Abstract
Introduction
Arthrofibrosis remains a persistent complication following total knee arthroplasty (TKA). Although manipulation under anesthesia (MUA) is an effective early treatment, the risks and value of this procedure beyond 3 months after TKA remain controversial. The purpose of this study was to examine the safety and efficacy of late MUAs for arthrofibrosis.
Methods
From our institutional total joint registry, 82 TKAs (77 patients) who underwent MUA >3 months after primary (83%) or revision (17%) TKA were identified. Mean time to MUA was 7 months: 66% performed between 4–6 months, 18% between 7–12 months, 16% beyond 12 months. MUAs were coupled with arthroscopic assistance in 26% (12% limited lysis of adhesions, 13% formal arthroscopic debridement). Mean age was 61 years, 59% females, and mean BMI was 33kg/m2. Mean follow-up was 5 years.
Results
No fractures, extensor mechanism disruptions, or other complications related to late MUA occurred. The mean ROM gained after MUA was 18° (76° to 94°, p<0.001). Substantial ROM gains (≥20°) occurred in 50%, while 21% made no gains or lost ROM after MUA. ROM gains ≥20° occurred in 54% of primary TKAs and 28% of revision TKAs. While ROM gains were higher when performed between 3–6 months (21°) compared to 6–12 months (13°) and >12 months (11°), these differences did not reach statistical significance (p=0.26). No differences in mean ROM gains were observed in MUAs performed with or without arthroscopic assistance (19° versus 15°, p=0.54). Kaplan Meier survivorship free of repeat MUA and revision TKA were 85% and 80% at 20 years, respectively.
Conclusion
Late MUA, coupled with arthroscopic assistance in selected patients, was safe in a broad range of stiff primary and revision TKAs with no fractures or extensor disruptions occurring. While mean ROM improvements were modest, a substantial subset of patients achieved clinically important ROM gains ≥20°.
Summary
Late MUA substantially improved ROM in a subset of patients with stiff TKAs and was done safely. In selected patients, arthroscopic lysis of adhesions or formal debridement aided the perceived safety and efficacy.
