Pagoti R, O'Brien S, Blaney J, Doran E, Beverland D
Outcomes Unit, Primary Joint Unit, Musgrave Park Hospital, Stockman's Lane, Belfast, BT9 7JB, UK.
J Clin Orthop Trauma. 2018 Oct-Dec;9(4):295-299. doi: 10.1016/j.jcot.2017.11.017. Epub 2017 Dec 1.
Reduced flexion following knee arthroplasty (TKA) may compromise patient's function and outcome. The timing of manipulation under anaesthesia (MUA) has been controversial. We present our experience in a high volume practice and analyse the impact of timing.
All TKA patients requiring MUA from February 1996 to June 2015 under the care of a single surgeon were analysed. MUA was offered to patients who had ≤ 75° of flexion post-op, providing that they had 30° more flexion preoperatively. To address the impact of timing from primary surgery to MUA on flexion gain we looked at 3 groups: Group I ≤ 90 days, Group II 91-180 days and Group III > 180 days.
Sixty two out of 7,423 (0.84%) underwent MUA. The MUA patients were significantly younger than the overall TKA cohort 61.2 vs 70.5 years (p = < 0.01). The median duration between arthroplasty and MUA was 3.9 months (IQR 3.4, Range 1.6-72.5 months). Overall flexion gained at 6-12 Weeks and 1 year post MUA showed significant improvements of 20.9° (p = <0.01) and 25° respectively (p = < 0.01). The flexion gain in group I (≤ 90 days) was significantly better than group III ( > 180 days) both at 6 weeks and 1 year following MUA but not better than group II (90-180 days).
MUA is an effective treatment for reduced flexion following TKA and should be the first line of management after failed physiotherapy. It can still have benefit beyond 6 months but the gains become less effective with time.
膝关节置换术（TKA）后屈曲度降低可能会影响患者的功能和预后。麻醉下手法治疗（MUA）的时机一直存在争议。我们介绍了我们在大量病例中的经验，并分析了时机的影响。
对1996年2月至2015年6月在单一外科医生治疗下需要进行MUA的所有TKA患者进行分析。术后屈曲度≤75°且术前屈曲度多30°的患者接受MUA。为了研究从初次手术到MUA的时机对屈曲度增加的影响，我们观察了3组：第一组≤90天，第二组91 - 180天，第三组>180天。
7423例患者中有62例（0.84%）接受了MUA。接受MUA的患者明显比整个TKA队列年轻，分别为61.2岁和70.5岁（p = <0.01）。关节置换术与MUA之间的中位间隔时间为3.9个月（四分位间距3.4，范围1.6 - 72.5个月）。MUA后6 - 12周和1年时总体屈曲度增加分别有显著改善，为20.9°（p = <0.01）和25°（p = <0.01）。MUA后6周和1年时，第一组（≤90天）的屈曲度增加明显优于第三组（>180天），但不比第二组（90 - 180天）好。
MUA是治疗TKA后屈曲度降低的有效方法，应作为物理治疗失败后的一线治疗方法。6个月后仍可能有益，但随着时间推移效果会变差。
