Department of Orthopaedic Surgery, Case Western Reserve University, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
Clin Orthop Relat Res. 2013 Jan;471(1):258-63. doi: 10.1007/s11999-012-2591-1.
Knee stiffness or limited range of motion (ROM) after total knee arthroplasty (TKA) may compromise patient function. Patients with stiffness are usually managed with manipulation under anesthesia (MUA) to improve ROM. However, the final ROM obtained is multifactorial and may depend on factors such as comorbidities, implant type, or the timing of MUA.
QUESTIONS/PURPOSES: We asked whether diabetes mellitus, implant type, and the interval between TKA and MUA influenced post-MUA ROM.
From a group of 2462 patients with 3224 TKAs performed between 1999 and 2007 we retrospectively reviewed 96 patients with 119 TKAs (4.3%) who underwent MUA. We determined the presence of diabetes mellitus, implant type, and the interval between TKA and MUA.
The average increase in ROM after MUA was 34°. Patients with diabetes mellitus experienced lower final ROM after MUA (87.5° versus 100.3°) as did patients with cruciate-retaining (CR) prostheses versus posterior-stabilized (92.3° versus 101.6°). The interval between TKA and MUA inversely correlated with final ROM with a decrease after 75 days.
Most patients experience improvements in ROM after MUA. Patients with diabetes mellitus or CR prostheses are at risk for lower final ROM after MUA. Manipulation within 75 days of TKA is associated with better ROM.
全膝关节置换术（TKA）后膝关节僵硬或活动范围（ROM）受限可能会影响患者的功能。通常通过在麻醉下进行手法松解（MUA）来治疗僵硬的患者，以改善 ROM。然而，最终获得的 ROM 是多因素的，可能取决于合并症、植入物类型或 MUA 的时间等因素。
问题/目的：我们询问了糖尿病、植入物类型以及 TKA 和 MUA 之间的时间间隔是否会影响 MUA 后的 ROM。
我们回顾性分析了 1999 年至 2007 年间进行的 2462 例 TKA 患者中的 96 例（4.3%）接受 MUA 的患者，这些患者中有 119 例 TKA。我们确定了是否存在糖尿病、植入物类型以及 TKA 和 MUA 之间的时间间隔。
MUA 后 ROM 的平均增加为 34°。患有糖尿病的患者在 MUA 后最终 ROM 较低（87.5°对 100.3°），与保留交叉韧带（CR）假体的患者相比（92.3°对 101.6°）。TKA 和 MUA 之间的时间间隔与最终 ROM 呈反比，在 75 天后减少。
大多数患者在 MUA 后 ROM 得到改善。患有糖尿病或 CR 假体的患者在 MUA 后最终 ROM 较低的风险增加。TKA 后 75 天内进行手法松解与更好的 ROM 相关。
