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Research

ADJUNCT CPM THERAPY DOES NOT APPEAR TO IMPROVE THE ROM ACHIEVED AFTER MUA FOR STIFFNESS IN TOTAL KNEE ARTHROPLASTY

The European Orthopaedic Research Society (EORS) 31st Annual Meeting, Porto, Portugal, 27–29 September 2023. Part 2 of 2.



Abstract

Stiffness is reported in up to 16% of patients after total knee replacement (TKR)1. Treatment of stiffness after TKR remains a challenge. Manipulation under anaesthesia (MUA) accounts for between 6%-36% of readmissions following TKR2,3. The outcomes of MUA remain variable/unpredictable. Post-operative CPM is used as an adjuvant to MUA, potentially offering improved ROM, however, remains the subject of debate. We report a retrospective study comparing MUA with and without post-operative CPM.

In our institution patients undergoing MUA to receive CPM post-operatively. Owing to the COVID-19 pandemic hospital admissions were limited. During this period MUA procedures were undertaken without CPM. Two cohorts were included: 1) MUA + post-operative CPM 2) Daycase MUA. Patients’ demographics, pre-manipulation ROM, post-MUA ROM, and ROM at final follow-up were recorded.

Between 2017-2022 126 patients underwent MUA and were admitted for CPM and 42 had daycase MUA. The median Age was 66.5 and 64% were female. 57% had extension deficit (>5o), 70% had flexion deficit (< 90o), and 37% had both. The mean Pre-operative ROM was 72.3o(SD:18.3o) vs. 68.5o(19.0o), ROM at MUA was 95.5o(SD:20.7o) vs 108.3o(SD:14.1o) [p< 0.01], and at final follow-up 87.4o(SD:21.9o) vs. 92.1o(SD:18.2o) for daycase and CPM groups respectively. At final follow-up for the daycase and CPM groups respectively 10% vs. 7% improved, 29% vs. 13% maintained, and 57% vs. 79% regressed from the ROM achieved at MUA. The mean percentage of ROM gained at MUA maintained at final follow-up was 92%(SD:17) and 85%(SD:14)[p=0.03] for daycase and CPM groups respectively.

There was no significant difference in ROM achieved at final follow-up despite the significantly greater improvement in ROM achieved at MUA for the CPM group. The CPM group lost a greater ROM after MUA (15% vs. 8%). We conclude that post-operative CPM does not improve ROM achieved after MUA.


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