title: Risk factors for manipulation after total knee arthroplasty: a pooled electronic health record database study.
abstract: A commercially available software platform, Explorys (Explorys, Inc., Cleveland, OH), was used to mine a pooled electronic healthcare database consisting of the medical records of more than 27 million patients. A total of 229,420 patients had undergone a total knee arthroplasty; 3470 (1.51%) patients were identified to have undergone manipulation under anesthesia. Individual risk factors of being female, African American race, age less than 60, BMI >30 and nicotine dependence were determined to have relative risk of 1.25, 2.20, 3.46, 1.33 and 1.32 respectively. Depressive disorder, diabetes mellitus, opioid abuse/dependence and rheumatoid arthritis were not significant risk factors. African Americans under the age of 60 at time of TKA had the greatest incidence of MUA (5.17%) and relative risk of 3.73 (CI: 3.36, 4.13).
authors.affiliation: Department of Orthopaedic Surgery, Summa Health System, Akron, Ohio.
authors.forename: Kiel J
authors.initials: KJ
authors.lastname: Pfefferle
authors.affiliation: Department of Orthopaedic Surgery, Summa Health System, Akron, Ohio.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Shemory
authors.affiliation: Harvard Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Dilisio
authors.affiliation: Department of Orthopaedic Surgery, Summa Health System, Akron, Ohio; Austen BioInnovation Institue, Akron, Ohio.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Fening
authors.affiliation: Crystal Clinic Orthopedic Center, Akron, Ohio.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Gradisar
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D057225:Data Mining; D016208:Databases, Factual; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000209:etiology / Q000628:therapy*; D007719:Knee Joint; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D016059:Range of Motion, Articular; D012086:Reoperation; D012307:Risk Factors
keywords: arthrofibrosis; knee stiffness; manipulation; manipulation under anesthesia; stiffness; total knee arthroplasty