title: Knee manipulation under anaesthetic following total knee arthroplasty: a matched cohort design.
abstract: The purpose of this study was to compare clinical outcomes of total knee arthroplasty (TKA) after manipulation under anaesthesia (MUA) for post-operative stiffness with a matched cohort of TKA patients who did not requre MUA. In total 72 patients (mean age 59.8 years, 42 to 83) who underwent MUA following TKA were identified from our prospective database and compared with a matched cohort of patients who had undergone TKA without subsequent MUA. Patients were evaluated for range of movement (ROM) and clinical outcome scores (Western Ontario and McMaster Universities Arthritis Index, Short-Form Health Survey, and Knee Society Clinical Rating System) at a mean follow-up of 36.4 months (12 to 120). MUA took place at a mean of nine weeks (5 to 18) after TKA. In patients who required MUA, mean flexion deformity improved from 10° (0° to 25°) to 4.4° (0° to 15°) (p < 0.001), and mean range of flexion improved from 79.8° (65° to 95°) to 116° (80° to 130°) (p < 0.001). There were no statistically significant differences in ROM or functional outcome scores at three months, one year, or two years between those who required MUA and those who did not. There were no complications associated with manipulation. At most recent follow-up, patients requiring MUA achieved equivalent ROM and clinical outcome scores when compared with a matched control group. While other studies have focused on ROM after manipulation, the current study adds to current literature by supplementing this with functional outcome scores.
authors.affiliation: McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Dzaja
authors.affiliation: Western University, London Health Sciences Centre, 339 Windermere Road, London, Ontario, N6A 5A5, Canada.
authors.forename: E M
authors.initials: EM
authors.lastname: Vasarhelyi
authors.affiliation: Western University, London Health Sciences Centre, 339 Windermere Road, London, Ontario, N6A 5A5, Canada.
authors.forename: B A
authors.initials: BA
authors.lastname: Lanting
authors.affiliation: Western University, London Health Sciences Centre, 339 Windermere Road, London, Ontario, N6A 5A5, Canada.
authors.forename: D D
authors.initials: DD
authors.lastname: Naudie
authors.affiliation: Western University, London Health Sciences Centre, 339 Windermere Road, London, Ontario, N6A 5A5, Canada.
authors.forename: J L
authors.initials: JL
authors.lastname: Howard
authors.affiliation: Western University, London Health Sciences Centre, 339 Windermere Road, London, Ontario, N6K 3B5, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Somerville
authors.affiliation: Western University, London Health Sciences Centre, 339 Windermere Road, London, Ontario, N6A 5A5, Canada.
authors.forename: R W
authors.initials: RW
authors.lastname: McCalden
authors.affiliation: Western University, London Health Sciences Centre , 339 Windermere Road, London, Ontario, N6A 5A5, Canada.
authors.forename: S J
authors.initials: SJ
authors.lastname: MacDonald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000777:Anesthetics / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics
keywords: Total knee arthroplasty; clinical outcomes; manipulation; stiffness