TY - JOUR AU - Rantasalo, Mikko T AU - Palanne, Riku A AU - Saini, Sukhdev AU - Vakkuri, Anne P AU - Madanat, Rami AU - Noora, Skants K PY - 2022/04/14 Y2 - 2024/03/29 TI - Postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia JF - Acta Orthopaedica JA - ActaO VL - 93 IS - SE - Non-randomized clinical study DO - 10.2340/17453674.2022.2272 UR - https://actaorthop.org/actao/article/view/2272 SP - 432-437 AB - <p><strong>Background and purpose:</strong> 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.<br /><strong>Patients and methods:</strong> 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.<br /><strong>Results:</strong> 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 &lt; 0.001). No difference was found in the OKS between the MUA and no-MUA patients.<br /><strong>Interpretation:</strong> 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.</p> ER -