title: Low manipulation prevalence following fast-track total knee arthroplasty.
abstract: OBJECTIVE
  Postoperative joint stiffness following total knee arthroplasty (TKA) may compromise the outcome and necessitate manipulation. Previous studies have not been in a fast-track setting with optimized pain treatment, early mobilization, and short length of stay (LOS), which may have influenced the prevalence of joint stiffness and subsequent manipulation. We investigated the prevalence of manipulation following fast-track TKA and identified patients at risk of needing manipulation.
  
  
  METHODS
  3,145 consecutive unselected elective primary unilateral TKA patients operated in 6 departments with well-defined fast-track settings were included in the study. Demographic data, prevalence, type and timing of manipulation, and preoperative and postoperative ROM were recorded prospectively, ensuring complete 1-year follow-up.
  
  
  RESULTS
  70 manipulations were performed within 1 year (2.2%) at a mean of 4 months after index surgery. Younger age and not using walking aids preoperatively were associated with a higher risk of manipulation. LOS ≤ 4 days (as opposed to a longer LOS) was not associated with an increased risk of manipulation.
  
  
  CONCLUSIONS
  The prevalence of manipulation was lower or comparable to that in most published studies following more conventional pathways. Inherent patient demographics were identified as risk factors for manipulation whereas LOS ≤ 4 days was not. Thus, fast-track TKA does not result in increased risk of manipulation-despite a shorter LOS. Optimized pain treatment and early mobilization may contribute to these favorable results that support the use of fast-track.
authors.affiliation: Department of Orthopaedic Surgery , Copenhagen University Hospital Hvidovre , Copenhagen.
authors.forename: Henrik
authors.initials: H
authors.lastname: Husted
authors.forename: Christoffer C
authors.initials: CC
authors.lastname: Jørgensen
authors.forename: Kirill
authors.initials: K
authors.lastname: Gromov
authors.forename: Anders
authors.initials: A
authors.lastname: Troelsen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods* / Q000534:rehabilitation; D002985:Clinical Protocols; D051341:Dependent Ambulation / Q000706:statistics & numerical data; D004434:Early Ambulation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic / Q000706:statistics & numerical data*; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D019990:Perioperative Care / Q000379:methods*; D016059:Range of Motion, Articular; D055815:Young Adult