Specific preoperative factors increase manipulations under anesthesia following primary TKA

Background Arthrofibrosis following primary total knee arthroplasty (TKA) can result in pain and limit postoperative range of motion (ROM), jeopardizing clinical outcomes and patient satisfaction. This study aims to identify preoperative risk factors associated with necessitating a manipulation under anesthesia (MUA) following primary TKA. Methods We retrospectively reviewed 950 cases of consecutive primary TKAs performed at one institution by three arthroplasty surgeons between May 2017 and May 2019. Recorded preoperative variables included smoking status, race, preoperative ROM, presence of effusion or positive anterior drawer, and medical comorbidities. Demographic characteristics were compared with Student’s t-tests or Chi-squared tests as appropriate. For each preoperative factor, we obtained an odds ratio for MUA risk using multivariate logistic regression. Results Twenty (2.3%) patients underwent MUA following their index primary TKA surgery. History of ipsilateral knee surgery (odds ratio [OR]: 2.727, p=0.047) and diagnosed hypertension (OR: 4.764, p=0.016) were identified as risk factors associated with significantly increased risk of MUA. The greater the preoperative range of motion, the higher likelihood needed of MUA (OR: 1.031, p=0.034). Conclusions Patients who had diagnosed hypertension or a history of prior ipsilateral knee surgery were associated with increased risk of necessitating an MUA following primary TKA. Additionally, a greater total arc of motion preoperatively increased the odds of needing MUA.

Publication History

Received: 18 September 2023

Accepted after revision: 23 April 2024

Accepted Manuscript online:
27 April 2024