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Predictors of Range of Motion in Patients Undergoing Manipulation After TKA

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Knee stiffness or limited range of motion (ROM) after total knee arthroplasty (TKA) may compromise patient function. Patients with stiffness are usually managed with manipulation under anesthesia (MUA) to improve ROM. However, the final ROM obtained is multifactorial and may depend on factors such as comorbidities, implant type, or the timing of MUA.

Questions/purposes

We asked whether diabetes mellitus, implant type, and the interval between TKA and MUA influenced post-MUA ROM.

Methods

From a group of 2462 patients with 3224 TKAs performed between 1999 and 2007 we retrospectively reviewed 96 patients with 119 TKAs (4.3%) who underwent MUA. We determined the presence of diabetes mellitus, implant type, and the interval between TKA and MUA.

Results

The average increase in ROM after MUA was 34°. Patients with diabetes mellitus experienced lower final ROM after MUA (87.5° versus 100.3°) as did patients with cruciate-retaining (CR) prostheses versus posterior-stabilized (92.3° versus 101.6°). The interval between TKA and MUA inversely correlated with final ROM with a decrease after 75 days.

Conclusions

Most patients experience improvements in ROM after MUA. Patients with diabetes mellitus or CR prostheses are at risk for lower final ROM after MUA. Manipulation within 75 days of TKA is associated with better ROM.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank William Petersilge, MD, for contributing patients to the study and Patricia Conroy-Smith for help with data collection.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Case Western Reserve University, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Harpreet S. Bawa MD, Glenn D. Wera MD, Matthew J. Kraay MS, MD, Randall E. Marcus MD & Victor M. Goldberg MD

Authors
  1. Harpreet S. Bawa MD
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  2. Glenn D. Wera MD
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  3. Matthew J. Kraay MS, MD
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  4. Randall E. Marcus MD
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  5. Victor M. Goldberg MD
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Corresponding author

Correspondence to Harpreet S. Bawa MD.

Additional information

One of the authors (VMG) certifies that he has received payments or benefits, in any one year, an amount in excess of $1,000,000 from Zimmer (Warsaw, IN, USA) related to this work.

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, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Bawa, H.S., Wera, G.D., Kraay, M.J. et al. Predictors of Range of Motion in Patients Undergoing Manipulation After TKA. Clin Orthop Relat Res 471, 258–263 (2013). https://doi.org/10.1007/s11999-012-2591-1

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  • DOI: https://doi.org/10.1007/s11999-012-2591-1

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