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Do Various Factors Affect the Frequency of Manipulation Under Anesthesia After Primary Total Knee Arthroplasty?

  • Symposium: 2014 Knee Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 31 July 2014

Abstract

Background

One of the most important goals of primary total knee arthroplasty (TKA) is to achieve a functional range of motion (ROM). However, up to 20% of patients fail to do so, which can impair activities of daily living.

Questions/purposes

The purpose of this study was to evaluate the effect of various (1) demographic factors; (2) comorbidities; and (3) knee-specific factors on the frequency of manipulation under anesthesia, which was used as an indicator of knee stiffness after a primary TKA.

Methods

We evaluated the registries of two high-volume centers and reviewed all 3182 TKAs that were performed between 2005 and 2011 to identify all patients who had undergone manipulation under anesthesia (MUA). A total of 156 knees in 133 patients underwent MUA after an index arthroplasty. These patients were compared in a one-to-four ratio with a group of patients with satisfactory ROM drawn from the same database who met prespecified criteria and who had not undergone MUA. Effects of various factors, including age, sex, body mass index, race, comorbidities, and the underlying cause of knee arthritis, were compared between these two cohorts using multivariable logistic regressions.

Results

After controlling for various confounding, nonwhite race was associated with an increase (odds ratio [OR], 2.01; p = 0.03), and age ≥ 65 years (OR, 0.17; 95% confidence interval [CI], 0.04–0.74; p = 0.0179) was associated with a reduction in the incidence of MUA. In comorbidities, diabetes (OR, 1.72; 95% CI, 1.02–2.32; p = 0.03), high cholesterol levels (OR, 2.70; p = 0.03), and tobacco smoking (OR, 1.59; 95% CI, 1.03–2.47; p = 0.03) were associated with an increase in frequency of MUA. In knee-specific factors, preoperative knee ROM of less than 100° (OR, 0.80; p < 0.0001) and knee osteonecrosis (p = 3.61; 95% CI, 1.29–10.1; p = 0.014) were associated with increased frequency of MUA.

Conclusions

We identified several demographic, medical, and knee-specific factors that were associated with poor postoperative ROM in our patients undergoing TKA. Patients who have multiple risk factors may benefit from preoperative counseling to set realistic ROM expectations.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Amanda Palich, Tarak Shah, and Swetha Dhanireddy for assisting us in the data collection related to this study.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael A. Mont MD.

Additional information

One of the authors certifies that he (MAM) has received or may receive payments, during the study period, an amount of USD 100,000 to USD 1,000,000 from Stryker Orthopaedics (Mahwah, NJ,USA), an amount of USD 10,000 to USD 100,000 from Wright Medical Technology, Inc (Arlington, TN, USA), an amount of USD 10,000 to USD 100,000 from Biocomposites Inc (Wilmington, NC, USA), an amount of USD 10,000 to USD 100,000 from Jannsen, Inc (Toronto, Ontario, CA), an amount of USD 10,000 to USD 100,000 from Joint Active Systems, Inc (Effingham, IL, USA), an amount of USD 10,000 to USD 100,000 from Medtronic, Inc (Minneapolis, MN, USA), an amount of USD 10,000 to USD 100,000 from Sage Products LLC (Cary, IL, USA), and an amount of USD 10,000 to USD 100,000 from TissueGene (Rockville, MD, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Sinai Hospital of Baltimore, Baltimore, MD, USA; and Seton Hall University of Health and Medical Sciences, South Orange Village, NJ, USA.

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Issa, K., Rifai, A., Boylan, M.R. et al. Do Various Factors Affect the Frequency of Manipulation Under Anesthesia After Primary Total Knee Arthroplasty?. Clin Orthop Relat Res 473, 143–147 (2015). https://doi.org/10.1007/s11999-014-3772-x

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  • DOI: https://doi.org/10.1007/s11999-014-3772-x

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