Department of Institution of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Division of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
Division of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
Orthop Traumatol Surg Res. 2019 Oct;105(6):1067-1071. doi: 10.1016/j.otsr.2019.05.014. Epub 2019 Aug 27.
Limited range of motion (ROM) after total knee replacement (TKR) is associated with low function and might require manipulation under anaesthesia (MUA). In order to identify factors associated with a limited ROM we investigated predictors for MUA. We hypothesized that older age was associated with higher MUA due to limited ROM post TKR.
In a case control study we investigated all patients undergoing primary TKR at a University Hospital in Sweden between 2007-2012. We registered background factors and compared those between the group who underwent MUA and those who did not. Odds ratios (OR) were calculated in a univariate analysis and an adjusted regression analysis.
Of the total of 669 TKRs performed, 31 patients who had undergone MUA were identified. The prevalence of MUA was 4.6%. The mean increase in ROM after MUA was 27 degrees at final minimum one-year follow-up. After controlling for confounders, patients with good health and young age had increased OR for MUA. OR decreased 0.93 (CI 0.93-0.97) per increased age year in the multiple regression analysis. Diabetes mellitus, BMI and sex did not have a significant effect on the odds ratio for MUA.
Young patients undergoing TKR has earlier been identified as a group with a higher grade of dissatisfaction and complications. We found an association between young age and MUA after TKR indicating an additional, rather unknown complication for this group of patients. The background and reasons for this has to be further investigated.
II, cohort study/case control study (case control is level III).
全膝关节置换（TKR）后活动范围（ROM）有限与功能低下有关，可能需要在麻醉下进行手法松解（MUA）。为了确定与 ROM 受限相关的因素，我们研究了 MUA 的预测因素。我们假设由于 TKR 后 ROM 受限，年龄较大与更高的 MUA 相关。
在一项病例对照研究中，我们调查了瑞典一家大学医院 2007-2012 年间接受初次 TKR 的所有患者。我们记录了背景因素，并比较了接受 MUA 组和未接受 MUA 组之间的差异。在单变量分析和调整后的回归分析中计算了比值比（OR）。
在总共 669 例 TKR 中，确定了 31 例接受 MUA 的患者。MUA 的患病率为 4.6%。在最终至少一年的随访时，MUA 后 ROM 的平均增加幅度为 27 度。在控制混杂因素后，健康状况良好且年龄较小的患者 MUA 的 OR 增加。在多元回归分析中，年龄每增加 1 岁，OR 降低 0.93（CI 0.93-0.97）。糖尿病、BMI 和性别对 MUA 的比值比没有显著影响。
年轻的 TKR 患者以前被确定为一组具有更高程度的不满和并发症的患者。我们发现 TKR 后年轻与 MUA 之间存在关联，这表明该组患者存在另一种未知的并发症。需要进一步调查这种情况的背景和原因。
II，队列研究/病例对照研究（病例对照为 III 级）。
