Predictors of Range of Motion in Patients Undergoing Manipulation After TKA

• Published in: Clinical orthopaedics and related research Vol. 471; no. 1; pp. 258 - 263
• Main Authors: Bawa, Harpreet S., Wera, Glenn D., Kraay, Matthew J., Marcus, Randall E., Goldberg, Victor M.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.01.2013; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Conservative Orthopedics; Diabetes Mellitus - physiopathology; Female; Humans; Knee; Knee Joint - physiopathology; Knee Prosthesis; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Predictive Value of Tests; Range of Motion, Articular - physiology; Retrospective Studies; Sports Medicine; Surgery; Surgical Orthopedics; Symposium: Papers Presented at the Annual Meetings of the Knee Society; Treatment Outcome; Manipulation Under Anesthesia; Posterior Stabilize; Total Knee Arthroplasty; Posterior Cruciate Ligament; Flexion Contracture
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-012-2591-1

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.