Department of Orthopaedic Surgery, Tuebingen University Hospital, Germany.
Orthop Traumatol Surg Res. 2011 May;97(3):292-6. doi: 10.1016/j.otsr.2011.01.006. Epub 2011 Apr 11.
The aim of the present study was to determine the prevalence and the effect of manipulation under anaesthesia in patients with Total Knee Arthroplasty (TKA), "revision-knee" and all forms of other intra-articular surgical procedures. We aimed to determine differences in the outcome according to the number of previous surgeries and according to time of manipulation under anaesthesia (MUA).
One thousand three hundred and forty-four elective intra-articular surgeries (no trauma cases) were performed at our institution between 2004 and 2009. Fifty-two of them underwent MUA because of postoperative knee stiffness with a flexion less than 90°. The prevalence for stiffness after primary TKA was 4.54%, for revision-knee procedures 5.11%, and for other forms of intra-articular surgery 1.29%.
Flexion was statistically significantly improved directly after MUA in the group after primary TKA with a mean gain of 35.13°±17.03°, in the group with revision procedures of 41.31°±9.08° and in the group with other forms of intra-articular surgery of 24.37°±5.21°. Patients with more than two previous operations showed significantly worse results (P=0.039). No statistically significant difference (P=0.307) was seen according to time (>/<30 days) of MUA.
MUA is a valuable technique to increase ROM after TKA in patients with stiff knees, for "revision-knees" and all other patients with reduced flexion after different forms of intra-articular knee surgical procedures (excluding trauma cases). The results were similar for early and delayed MUA relative to the last surgery. The patients can therefore undergo conservative treatment (e.g. physiotherapy) before the MUA without the risk of poorer outcome. The results after MUA in patients with many previous operations were significantly worse and so an open/arthroscopic arthrolysis should be discussed earlier for this subgroup.
本研究旨在确定在接受全膝关节置换术（TKA）、“膝关节翻修”和各种其他关节内手术的患者中，麻醉下手法松解的发生率和效果。我们旨在根据既往手术次数和麻醉下手法松解（MUA）时间的不同，确定结果的差异。
2004 年至 2009 年，我们机构共进行了 1344 例择期关节内手术（无创伤病例）。其中 52 例因术后膝关节僵硬、屈曲度<90°而行 MUA。初次 TKA 后发生僵硬的发生率为 4.54%，膝关节翻修术为 5.11%，其他关节内手术为 1.29%。
直接在初次 TKA 后进行 MUA 的患者中，膝关节屈曲度有统计学意义的显著改善，平均增加 35.13°±17.03°；膝关节翻修术组为 41.31°±9.08°，其他关节内手术组为 24.37°±5.21°。既往手术次数超过 2 次的患者结果明显较差（P=0.039）。根据 MUA 时间（>/<30 天），未见统计学显著差异（P=0.307）。
MUA 是增加膝关节僵硬患者 TKA 后 ROM 的一种有价值的技术，对于“膝关节翻修”和各种其他关节内膝关节手术（不包括创伤病例）后膝关节屈曲度降低的患者也适用。与最后一次手术相比，早期和延迟 MUA 的结果相似。因此，患者可以在 MUA 前进行保守治疗（例如物理治疗），而不会增加不良预后的风险。既往手术次数多的患者 MUA 后结果明显较差，因此对于这一亚组患者，应更早考虑行开放/关节镜下松解术。
