The risk of manipulation under anesthesia due to unsatisfactory knee flexion after fast-track total knee arthroplasty

• Published in: The knee Vol. 22; no. 5; pp. 419 - 423
• Main Authors: Wied, Christian, Thomsen, Morten G, Kallemose, Thomas, Myhrmann, Lis, Jensen, Lotte S, Husted, Henrik, Troelsen, Anders
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.10.2015; Elsevier Limited
• Subjects: Aged; Analgesics; Anesthesia, Spinal; Arthrometry, Articular; Arthroplasty, Replacement, Knee - methods; Female; Gender; Hospitals; Humans; Intraoperative Care; Joint surgery; Knee Joint - physiopathology; Knee Joint - surgery; Male; Manipulation, Orthopedic; Middle Aged; Mortality; MUA; Narcotics; Optimal-zone; Orthopedics; Pain; Patient Discharge; Patient satisfaction; Patients; Prostheses; Range of Motion, Articular - physiology; ROM; Surgery; TKA; MUA; ROM; Optimal-zone; TKA
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2015.02.008

Abstract Background Fast-track TKA has significantly shortened the time available for physiotherapists to optimize knee ROM before discharge. Safety aspects concerning knee stiffness and the need for manipulation in a fast-track setting need to be illuminated. The study aims were to analyze if fast-track TKA can be considered safe considering rates of knee manipulation and if there is an association between knee ROM at time of discharge and the need for later manipulation. Methods Primary TKAs operated in 2011 at our institution were eligible for inclusion. The study group consisted of 359 TKAs. Results Manipulation of the knee was performed in 21 of 359 TKAs (5.8%). Seventy-one percent were discharged with a flexion ≥ 70° combined with an extension deficit of ≤ 10°. The occurrence of MUA for these patients was 4.3%. The prevalence of knee manipulation showed a statistically significant association with the achieved knee flexion at discharge (p = 0.02). Median length of stay was two days. Conclusion Compared with literature findings fast-track TKA surgery may be considered safe based on the acceptable rate of knee manipulations after TKA (5.8%). We suggest ROM of ≥ 70° flexion combined with an extension deficit of ≤ 10° as an “optimal-zone” for ROM at discharge. The reason for this is the low occurrence of MUA (4.3%) in relation to the large amount of TKAs it represents (71%). The indication for MUA is multifactorial and ROM at discharge serves only as an indicator of later MUA risk.