Early and late manipulation improve flexion after total knee arthroplasty.

Manipulations have been considered effective only in the early postoperative period. From a total joint registry containing 9640 primary total knee arthroplasties (TKAs), 195 patients who underwent manipulation under anesthesia (MUA) were identified. A total of 102 had MUA within 90 days (early), and 93 more than 90 days (late) after TKA. Average pain (10-point scale), satisfaction (10-point scale), flexion (degrees), and extension (degrees) were recorded before and after MUA. Flexion was significantly improved after MUA for both groups: early MUA from 68.4 degrees (+/-17.2 degrees ) to 101.4 degrees (+/-16.15 degrees ), P < .001; late MUA from 81.0 degrees (+/-13.3 degrees ) to 98.0 degrees (+/-18.0 degrees ), P = .001. Pain decreased significantly with early MUA from 4.92 (+/-2.25) to 3.34 (+/-2.67) and with late MUA from 4.51 (+/-2.62) to 3.44 (+/-2.78), P = .048. Extension improved only in the early MUA group from 7.15 (+/-10.1) to 2.50 (+/-4.98). Satisfaction scores were not improved. Both early and late manipulation can improve TKA pain and flexion.