Volume VII, Number 1 | April 2023

Do patients who undergo manipulation under anesthesia have decreased PROMs following primary total knee arthroplasty?

1Presley T, 1Rowe R, 1Parkulo T, 2Smith L, 1Malkani A
1University of Louisville, Louisville, KY, United States; 2UofL Health, Louisville, KY, United States

Stiffness following TKA can lead to sub-optimal function, range of motion (ROM), and patient dissatisfaction. Manipulation under anesthesia (MUA) is often undertaken to improve ROM in patients with postoperative stiffness. There is no consensus on the indications and timing for MUA. The purpose of this study was to compare patient satisfaction post-MUA versus those with an uncomplicated postoperative course following TKA.

This was a retrospective cohort study. 115 primary TKAs requiring MUA from 2013-2019 were identified from a prospective institutional registry. Indication for MUA was failure to achieve 105⁰ active knee flexion at 6 weeks postop. 12 were lost to follow-up, 1 deceased, and 4 excluded due to revision (85.22% retention). 98 remaining MUAs were matched to 300 consecutive cases not requiring MUA from the same time period. Patients in both groups had minimum 1-year follow-up. Outcome measures included postoperative complications, Knee Society Scores (KSS), and 5-point Likert scale patient satisfaction. Statistical analyses were performed using t-Test: Two-Sample Assuming Unequal Variances.

There were no differences in the MUA group versus the control group with respect to: BMI (32.52 and 33.95, respectively, p=.095); preoperative KSS Function or Pain Score (45.71 and 43.97 respectively, p=0.35 and 41.23 versus 39.05, p=0.19); complications (8.2% versus 10.3%,); ROM improvement (10.59&#8304; versus 9.39&#8304;, p=0.63); postoperative KSS Pain Score (88.96 versus 89.59, p=0.63); Charlson Comorbidity Index (3.12 versus 3.3, p=.55); or Likert satisfaction (4.5 versus 4.46, p=.72). There were significant differences between the groups with respect to age (p<0.001); preoperative ROM (p<0.01); post-operative ROM (p=0.02); and post-operative KSS Function Scores (p<0.001), respectively.

Patients requiring MUA were younger with decreased preoperative ROM. Using the target goal of 105&#8304; of flexion at 6 weeks postop as indications for MUA, led to excellent patient satisfaction following primary TKA despite diminished postoperative ROM and KSS function scores.

The Journal of the American Osteopathic Academy of Orthopedics

Steven J. Heithoff, DO, FAOAO

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