Department of Orthopaedic Surgery in Diakovere Annastift, Hannover Medical School (MHH), Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany.
Clinic for Internal Medicine, Diakovere Henriettenstift, Marienstraße 72-90, 30171, Hannover, Germany.
Arch Orthop Trauma Surg. 2020 Jun;140(6):785-791. doi: 10.1007/s00402-020-03381-y. Epub 2020 Feb 25.
Due to demographic changes, total knee arthroplasty (TKA) is one of the most frequently performed orthopedic surgeries. Therapies for associated postoperative complications, such as postoperative knee stiffness (PKS), are becoming increasingly important. The aim of this retrospective matched-pair analysis was to evaluate mid-term-results following manipulation under anesthesia (MUA).
Fifty-one patients with PKS were evaluated and 51 matched-pair patients without PKS after primary TKA were chosen for the control group. In addition to the range of motion, the functionality was recorded by Knee Society Score (KSS), Western Ontario and Mc Masters Universities Osteoarthritis Index (WOMAC), and Short-Form-12 Questionnaire (SF-12). Experience of pain was mapped using a 10-point Numeric Rating Scale (NRS), and the analgesic requirement was mapped using the WHO step scheme. A final follow-up examination was conducted approximately three years after TKA. To evaluate potential risk factors for the development of PKS, TKA alignment was measured via postoperative X-ray images.
Improvement of the average knee flexion of 35.7° and total flexion of 107.4° was detected in PKS patients after MUA. The flexion of the control group was 112.4°; no significant between-group difference was present regarding prosthesis type, sex, age and BMI. Regarding KSS, WOMAC, and SF-12, the MUA cohort achieved statistically-relevant lower overall scores than the control group, p = 0.006, p = 0.005, p = 0.001, respectively. Significantly higher experiences of pain and a higher need for analgesics in MUA patients were reported (p = 0.001 and p < 0.001, respectively). Radiological evaluation of the prosthesis alignment did not show any differences between the two groups.
MUA can improve mobility after PKS, whereby MUA seemed to be a functional therapy option for PKS. Compared to the control group, the MUA group showed lower functional values and an increased experience of pain. A correlation between prosthesis malalignment and MUA could not be detected radiologically. Further studies are necessary to investigate the reasons for PKS.
由于人口结构的变化，全膝关节置换术（TKA）是最常进行的矫形外科手术之一。与术后并发症相关的治疗方法，如术后膝关节僵硬（PKS），正变得越来越重要。本回顾性配对分析的目的是评估麻醉下手法松解（MUA）后的中期结果。
评估了 51 例 PKS 患者，并选择了 51 例初次 TKA 后无 PKS 的配对患者作为对照组。除了活动范围外，膝关节学会评分（KSS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和简短形式 12 问卷（SF-12）也记录了功能。使用 10 分数字评定量表（NRS）来记录疼痛体验，使用世界卫生组织步骤方案来记录镇痛需求。TKA 后大约 3 年进行了最终随访检查。为了评估 PKS 发生的潜在危险因素，通过术后 X 射线图像测量 TKA 对线。
MUA 后 PKS 患者的平均膝关节屈曲度从 35.7°增加到 107.4°，总屈曲度增加了 107.4°。对照组的屈曲度为 112.4°；在假体类型、性别、年龄和 BMI 方面，两组间无显著差异。在 KSS、WOMAC 和 SF-12 方面，MUA 组的总体评分明显低于对照组，p=0.006，p=0.005，p=0.001。MUA 患者报告的疼痛体验和镇痛需求明显更高（p=0.001 和 p<0.001）。对假体对线的影像学评估未显示两组之间存在差异。
MUA 可以改善 PKS 后的活动度，MUA 似乎是 PKS 的一种功能治疗选择。与对照组相比，MUA 组的功能值较低，疼痛体验增加。影像学上未发现假体对线不良与 MUA 之间存在相关性。需要进一步的研究来探讨 PKS 的原因。
