Skip to main content
SpringerLink
Log in

Patients undergoing manipulation after total knee arthroplasty are at higher risk of revision within 2 years

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Total knee arthroplasty (TKA) is a very common orthopedic procedure and stiffness is a common complication following TKA. There is extensive data regarding timing and success of Manipulation under anesthesia (MUA) for stiffness following TKA. However, Studies reporting outcome following MUA have often focused on the improvement in ROM and improvement in functional score with very few studies reporting on the revision risk.

Methods and materials

In this study we retrospectively reviewed PearlDiver insurance database and analyzed the characteristics of the patient undergoing MUA after TKA. We also analyzed the risk of revision at 2 years in a cohort of MUA patients who were matched to patients without MUA.

Result

Our study identified 9156 patients who underwent MUA within one year following TKA. MUA was slightly more common in females and risk of manipulation decreases with increasing age. Comparative analysis showed that at two years, patients in the matched MUA cohort (538 patients, 5.99%) were 2.9 times more likely to undergo revision TKA compared to the matched non MUA group (194, 2.16%)OR 2.88 (95% CI—2.44 to 3.41), P < 0.05

Conclusion

Retrospective database review showed that the risk of revision is higher in patients undergoing MUA after TKA and hence patient should be counselled about the possibility of revision in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cheuy VA, Foran JRH, Paxton RJ, Bade MJ, Zeni JA, Stevens-Lapsley JE (2017) Arthrofibrosis associated with total knee arthroplasty. J Arthroplasty 32(8):2604–2611. https://doi.org/10.1016/j.arth.2017.02.005 (Epub 2017 Feb 14 PMID: 28285897)

    Article  PubMed  Google Scholar 

  2. Cartwright-Terry M, Cohen DR, Polydoros F, Davidson JS, Santini AJ (2018) Manipulation under anesthetic following total knee arthroplasty: predicting stiffness and outcome. J OrthopSurg (Hong Kong) 26(3):2309499018802971. https://doi.org/10.1177/2309499018802971

    Article  Google Scholar 

  3. Newman ET, Herschmiller TA, Attarian DE, Vail TP, Bolognesi MP, Wellman SS (2018) Risk factors, outcomes, and timing of manipulation under anesthesia after total knee arthroplasty. J Arthroplasty 33(1):245–249. https://doi.org/10.1016/j.arth.2017.08.002 (Epub 2017 Aug 10 PMID: 28935340)

    Article  PubMed  Google Scholar 

  4. Vanlommel L, Luyckx T, Vercruysse G, Bellemans J, Vandenneucker H (2017) Predictors of outcome after manipulation under anesthesia in patients with a stiff total knee arthroplasty. Knee Surg Sports TraumatolArthrosc 25(11):3637–3643. https://doi.org/10.1007/s00167-016-4413-6 (Epub 2016 Dec 29 PMID: 28032122)

    Article  CAS  Google Scholar 

  5. Crawford DA, Adams JB, Morris MJ, Berend KR, Lombardi AV Jr (2009) Manipulation under anesthesia after knee arthroplasty is associated with worse long-term clinical outcomes and survivorship. J Knee Surg. doi: https://doi.org/10.1055/s-0039-1700569. (Epub ahead of print; PMID: 31645072)

  6. Knapp P, Weishuhn L, Pizzimenti N, Markel DC (2020) Risk factors for manipulation under anesthesia after total knee arthroplasty. Bone Joint J 102-B(6_Supple_A):66–72. https://doi.org/10.1302/0301-620X.102B6.BJJ-2019-1580.R1

    Article  PubMed  Google Scholar 

  7. Issa K, Rifai A, Boylan MR, Pourtaheri S, McInerney VK, Mont MA (2015) Do various factors affect the frequency of manipulation under anesthesia after primary total knee arthroplasty? ClinOrthopRelat Res 473(1):143–147. https://doi.org/10.1007/s11999-014-3772-x

    Article  Google Scholar 

  8. Thorsteinsson H, Hedström M, Robertsson O, Lundin N, W-Dahl A (2019) Manipulation under anesthesia after primary knee arthroplasty in Sweden: incidence, patient characteristics and risk of revision. Acta Orthop 90(5):484–488. doi: https://doi.org/10.1080/17453674.2019.1637177 (Epub 2019 Jul 4. PMID: 31269851; PMCID: PMC6746267)

  9. Kahlenberg CA, Richardson SS, Schairer WW, Sculco PK (2018) Type of anticoagulant used after total knee arthroplasty affects the rate of knee manipulation for postoperative stiffness. J Bone Joint Surg Am 100(16):1366–1372. https://doi.org/10.2106/JBJS.17.01110

    Article  PubMed  Google Scholar 

  10. Meehan JP, Monazzam S, Miles T, Danielsen B, White RH (2017) Postoperative stiffness requiring manipulation under anesthesia is significantly reduced after simultaneous versus staged bilateral total knee arthroplasty. J Bone Joint Surg Am 99(24):2085–2093. https://doi.org/10.2106/JBJS.17.00130

    Article  PubMed  Google Scholar 

  11. Werner BC, Carr JB, Wiggins JC, Gwathmey FW, Browne JA (2015) Manipulation under anesthesia after total knee arthroplasty is associated with an increased incidence of subsequent revision surgery. J Arthroplasty 30(9 Suppl):72–75. https://doi.org/10.1016/j.arth.2015.01.061

    Article  PubMed  Google Scholar 

  12. Gwam CU, McGinnis T, Etcheson JI, George NE, Sultan AA, Delanois RE, Bhave A, Harwin SF, Mont MA (2018) Use of neuromuscular electrical stimulation during physical therapy may reduce the incidence of arthrofibrosis after total knee arthroplasty. SurgTechnolInt 1(32):356–360

    Google Scholar 

  13. Colacchio ND, Abela D, Bono JV, Shah VM, Bono OJ, Scott RD (2019) Efficacy of manipulation under anesthesia beyond three months following total knee arthroplasty. Arthroplasty Today 5(4):515–520. https://doi.org/10.1016/j.artd.2019.08.002

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gu A, Michalak AJ, Cohen JS, Almeida ND, McLawhorn AS, Sculco PK (2018) Efficacy of manipulation under anesthesia for stiffness following total knee arthroplasty: a systematic review. J Arthroplasty 33(5):1598–1605. https://doi.org/10.1016/j.arth.2017.11.054

    Article  PubMed  Google Scholar 

  15. Issa K, Banerjee S, Kester MA, Khanuja HS, Delanois RE, Mont MA (2014) The effect of timing of manipulation under anesthesia to improve range of motion and functional outcomes following total knee arthroplasty. J Bone Joint Surg Am 96(16):1349–1357. https://doi.org/10.2106/JBJS.M.00899

    Article  PubMed  Google Scholar 

  16. Martinez-Carranza N, Pettas A, Razzaz D, Broström E, Hedström M (2019) Younger age is associated with increased odds of manipulation under anesthesia for joint stiffness after total knee arthroplasty. OrthopTraumatolSurg Res 105(6):1067–1071. https://doi.org/10.1016/j.otsr.2019.05.014

    Article  Google Scholar 

  17. Namba RS, Inacio M (2007) Early and late manipulation improve flexion after total knee arthroplasty. J Arthroplasty 22(6 Suppl 2):58–61. https://doi.org/10.1016/j.arth.2007.02.010

    Article  PubMed  Google Scholar 

  18. Gu A, Michalak AJ, Cohen JS, Stepan JG, Almeida ND, McLawhorn AS, Sculco PK (2018) Prognostic factors that predict failure of manipulation under anesthesia for the stiff total knee arthroplasty: a systematic review. J Orthop 15(3):842–846. https://doi.org/10.1016/j.jor.2018.08.003

    Article  PubMed  PubMed Central  Google Scholar 

  19. Pfefferle KJ, Shemory ST, Dilisio MF, Fening SD, Gradisar IM (2014) Risk factors for manipulation after total knee arthroplasty: a pooled electronic health record database study. J Arthroplasty 29(10):2036–2038. https://doi.org/10.1016/j.arth.2014.05.001

    Article  PubMed  Google Scholar 

  20. Yeoh D, Nicolaou N, Goddard R, Willmott H, Miles K, East D, Hinves B, Shepperd J, Butler-Manuel A (2012) Manipulation under anesthesia post total knee replacement: long term follow up. Knee 19(4):329–331. https://doi.org/10.1016/j.knee.2011.05.009

    Article  PubMed  Google Scholar 

  21. Pierce TP, Issa K, Festa A, Scillia AJ, McInerney VK, Mont MA (2017) Does manipulation under anesthesia increase the risk of revision total knee arthroplasty? A matched case control study. J Knee Surg 30(7):730–733. https://doi.org/10.1055/s-0037-1598040

    Article  PubMed  Google Scholar 

  22. Brigati DP, Huddleston J, Lewallen D, Illgen R, Jaffri H, Ziegenhorn D, Weitzman DS, Bozic K (2020) Manipulation under anesthesia after total knee: who still requires a revision arthroplasty? J Arthroplasty 35(6S):S348–S351. https://doi.org/10.1016/j.arth.2020.03.009

    Article  PubMed  Google Scholar 

  23. Desai AS, Karmegam A, Dramis A, Board TN, Raut V (2014) Manipulation for stiffness following total knee arthroplasty: when and how often to do it? Eur J OrthopSurgTraumatol 24(7):1291–1295. https://doi.org/10.1007/s00590-013-1387-7

    Article  Google Scholar 

  24. Pariente GM, Lombardi AV Jr, Berend KR, Mallory TH, Adams JB (2006) Manipulation with prolonged epidural analgesia for treatment of TKA complicated by arthrofibrosis. SurgTechnolInt 15:221–224

    Google Scholar 

Download references

Funding

No external sources of funding were received for this study.

Author information

Authors and Affiliations

  1. Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA

    Senthil Sambandam, Varatharaj Mounasamy & Dane Wukich

  2. Department of Orthopedics, Dallas VAMC, 8th floor, Main Building, 4500, S Lancaster Road, Dallas, TX, 75216, USA

    Senthil Sambandam & Varatharaj Mounasamy

Authors
  1. Senthil Sambandam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Varatharaj Mounasamy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dane Wukich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Senthil Sambandam.

Ethics declarations

Conflict of interest

None of the authors have any conflict of interest pertinent to this study.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sambandam, S., Mounasamy, V. & Wukich, D. Patients undergoing manipulation after total knee arthroplasty are at higher risk of revision within 2 years. Eur J Orthop Surg Traumatol 32, 145–150 (2022). https://doi.org/10.1007/s00590-021-02943-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-021-02943-z

Keywords

Search

Navigation