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Akhtar M, Razick D, Seibel A, Asad S, Shekhar A, Shelton T. Outcomes of Early Versus Delayed Manipulation Under Anesthesia for Stiffness Following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2024:S0883-5403(24)00531-X. [PMID: 38797451 DOI: 10.1016/j.arth.2024.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Stiffness following total knee arthroplasty (TKA) is often treated with manipulation under anesthesia (MUA). However, there is debate regarding the timing of MUA, with many recommending against MUA beyond 3 months after TKA. Therefore, the purpose of this systematic review was to evaluate the functional and clinical outcomes of early versus delayed MUA for stiffness following TKA. METHODS A search following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was performed in the PubMed, Embase, Scopus, and Cochrane databases in November 2023. Data regarding study characteristics, demographics, knee flexion and extension, patient-reported outcomes, complications, and revisions were collected. A quality assessment was performed using the Methodological Index for Non-randomized Studies. Included were 14 studies analyzing 13,445 knees, 72.1% of which underwent early MUA and 27.8% of which underwent delayed MUA. Of the 14 studies, 10 defined early MUA as being performed within 3 months of the index TKA. RESULTS Pre-MUA and post-MUA knee flexion for the early/delayed groups was 71.3°/77.9° and 103.0°/96.1°, respectively. Upon meta-analysis, pre-MUA knee flexion was significantly higher in the delayed group (P = .003), whereas post-MUA flexion was similar in both groups (P = .36). The mean gain in knee flexion for the early and delayed groups was 32.0°/19.2°. The surgical complication and revision TKA rates for the early and delayed groups were 4.9%/10.3% and 5%/9%, respectively. A meta-analysis found the risk of surgical or medical complications and revision TKA to be significantly higher in the delayed MUA group (P < .00001 and = .002, respectively). CONCLUSIONS Although post-MUA knee flexion was similar in patients undergoing early and delayed MUA following TKA, the mean gain in flexion for early patients was nearly double that of delayed patients. Delayed patients also had significantly higher risks of surgical or medical complications and revision TKA following MUA.
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Affiliation(s)
- Muzammil Akhtar
- College of Medicine, California Northstate University, Elk Grove, California
| | - Daniel Razick
- College of Medicine, California Northstate University, Elk Grove, California
| | - Amalia Seibel
- College of Medicine, California Northstate University, Elk Grove, California
| | - Shaheryar Asad
- College of Medicine, California Northstate University, Elk Grove, California
| | - Adithya Shekhar
- Department of Orthopedic Surgery, Samaritan Health System, Corvallis, Oregon
| | - Trevor Shelton
- Utah Valley Orthopedics and Sports Medicine, Intermountain Health, Provo, Utah
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Alghamdi BA, Karkousha RN, Elgeidi AA, Amin FS, Tolba AM. Effect of Low-Level Laser Therapy on Knee Range of Motion and Functional Abilities After Total Knee Arthroplasty. Cureus 2023; 15:e50893. [PMID: 38249281 PMCID: PMC10799633 DOI: 10.7759/cureus.50893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE The aim of this study was to determine the effectiveness of combined low-level laser therapy (LLL) and rehabilitation in patients following recent total knee replacement (TKR). METHODS A double-blind randomized controlled study was conducted at the Orthopedic Department of Mansoura University Hospital. Forty-four patients were chosen from a total of 58 patients who met the inclusion criteria and were assigned randomly into control and experimental groups of equal size. Ultimately, 40 patients completed the study (20 from each group). Both groups participated in an intensive functional rehabilitation program, and the experimental group also received LLL therapy around the knee at the incisional line, the medial and lateral intra-articular space, above and below the patella, and at the popliteal fossa at low fluence (6 J/cm2, 650 nm continuous wave) and 60 s per point with a total dose of 48 J per session over 12 treatment sessions for six weeks. Knee range of motion (ROM) was measured with a digital goniometer, and functional abilities were assessed with the Arabic version of the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. RESULTS There were significant differences in all variables pre- and post-treatment within each group. Before treatment, there was no significant difference in any of the measured variables between the groups (P>0.05). After treatment, there were significant differences in knee flexion ROM and WOMAC index (P<0.05) but no significant difference in knee extension ROM between the groups (P>0.05). CONCLUSION The addition of low-level laser therapy to a rehabilitation program post-TKR resulted in substantial enhancements in knee flexion range of motion and the WOMAC index.
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Affiliation(s)
- Bandar A Alghamdi
- Orthopedic, Department of Surgery, College of Medicine, Umm Al-Qura University, Al-Qunfudhah, SAU
| | - Rania N Karkousha
- Physical Therapy, Basic Science Department, Faculty of Physical Therapy, Cairo University, Cairo, EGY
| | - Adham A Elgeidi
- Orthopedic and Traumatology, Orthopedic Department, Faculty of Medicine, Mansoura University, Mansoura, EGY
| | - Fatma S Amin
- Physical Therapy, Basic Science Department, Faculty of Physical Therapy, Cairo University, Cairo, EGY
| | - Ahmed M Tolba
- Physical Therapy, Basic Science Department, Faculty of Physical Therapy, Delta University for Science and Technology, Gamsa, EGY
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Gibbons JP, Cassidy RS, Bryce L, Napier RJ, Bloch BV, Beverland DE. Is Cementless Total Knee Arthroplasty Safe in Women Over 75 Y of Age? J Arthroplasty 2023; 38:691-699. [PMID: 36272510 DOI: 10.1016/j.arth.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) is the subject of renewed interest. Previous concerns about survivorship have been addressed and there is an appeal in terms of biological fixation and surgical efficiency. However, even surgeon advocates have concerns about the risk of marked subsidence when using this technology in older patients at risk for osteoporosis. METHODS This was a retrospective analysis of 1,000 consecutive fully cementless mobile bearing TKAs performed at a single institution on women over 75 years of age who had postoperative and 1-year x-rays. The primary outcome was the incidence of subsidence. RESULTS There were three asymptomatic cases with definite subsidence and change in alignment. In a fourth symptomatic case, the femoral component subsided into varus and the tibia into valgus, thus maintaining alignment which facilitated nonoperative treatment in a 92-year-old. Overall, at 1 year, there were two- liner revisions for infection without recurrence. Five patients had further surgery, of which three were washouts and two were for periprosthetic fractures sustained postoperatively within 1 year. Seven patients had further anesthesia, of which five were manipulations and two were nonrecurrent closed reductions for spinouts. CONCLUSION Cementless TKA did not have a high risk of subsidence in this at-risk population. In the hands of experienced surgeons, these procedures can be used safely irrespective of bone quality.
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Affiliation(s)
- John P Gibbons
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Roslyn S Cassidy
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Leeann Bryce
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Richard J Napier
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Benjamin V Bloch
- Nottingham Elective Orthopaedic Services, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, England
| | - David E Beverland
- Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, Northern Ireland
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Sheridan GA, Cassidy RS, McKee C, Hughes I, Hill JC, Beverland DE. Survivorship of 500 Cementless Total Knee Arthroplasties in Patients Under 55 Years of Age. J Arthroplasty 2022; 38:820-823. [PMID: 36309144 DOI: 10.1016/j.arth.2022.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND With respect to survivorship following total knee arthroplasty (TKA), joint registries consistently demonstrate higher revision rates for both genders in those aged less than 55 years. The present study analyzed the survivorship of 500 cementless TKAs performed in this age group in a high-volume primary joint unit where cementless TKA has traditionally been used for the majority of patients. METHODS This was a retrospective review of 500 consecutive TKAs performed in patients aged less than 55 years between March 1994 and April 2017. The primary outcome measures for the study were survivorship and all-cause revisions. Secondary outcome measures included nonrevision procedures, clinical, functional, and radiological outcomes. RESULTS An all-cause survival rate of 98.4% and an aseptic survival rate of 99.2% at a median time of 10.7 years (interquartile range 7.3-14.9, range 0.2-27.7) were found. Four patents were revised for infection, 2 for stiffness, 1 for aseptic loosening of the tibial component, and 1 for a patella that was resurfaced for anterior knee pain. Thirty four patients (6.8%) had a nonrevision procedure with manipulation under anesthetic accounting for 27. On a multivariate analysis, preoperative range of motion and female gender were negatively associated with postoperative range of motion (P < .001 and P = .003, respectively). Sixty seven patients (17.3%) had radioluscent lines and on a multivariate analysis, there were no significant predictors of radiolucent lines. CONCLUSION Cementless TKA in the young patient can achieve excellent clinical and functional outcomes. At a median of 10.7 years, aseptic revision rates are exceptionally low at 0.8% for the entire cohort.
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Affiliation(s)
- Gerard A Sheridan
- Primary Joint Unit, Musgrave Park Hospital, Belfast, Northern Ireland, United Kingdom
| | - Roslyn S Cassidy
- Primary Joint Unit, Musgrave Park Hospital, Belfast, Northern Ireland, United Kingdom
| | - Christopher McKee
- Primary Joint Unit, Musgrave Park Hospital, Belfast, Northern Ireland, United Kingdom
| | - Ioan Hughes
- Primary Joint Unit, Musgrave Park Hospital, Belfast, Northern Ireland, United Kingdom
| | - Janet C Hill
- Primary Joint Unit, Musgrave Park Hospital, Belfast, Northern Ireland, United Kingdom
| | - David E Beverland
- Primary Joint Unit, Musgrave Park Hospital, Belfast, Northern Ireland, United Kingdom
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DeFrance MJ, Cheesman QT, Hameed D, DiCiurcio WT, Harrer MF. Manipulation Under Anesthesia Is Associated With an Increased Rate of Early Total Knee Arthroplasty Revision. Orthopedics 2022; 45:270-275. [PMID: 35700432 DOI: 10.3928/01477447-20220608-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Manipulation under anesthesia (MUA) after total knee arthroplasty (TKA) frequently has been used as a first-line treatment to restore functional range of motion after unsuccessful physical therapy. Although there are studies reporting that MUA assisted in restoring range of motion, there is a paucity of literature on the influence of MUA on the risk of revision TKA. The goal of our study was to determine whether MUA was associated with an increase in the rate of revision TKA within 2 years of MUA. A total of 49,310 patients within a single institution who underwent primary TKA were identified from 1999 to 2019. Data were matched at a 1:3 ratio (TKA with and without MUA, respectively) based on age, sex, and body mass index. A matched comparison cohort was conducted, with the MUA cohort having 575 patients and the no MUA cohort having 1725 patients. A statistically significant increase in the rate of noninfectious etiology revision TKA was found in the MUA cohort (7.3%) compared with the no MUA cohort (4.9%; P=.034). The most common reason for revision TKA after MUA was persistent stiffness, including arthrofibrosis and ankylosis; however, aseptic loosening, ligamentous instability, and periprosthetic fracture were found to be responsible for 21.4% of revision TKA procedures. Although MUA is a commonly performed procedure for treating stiffness after primary TKA, the orthopedic surgeon should counsel patients on the association of increased rate of revision TKA after MUA, most commonly, persistent stiffness. [Orthopedics. 2022;45(5):270-275.].
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Yang DS, Lemme NJ, Glasser J, Daniels AH, Antoci V. The Effect of Early versus Late Manipulation Under Anesthesia on Opioid Use, Surgical Complications, and Revision Following Total Knee Arthroplasty. J Knee Surg 2022. [PMID: 35817059 DOI: 10.1055/s-0042-1749607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Previous studies of early versus late manipulation under anesthesia (MUA) do not report on postoperative opioid utilization or revisions and focused on small single-institution retrospective cohorts. The PearlDiver Research Program (www.pearldiverinc.com), which uses an all-inclusive insurance database, was used to identify patients undergoing primary total knee arthroplasty (TKA) who received (1) late MUA (>12 weeks), (2) early MUA (≤12 weeks), or (3) TKA only. To develop the control group cohort of TKA-only patients, 3:1 matching was conducted using 11 risk factor variables deemed significant by chi-squared analysis. Complications and opioid utilization were compared through multivariate regression analysis, controlling for age, gender, and Charlson Comorbidity Index. The risk of TKA revision was assessed through Cox-proportional hazards modeling and Kaplan-Meier survival analysis with log-rank test. Between 2011 and 2017, 2,062 TKA patients with early MUA, 1,112 TKA patients with late MUA, and a control cohort of 8,327 TKA-only patients were identified in the database. The percent of patients registering opioid use decreased from 54.6% 1 month pre-MUA to 4.6% (p < 0.0001) 1 month post-MUA following early MUA, whereas only from 32.6 to 10.4% (p < 0.0001) following late MUA. Late MUA was associated with higher risk of repeat MUA at 6 months (adjusted odds ratio [aOR] = 2.74, p < 0.0001), 1 year (aOR = 2.66, p < 0.0001), and 2 years (aOR = 2.63, p < 0.0001) following index MUA. Hazards modeling and survival analysis showed increased risk of TKA revision following late MUA (adjusted hazard ratio [aHR] = 3.50, 95% confidence interval [CI]: 2.77-4.43, p < 0.0001) compared to early MUA (aHR = 2.15, 95% CI: 1.72-2.70, p < 0.0001), with significant differences in survival to revision curves (p < 0.0001). When compared to early MUA at 1 year, late MUA was associated with a significantly increased risk of prosthesis explantation (aOR = 2.89, p = 0.0026 vs. aOR = 0.93, p = 0.8563). MUA within 12 weeks after index TKA had improved pain resolution and significant curtailing of opioid use. Furthermore, late MUA was associated with prolonged opioid use, increased risks of revision, as well as prosthesis explantation, supporting screening and early intervention in cases of slow progression and stiffness. The level of evidence of this study is III.
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Affiliation(s)
- Daniel S Yang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nicholas J Lemme
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jillian Glasser
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Valentin Antoci
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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RANTASALO MT, PALANNE RA, SAINI S, VAKKURI AP, MADANAT R, NOORA SK. Postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia. Acta Orthop 2022; 93:432-437. [PMID: 35419610 PMCID: PMC9008578 DOI: 10.2340/17453674.2022.2272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Manipulation under anesthesia (MUA) is the first-choice treatment for stiffness following total knee arthroplasty (TKA) unresponsive to pain management and physiotherapy. Some of the predisposing factors and patient-reported outcome measures (PROMs) following MUA remain poorly studied. We retrospectively investigated the etiological risk factors and the outcomes of MUA. PATIENTS AND METHODS 391 TKA patients from a randomized trial comparing the use of a tourniquet and anesthesia (spinal or general) were analyzed, and patients needing MUA were identified (MUA group). We evaluated in-hospital opioid consumption, Oxford Knee Score (OKS), range of motion (ROM), and pain assessed by the Brief Pain Inventory-short form with a 1-year follow-up. RESULTS 39 (10%) MUA patients were identified. The MUA patients were younger (60 years vs. 64 years, difference -4, 95% CI -6 to -1) and had higher postoperative oxycodone consumption (66 mg vs. 51 mg, median difference 11, CI 1-22) than the no-MUA patients. The proportion of MUA patients who contacted the emergency department within 3 months because of pain was larger than that of non-MUA patients (41% vs. 12%, OR 5, CI 3-10). At the 1-year follow-up, the ROM was improved by 39° following MUA, but the total ROM was worse in the MUA group (115° vs. 124°, p < 0.001). No difference was found in the OKS between the MUA and no-MUA patients. INTERPRETATION Higher postoperative pain seems to predict MUA risk. MUA performed 3 months postoperatively offers substantial ROM improvement and comparable PROMs to no-MUA patients 1 year after TKA.
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Affiliation(s)
- Mikko T RANTASALO
- Department of Orthopedics and Traumatology, Arthroplasty Center, University of Helsinki and Helsinki University Hospital
| | - Riku A PALANNE
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital
| | - Sukhdev SAINI
- Department of Medical Imaging, HUS Diagnostic Centre, University of Helsinki and Helsinki University Hospital
| | - Anne P VAKKURI
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital
| | - Rami MADANAT
- Department of Orthopedics and Traumatology, Arthroplasty Center, University of Helsinki and Helsinki University Hospital,Terveystalo Kamppi, Helsinki, Finland
| | - Skants K NOORA
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital
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Sheridan GA, Keenan G, Beverland DE. Knee Flexion Angle Measurement Using Virtual Assessment Tools: Correct Procedure and Potential Pitfalls. Arthroplast Today 2022; 14:205-209.e2. [PMID: 35510069 PMCID: PMC9059070 DOI: 10.1016/j.artd.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/21/2021] [Accepted: 11/25/2021] [Indexed: 11/26/2022] Open
Abstract
Virtual patient assessment will inevitably require smartphone technology to remotely measure knee range of motion. We conducted an experiment to analyze the impact of observer position relative to the flexed knee on the perceived angle measured using an electronic application (Dr. Goniometer) for iPhone. Two observers measured the apparent knee flexion angle from 7 different positions at 3 different heights relative to the center of the knee joint. Intraclass correlations were calculated to evaluate the intraobserver and interobserver variability using two-way mixed-effects models. The intraclass correlation for interobserver variability was excellent at 0.804 (95% confidence interval 0.663-0.889). When the observer was greater than 15° from the knee perpendicular, the true angle of knee flexion (90°) was not observed in any of the measurements. This was the case when observed from both proximal (range 95°-121°) and distal (range 92°-108°) directions. Ideally the camera lens should be perpendicular to the long axis of the lower limb in the proximal-distal direction and at the same height. However, if the camera lens is within 15° of the perpendicular, then at 90° of true flexion, the perceived angle will not be greater than 95° in 94% of cases.
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Fukaya T, Mutsuzaki H, Yoshikawa K, Koseki K, Iwai K. Effect of Training With the Hybrid Assistive Limb on Gait Cycle Kinematics After Total Knee Arthroplasty. Geriatr Orthop Surg Rehabil 2021; 12:21514593211049075. [PMID: 34659870 PMCID: PMC8511922 DOI: 10.1177/21514593211049075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Reportedly, wearable robots, such as the hybrid assistive limb (HAL), are
effective in the functional recovery of various locomotor disabilities,
including disrupted walking, restricted range of motion, and muscle
weakness. However, the effect of walking exercises with a HAL on the
kinematic and kinetic variables of lower limb joint function is not yet
fully understood. Therefore, the purpose of this study was to elucidate the
effect of HAL on the kinematic and kinetic variables of lower limb function
in patients 5 weeks after total knee arthroplasty (TKA). Materials and Methods Nine patients (ten knees) in the HAL training group and nine patients (nine
knees) in the control group underwent TKA. HAL training was initiated
1–5 weeks after TKA, and general rehabilitation was performed in the control
group. Gait analysis was performed on each patient using a motion analysis
system at 5 weeks after TKA. We compared the effects of the joint angles of
the walking cycle between groups, and investigated the effect of the walking
cycle’s joint angles on step length. Results In the HAL group, the odds ratio of hip extension was as large as 1.741,
while that of knee swing was as large as 1.501. These 2 variables were
significant between the 2 groups. Knee swing and varus significantly
affected step length. Conclusions Our results suggest that training by wearing HAL after TKA increased the
mobility of the knee and hip joints during early postoperative walking, and
that walking ability was improved by increasing the step length.
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Affiliation(s)
- Takashi Fukaya
- Department of Physical Therapy, Faculty of Health Sciences, Tsukuba International University, Tsuchiura, Ibaraki, Japan
| | - Hirotaka Mutsuzaki
- Centre for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Koichi Iwai
- Centre for Humanities and Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
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Brigati DP, Huddleston J, Lewallen D, Illgen R, Jaffri H, Ziegenhorn D, Weitzman DS, Bozic K. Manipulation Under Anesthesia After Total Knee: Who Still Requires a Revision Arthroplasty? J Arthroplasty 2020; 35:S348-S351. [PMID: 32247675 DOI: 10.1016/j.arth.2020.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Stiffness after total knee arthroplasty (TKA) is a multifactorial complication involving patient, implant, surgical technique, and rehabilitation, occasionally necessitating manipulation under anesthesia (MUA) or revision. Few modern databases contain sufficient longitudinal information of all factors. We characterized MUA after primary TKA and identified independent risk factors for revision TKA after MUA from the American Joint Replacement Registry. METHODS We retrospectively reviewed primary TKAs for American Joint Replacement Registry patients ≥65 years from January 1, 2012 to 31 March, 2019. We linked these to the Centers for Medicare and Medicaid Services database to identify MUA and revision TKA procedure codes. We compared groups with chi-squared testing, identifying independent risk factors for subsequent revision with binary logistic regression presented as odds ratios with 95% confidence intervals. RESULTS Of 664,604 primary TKAs, 3918 (0.6%) underwent MUA after a median of 2.0 ± 1.0 months. Revision surgery occurred in 131 (3.4%) MUA patients after a median of 9.0 months. Timing of MUA was not different between revision and no revision patients (P = .09). Patients undergoing MUA compared to no MUA were older (age 71.5 vs 70.7, P < .01), predominantly female (63.9% vs 61.2%, P < .01), current/former tobacco users (24.2% vs 13.3%, P < .01), with osteoarthritis diagnoses (98.0% vs 84.3%, P < .01). Independent risk factors for revision after MUA were male gender (1.56, 1.09-2.22). CONCLUSION The incidence of MUA after primary TKA is low (0.6%) in Medicare patients ≥65 years of age; 3.4% progress to revision after a median of 9 months. Being male was significantly associated with revision TKA after MUA.
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Affiliation(s)
- David P Brigati
- Texas Healthcare Bone & Joint Clinic, Fort Worth, Texas, USA
| | | | | | | | - Heena Jaffri
- American Academy Orthopaedic Surgeons, Rosemont, Illinois, USA
| | | | - Dena S Weitzman
- American Academy Orthopaedic Surgeons, Rosemont, Illinois, USA
| | - Kevin Bozic
- Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
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Thorsteinsson H, Hedström M, Robertsson O, Lundin N, W-Dahl A. Manipulation under anesthesia after primary knee arthroplasty in Sweden: incidence, patient characteristics and risk of revision. Acta Orthop 2019; 90:484-488. [PMID: 31269851 PMCID: PMC6746267 DOI: 10.1080/17453674.2019.1637177] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The incidence of manipulation under anesthesia (MUA) after knee arthroplasty surgery has been reported to vary between 0.5% and 10%. We evaluated the incidence of MUA after primary knee arthroplasty in Sweden, the demographics of the patients and the risk of revision. Patients and methods - Between 2009 and 2013, 64,840 primary total and unicompartmental knee arthroplasties (TKA and UKA) were registered in the Swedish Knee Arthroplasty Register (SKAR). MUAs performed between 2009 and 2014 were identified through the in- and outpatient registers of the Swedish National Board of Health and Welfare. Pertinent data were verified through medical records and patient demographics and revisions were obtained from the SKAR. Results - 1,258 MUAs were identified. Of these, 1,078 were 1st-time MUAs, performed within 1 year after the primary knee arthroplasty. The incidence of MUA was 1.7% and the incidence varied between hospitals from 0% to 5%. The majority were performed after TKA (98%), in younger patients (65% < 65 years), women (64%), and relatively healthy persons (88% had ASA ≤ 2). The cumulative risk of revision at 10 years was 10% (95% CI 8.6-12), similar for men and women. Interpretation - In Sweden, MUA is a rather uncommon measure after knee arthroplasty, especially after UKA. The CRR at 10 years was doubled compared to the general knee arthroplasty population. The frequency of the procedure varies between hospitals but in general it is performed more frequently in healthier and younger patients.
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Affiliation(s)
| | - Margareta Hedström
- Department of Orthopedics, Karolinska University Hospital, Huddinge; ,Department of Clinical Science, Intervention and Technology, Division of Orthopaedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
| | - Otto Robertsson
- Department of Orthopedics, Skane University Hospital, Lund; ,The Swedish Knee Arthroplasty Register;
| | - Natalie Lundin
- Department of Orthopedics, Karolinska University Hospital, Huddinge; ,Department of Clinical Science, Intervention and Technology, Division of Orthopaedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
| | - Annette W-Dahl
- Department of Orthopedics, Skane University Hospital, Lund; ,The Swedish Knee Arthroplasty Register;
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