Who Benefits from Manipulation under Anesthesia Following Total Knee Arthroplasty?

Matthew L Brown, Kenneth M Vaz, Julie C McCauley, Laura May, Clifford W Colwell
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Abstract

Arthrofibrosis is a multifactorial process that results in decreased knee range of motion (ROM). Manipulation under anesthesia (MUA) is commonly regarded as the preferred initial treatment of arthrofibrosis following total knee arthroplasty (TKA). There have been no well-controlled studies demonstrating that MUA effectively increases ROM in patients who develop arthrofibrosis after TKA when compared with routine care. The purpose of this study was to determine whether MUA had any advantage over routine care in the treatment of patients who developed arthrofibrosis following TKA. The authors identified patients who underwent primary TKA at the authors' institution between 2010 and 2014 and had flexion ≤ 100 degrees at early follow-up. Knees were grouped based on how the arthrofibrosis was treated: those who underwent MUA and those who received routine care. Knee flexion was captured preoperatively (prior to TKA), at early follow-up (prior to MUA or routine care), and at 1-year follow up. Flexion change from early follow-up to 1 year was calculated. The average flexion at 1-year follow-up was not significantly different between the two groups (106.1 ± 11.7 degrees in the routine care group versus 106.3 ± 12.8 degrees in the MUA group). The MUA group had a greater proportion of patients with flexion gains > 20 degrees at final follow-up when compared with patients who underwent routine care (56% vs. 8%, p < 0.0001). This study demonstrates that patients with decreased ROM at early follow-up after primary TKA can expect greater ROM increase at 1-year follow-up if they undergo MUA compared with patients who undergo routine care. (Journal of Surgical Orthopaedic Advances 33(1):033-036, 2024).

全膝关节置换术后麻醉下操作对哪些人有益?
关节纤维化是一个多因素过程,会导致膝关节活动范围(ROM)减小。麻醉下手法治疗(MUA)通常被认为是治疗全膝关节置换术(TKA)后关节纤维化的首选初始疗法。与常规治疗相比,目前还没有对照良好的研究证明麻醉下手法治疗能有效增加 TKA 术后关节纤维化患者的活动度。本研究旨在确定 MUA 在治疗 TKA 后出现关节纤维化的患者方面是否比常规护理更具优势。作者确定了2010年至2014年期间在作者所在机构接受初级TKA且早期随访时屈曲度≤100度的患者。根据关节纤维化的治疗方式对膝关节进行分组:接受MUA的患者和接受常规护理的患者。在术前(TKA之前)、早期随访(MUA或常规护理之前)和1年随访时采集膝关节屈曲度。计算从早期随访到 1 年的屈曲变化。两组患者随访1年时的平均屈曲度差异不大(常规护理组为106.1 ± 11.7度,MUA组为106.3 ± 12.8度)。与接受常规护理的患者相比,MUA 组患者在最终随访时屈曲增高大于 20 度的比例更高(56% 对 8% ,P < 0.0001)。这项研究表明,与接受常规治疗的患者相比,接受MUA治疗的患者在初次TKA术后早期随访时的关节活动度下降,而接受MUA治疗的患者在1年随访时的关节活动度有望得到更大的提高。(外科骨科进展杂志》33(1):033-036,2024 年)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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