Effect of Repeated Manipulation on Range of Motion in Patients With Stiff Total Knee Arthroplasty

Although manipulation under anesthesia (MUA) has been considered effective first-line treatment for stiff total knee arthroplasty (TKA), there is no consensus regarding the usefulness of repeated MUA. The purpose of this study was to investigate the usefulness of repeated MUA performed for patients in whom satisfactory range of motion (ROM) was not achieved by MUA. The authors retrospectively reviewed 15 patients who underwent repeated MUA after failure of initial MUA for stiff TKA. Demographic and ROM data were collected. A final ROM of less than 90 degrees was considered a failed manipulation (failure group) and a final ROM of 90 degrees or more was considered a successful manipulation (success group). Average pre-repeated MUA ROM (72.3 degrees +/- 19.5 degrees) immediately improved to 112.3 degrees +/- 9.7 degrees (P<.001) in the operating room, and final ROM was 89.6 degrees +/- 23.9 degrees, an overall gain of 17.3 degrees (P=.04). However, despite this overall ROM increase, a successful final ROM (90 degrees or more) was achieved in approximately half of patients (7 of 13; 54%). There were no significant differences in demographics between the success and failure groups, except that there was significantly less pre-TKA ROM in the failure group (P=.02). There were no complications related to either the first or the repeated MUA procedures. The findings of this study suggest that repeated MUA can improve overall ROM for stiff TKA. The success rate of repeated MUA was less than that of primary MUA; however, it is a useful treatment modality for stiff TKA. Decreased pre-TKA ROM appeared to be associated with poor outcomes after repeated MUA.