title: Early and late manipulation improve flexion after total knee arthroplasty.
abstract: Manipulations have been considered effective only in the early postoperative period. From a total joint registry containing 9640 primary total knee arthroplasties (TKAs), 195 patients who underwent manipulation under anesthesia (MUA) were identified. A total of 102 had MUA within 90 days (early), and 93 more than 90 days (late) after TKA. Average pain (10-point scale), satisfaction (10-point scale), flexion (degrees), and extension (degrees) were recorded before and after MUA. Flexion was significantly improved after MUA for both groups: early MUA from 68.4 degrees (+/-17.2 degrees ) to 101.4 degrees (+/-16.15 degrees ), P < .001; late MUA from 81.0 degrees (+/-13.3 degrees ) to 98.0 degrees (+/-18.0 degrees ), P = .001. Pain decreased significantly with early MUA from 4.92 (+/-2.25) to 3.34 (+/-2.67) and with late MUA from 4.51 (+/-2.62) to 3.44 (+/-2.78), P = .048. Extension improved only in the early MUA group from 7.15 (+/-10.1) to 2.50 (+/-4.98). Satisfaction scores were not improved. Both early and late manipulation can improve TKA pain and flexion.
authors.affiliation: Department of Orthopedic Surgery, Kaiser Permanente, Orange County, Anaheim, California 92807, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Namba
authors.forename: Maria
authors.initials: M
authors.lastname: Inacio
mesh_terms: D000758:Anesthesia; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D007717:Knee / Q000502:physiology*; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D010149:Postoperative Pain; D017060:Patient Satisfaction; D011182:Postoperative Care; D012189:Retrospective Studies