title: Manipulation under anaesthesia post total knee replacement: long term follow up.
abstract: A reduced range of motion post total knee replacement (TKR) is a recognised problem. Manipulation under anaesthesia (MUA) is commonly performed in the stiff post-operative TKR. Long-term results are variable in the literature. We retrospectively reviewed, prospectively collected data on 48 patients followed up since 1996 from one centre, over an average of 7.5 years, (range 1 to 10 years) and report on the long-term results. During the study period 2.3% of TKRs underwent MUA. The mean time to MUA post TKR was 12.3 weeks (range 3 to 48). Pre MUA, the mean flexion was 53°. The mean immediate passive flexion post MUA was 97°, an improvement of 44° (Range 10° to 90°, p<0.05). By 1year, the mean flexion was 87°, an improvement of 34°, (range -15° to 70°, p<0.05). At 10 years the mean flexion was 86°, (range 55° to 100°, p<0.05). We found no difference in the gain in range of motion (ROM) between knees manipulated before or after 12 weeks. Additionally, the gain was no different in stiff knees with a pre TKR ROM <90°, compared to a pre TKR ROM >90°. There were no complications as a result of MUA. However, one patient was eventually revised at 2 years secondary to low grade infection. Our findings show that MUA is a safe and effective method at improving the ROM in a stiff post-operative TKR. The improvement is maintained in the long term irrespective of time to MUA and range of motion pre TKR.
authors.affiliation: Conquest Hospital, East Sussex Hospital Trust Hastings, United Kingdom. david_yeoh@yahoo.co.uk
authors.forename: David
authors.initials: D
authors.lastname: Yeoh
authors.forename: Nick
authors.initials: N
authors.lastname: Nicolaou
authors.forename: Richard
authors.initials: R
authors.lastname: Goddard
authors.forename: Henry
authors.initials: H
authors.lastname: Willmott
authors.forename: Kim
authors.initials: K
authors.lastname: Miles
authors.forename: Debra
authors.initials: D
authors.lastname: East
authors.forename: Barry
authors.initials: B
authors.lastname: Hinves
authors.forename: John
authors.initials: J
authors.lastname: Shepperd
authors.forename: Adrian
authors.initials: A
authors.lastname: Butler-Manuel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D011184:Postoperative Period; D016059:Range of Motion, Articular; D012189:Retrospective Studies