Tibiofemoral joint mobilizations following total knee arthroplasty and manipulation under anesthesia

• Published in: Physiotherapy theory and practice Vol. 36; no. 7; pp. 863 - 870
• Main Authors: Dailey, PT, DPT, OCS, Kathryn, McMorris, PT, DPT, OCS, FAAOMPT, Michael, Gross, PT, PhD, FAPTA, Michael T
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis Ltd 02.07.2020
• Subjects: Anesthesia; Arthroplasty; Arthroplasty, Replacement, Knee; Case reports; Disability Evaluation; Female; Fibrosis - etiology; Fibrosis - therapy; Humans; Intervention; Joint replacement surgery; Joint surgery; Knee; Lower limbs; Manipulation; Manipulation, Orthopedic - methods; Middle Aged; Musculoskeletal Manipulations - methods; Pain; Pain Measurement; Physiotherapy; Postoperative Complications - therapy; Range of Motion, Articular; total knee arthroplasty; Manual therapy; arthrofibrosis; joint mobilization
• ISSN: 0959-3985; 1532-5040
• DOI: 10.1080/09593985.2018.1510452

Case report. The purpose of this case report is to describe the use of tibiofemoral joint mobilizations to improve knee flexion in a patient with arthrofibrosis following total knee arthroplasty (TKA) and failed manipulation under anesthesia (MUA). A 62-year-old female presented to physical therapy 15 days after TKA with full knee extension, 45 deg of active knee flexion, 48 deg of passive knee flexion, pain, and a Lower Extremity Functional Scale (LEFS) score of 28. A multimodal intervention strategy was used initially with minimal improvement in knee flexion. The patient was diagnosed with fibrosis and MUA was performed. Passive knee flexion was 80 deg before MUA and 75 deg after MUA. Focused grade III and IV tibiofemoral joint mobilizations were used after MUA. At discharge, the patient had 90 deg of active and 116 deg of passive knee flexion, no pain, and an LEFS score of 80. A conventional multimodal intervention approach was ineffective for a patient who developed arthrofibrosis following TKA. A focused intervention approach of grade III and IV tibiofemoral joint mobilizations improved knee flexion, pain, and function following TKA and failed MUA.