1 Department of Trauma & Orthopaedics, Princess Alexandra Hospital, Hamstel Road, Harlow CM20 1QX, UK ; 2 Department of Trauma & Orthopaedics, 3 Department of Orthopaedics, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
Ann Transl Med. 2015 Nov;3(20):316. doi: 10.3978/j.issn.2305-5839.2015.10.09.
Stiffness following total knee arthroplasty (TKA) is a debilitating condition for the patient with limitation of functional outcome. There are various causes of stiffness, which can be classified as pre-operative, per-operative and post-operative. Arthrofibrosis is one of the causes, which can be managed in different ways, and manipulation under anaesthesia (MUA) is routinely performed as the first line of management. The timing of MUA is often debated. We review the paper by Issa et al., which looks at the effect of timing of manipulation on a stiff TKA. They conclude that early manipulation within 12 weeks of performing the TKA had a higher mean flexion gain (36.5°), higher final range of motion (ROM) (119°) and higher knee society score (89 points) compared to those performed after 12 weeks which were 17°, 95° and 84 points respectively. Other studies have also reinforced the idea that early manipulation within 12 weeks has a better outcome than those performed after 12 weeks. There may still be a benefit of manipulation until 26 weeks after which open arthrolysis may be needed to improve ROM.
全膝关节置换术后僵硬（TKA）是患者功能受限的一种致残性疾病。僵硬的原因有很多，可以分为术前、术中和术后。其中关节纤维性强直是一个原因，可以通过不同的方式进行治疗，而麻醉下手法松解（MUA）通常作为一线治疗方法。MUA 的时机经常存在争议。我们回顾了 Issa 等人的论文，该论文探讨了 TKA 后手法松解时机对僵硬膝关节的影响。他们的结论是，与术后 12 周进行的 MUA 相比，在 TKA 后 12 周内进行的早期 MUA 具有更高的平均屈曲度增加（36.5°）、更高的最终活动范围（ROM）（119°）和更高的膝关节学会评分（89 分）。其他研究也强化了早期 MUA（12 周内）比术后 12 周进行的 MUA 具有更好结果的观点。直到术后 26 周，手法松解可能仍然有益，之后可能需要行开放松解术来改善 ROM。
