title: The risk of manipulation under anesthesia due to unsatisfactory knee flexion after fast-track total knee arthroplasty.
abstract: BACKGROUND
  Fast-track TKA has significantly shortened the time available for physiotherapists to optimize knee ROM before discharge. Safety aspects concerning knee stiffness and the need for manipulation in a fast-track setting need to be illuminated. The study aims were to analyze if fast-track TKA can be considered safe considering rates of knee manipulation and if there is an association between knee ROM at time of discharge and the need for later manipulation.
  
  
  METHODS
  Primary TKAs operated in 2011 at our institution were eligible for inclusion. The study group consisted of 359 TKAs.
  
  
  RESULTS
  Manipulation of the knee was performed in 21 of 359 TKAs (5.8%). Seventy-one percent were discharged with a flexion ≥70° combined with an extension deficit of ≤10°. The occurrence of MUA for these patients was 4.3%. The prevalence of knee manipulation showed a statistically significant association with the achieved knee flexion at discharge (p=0.02). Median length of stay was two days.
  
  
  CONCLUSIONS
  Compared with literature findings fast-track TKA surgery may be considered safe based on the acceptable rate of knee manipulations after TKA (5.8%). We suggest ROM of ≥70° flexion combined with an extension deficit of ≤10° as an "optimal-zone" for ROM at discharge. The reason for this is the low occurrence of MUA (4.3%) in relation to the large amount of TKAs it represents (71%). The indication for MUA is multifactorial and ROM at discharge serves only as an indicator of later MUA risk.
authors.affiliation: Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark. Electronic address: Chr.wied@gmail.com.
authors.forename: Christian
authors.initials: C
authors.lastname: Wied
authors.affiliation: Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors.forename: Morten G
authors.initials: MG
authors.lastname: Thomsen
authors.affiliation: Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kallemose
authors.affiliation: Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors.forename: Lis
authors.initials: L
authors.lastname: Myhrmann
authors.affiliation: Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors.forename: Lotte S
authors.initials: LS
authors.lastname: Jensen
authors.affiliation: Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; The Lundbeck Foundation for Fast-track Hip and Knee Replacement, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Husted
authors.affiliation: Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Troelsen
mesh_terms: D000368:Aged; D000775:Anesthesia, Spinal; D053587:Arthrometry, Articular; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D010351:Patient Discharge; D016059:Range of Motion, Articular / Q000502:physiology*
keywords: MUA; Optimal-zone; ROM; TKA