Abstract
Introduction
Manipulation under anesthesia (MUA) remains the gold standard to address restricted range of motion (ROM) within 3–6 months after primary total knee arthroplasty (TKA). However, there is little data on the outcomes of MUA with different types of anesthesia. We sought to compare the outcomes of patients undergoing MUA with intravenous (IV) sedation and neuraxial anesthesia.
Methods
We identified 548 MUAs after primary TKA (136 IV sedation, 413 neuraxial anesthesia) at a single institution from 2016–2019. Mean age was 62 years and 349 patients (64%) were female. Mean body mass index was 32 kg/m2. The mean time from primary TKA to MUA was 10 weeks. Mean pre-MUA ROM was similar between each group; mean pre-MUA extension was 4.2° (p=0.35) and mean pre-MUA flexion was 77° (p=0.56). Patient demographics were statistically similar between both groups. We compared immediate complications, including fracture, extensor mechanism disruptions, and wound complications, Visual analogue pain scores (VAS), length of stay (LOS), and immediate and 3 month follow-up ROM between these groups.
Results
No patients in either group sustained an immediate post-MUA complication. Patients undergoing MUA with IV sedation had significantly higher day of MUA average VAS of 5.1 compared to 4.1 in the neuraxial group (p<0.001). The average LOS was shorter in patients that received IV sedation (9 hours) compared to neuraxial anesthesia (12 hours) (p=0.009). Immediate-post MUA ROM was 1° – 121° in the IV sedation group and 0.9° – 123° in the neuraxial anesthesia group (p=0.21). Three month follow-up ROM was 2° – 108° in the IV sedation group and 1.9° – 110° in the neuraxial anesthesia group.
Conclusion
IV sedation and neuraxial anesthesia are both effective anesthetic methods for patients undergoing MUA after primary TKA with minimal perioperative differences. Surgeons and anesthesiologists should cater anesthetic technique to patient specific needs as the orthopedic outcomes are similar for both methods; however, IV sedation resulted in a shorter LOS.
