70 degrees before manipulation. The average improvement in flexion from the measurement made before manipulation to that recorded at the five-year follow-up was 35 degrees (p < 0.0001, paired t test). There was no significant difference in the mean improvement in flexion when patients who had manipulation within twelve weeks postoperatively were compared with those who had manipulation more than twelve weeks postoperatively. Patients who eventually underwent manipulation had significantly lower preoperative Knee Society pain scores (more pain) than those who had not had manipulation (p = 0.0027).
  
  
  CONCLUSIONS
  Manipulation generally increases ultimate flexion following total knee arthroplasty. Patients with severe preoperative pain are more likely to require manipulation.
authors.affiliation: Center for Hip and Knee Surgery, St. Francis Hospital, 1199 Hadley Road, Mooresville, IN 46158, USA.
authors.forename: E Michael
authors.initials: EM
authors.lastname: Keating
authors.forename: Merrill A
authors.initials: MA
authors.lastname: Ritter
authors.forename: Leesa D
authors.initials: LD
authors.lastname: Harty
authors.forename: Gail
authors.initials: G
authors.lastname: Haas
authors.forename: John B
authors.initials: JB
authors.lastname: Meding
authors.forename: Philip M
authors.initials: PM
authors.lastname: Faris
authors.forename: Michael E
authors.initials: ME
authors.lastname: Berend
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D011184:Postoperative Period; D016059:Range of Motion, Articular