Prognostic factors that predict failure of manipulation under anesthesia for the stiff total knee arthroplasty: A systematic review

Alex Gu; Adam J Michalak; Jordan S Cohen; Jeffrey G Stepan; Neil D Almeida; Alexander S McLawhorn; Peter K Sculco

doi:10.1016/j.jor.2018.08.003

Prognostic factors that predict failure of manipulation under anesthesia for the stiff total knee arthroplasty: A systematic review

J Orthop. 2018 Aug 16;15(3):842-846. doi: 10.1016/j.jor.2018.08.003. eCollection 2018 Sep.

Authors

Alex Gu^{1

2}, Adam J Michalak¹, Jordan S Cohen¹, Jeffrey G Stepan², Neil D Almeida¹, Alexander S McLawhorn², Peter K Sculco²

Affiliations

¹ Department of Medicine, George Washington School of Medicine and Health Sciences, 2300 Eye St, Washington, DC 20037, USA.
² Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.

Abstract

Purpose: Prognostic factors associated with Manipulation under anesthesia (MUA) failure remain unknown.

Methods: A systematic review of the literature was performed to identify studies that reported prognostic factors associated with MUA for postoperative stiffness.

Results: 7 studies analyzing prognostic factors associated with MUA outcomes were included. Several studies note pre-MUA ROM to be a significant prognostic factor affecting post-MUA ROM at final follow-up. Knees with <70° of flexion pre-MUA had less final flexion arc than those with >70°.

Conclusions: The strongest prognostic factor for decreased ROM after MUA is severe pre-MUA stiffness.

Keywords: Manipulation under anesthesia; Prognostic factors; Review; Stiffness; Total knee arthroplasty.