title: A national questionnaire survey on knee manipulation following total knee arthroplasty.
abstract: BACKGROUND
  Adequate range of knee motion is critical for successful total knee arthroplasty. While aggressive physical therapy is an important component, manipulation may be a necessary supplement. There seems to be a lack of consensus with variable practices existing in managing stiff postoperative knees following arthroplasty. Hence we aim to determine the current practice and trend among knee surgeons throughout the United Kingdom.
  
  
  METHODS
  Postal questionnaires were sent out to 100 knee surgeons registered with British Association of Knee Surgeons, ensuring that the whole of United Kingdom was well represented. The questions included whether the surgeon used Manipulation Under Anaesthaesia (MUA) as an option for stiff postoperative knees; timing of MUA; use of Continuous Passive Motion (CPM) post-manipulation.
  
  
  RESULTS
  We received 82 responses. 46% of respondents performed MUA routinely, 43% sometimes, and 11 never. Majority (71.23%) performed MUA within 3 months of the index procedure. 68% routinely used CPM post-manipulation while 7% of the respondents applied splints or serial cast post MUA. 41% of the surgeons routinely used Patient Controlled Analgaesia ± Regional blocks. Majority (55%) never performed open/arthroscopic debridement of fibrous tissue for adhesiolysis.
  
  
  CONCLUSIONS
  Knee manipulation requires an additional anaesthetic and may result in complications such as: supracondylar femur fractures, wound dehiscence, patellar tendon avulsions, haemarthrosis, and heterotopic ossification. Moreover studies have shown that manipulation while being an important therapeutic adjunct does not increase the ultimate flexion achieved. Manipulation should be reserved for the patient with difficult and painful flexion in the early postoperative period.
authors.affiliation: Department of Orthopaedics, Monklands Hospital, Airdrie, Scotland ML6 0JS, UK.
authors.forename: Shen Hwa
authors.initials: SH
authors.lastname: Vun
authors.affiliation: Department of Orthopaedics, Monklands Hospital, Airdrie, Scotland ML6 0JS, UK.
authors.forename: David William
authors.initials: DW
authors.lastname: Shields
authors.affiliation: Department of Orthopaedics, Monklands Hospital, Airdrie, Scotland ML6 0JS, UK.
authors.forename: Aroop
authors.initials: A
authors.lastname: Sen
authors.affiliation: Department of Orthopaedics, Monklands Hospital, Airdrie, Scotland ML6 0JS, UK.
authors.forename: Sajan
authors.initials: S
authors.lastname: Shareef
authors.affiliation: Department of Orthopaedics, Monklands Hospital, Airdrie, Scotland ML6 0JS, UK.
authors.forename: Satyajit
authors.initials: S
authors.lastname: Sinha
authors.affiliation: Department of Orthopaedics, Monklands Hospital, Airdrie, Scotland ML6 0JS, UK.
authors.forename: Alexander Craig
authors.initials: AC
authors.lastname: Campbell
keywords: Arthrolysis; Manipulation; Stiff; Total knee arthroplasty