Postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia

Mikko T Rantasalo; Riku A Palanne; Sukhdev Saini; Anne P Vakkuri; Rami Madanat; Skants K Noora

doi:10.2340/17453674.2022.2272

Authors

Mikko T Rantasalo Department of Orthopedics and Traumatology, Arthroplasty Center, University of Helsinki and Helsinki University Hospital https://orcid.org/0000-0002-9688-209X
Riku A Palanne Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital https://orcid.org/0000-0002-6522-1272
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 https://orcid.org/0000-0003-4708-1779
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 https://orcid.org/0000-0002-1470-4397

DOI:

https://doi.org/10.2340/17453674.2022.2272

Keywords:

Arthroplasty, Complications, Knee, Pain, patient-reported outcomes, Stiff knee

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.