Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA.
Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, New York, USA.
Bone Joint J. 2021 Jun;103-B(6 Supple A):126-130. doi: 10.1302/0301-620X.103B6.BJJ-2020-1950.R1.
Manipulation under anaesthesia (MUA) remains an effective intervention to address restricted range of motion (ROM) after total knee arthroplasty (TKA) and occurs in 2% to 3% of primary TKAs at our institution. Since there are few data on the outcomes of MUA with different anaesthetic methods, we sought to compare the outcomes of patients undergoing MUA with intravenous (IV) sedation and neuraxial anaesthesia.
We identified 548 MUAs after primary TKA (136 IV sedation, 412 neuraxial anaesthesia plus IV sedation) from March 2016 to July 2019. The mean age of this cohort was 62 years (35 to 88) with a mean body mass index of 31 kg/m (18 to 49). The mean time from primary TKA to MUA was 10.2 weeks (6.2 to 24.3). Pre-MUA ROM was similar between groups; overall mean pre-MUA extension was 4.2° (p = 0.452) and mean pre-MUA flexion was 77° (p = 0.372). We compared orthopaedic complications, visual analogue scale (VAS) pain scores, length of stay (LOS), and immediate and three-month follow-up knee ROM between these groups.
Following MUA, patients with IV sedation had higher mean VAS pain scores of 5.2 (SD 1.8) compared to 4.1 (SD = 1.5) in the neuraxial group (p < 0.001). The mean LOS was shorter in patients that received IV sedation (9.5 hours (4 to 31)) compared to neuraxial anaesthesia (11.9 hours (4 to 51)) (p = 0.009), but an unexpected overnight stay was similar in each group (8.6%). Immediate-post MUA ROM was 1° to 121° in the IV sedation group and 0.9° to 123° in the neuraxial group (p = 0.313). Three-month follow-up ROM was 2° to 108° in the IV sedation group and 1.9° to 110° in the neuraxial anaesthesia group (p = 0.325) with a mean loss of 13° (ranging from 5° gain to 60° loss), in both groups by three months. No patients in either group sustained a complication.
IV sedation alone and neuraxial anaesthesia are both effective anaesthetic methods for MUA after primary TKA. Surgeons and anaesthetists should offer these anaesthetic techniques to match patient-specific needs as the orthopaedic outcomes are similar. Also, patients should be counselled that ROM following MUA may decrease over time. Cite this article: 2021;103-B(6 Supple A):126-130.
关节内手法松解术（MUA）仍然是解决全膝关节置换术后活动范围受限（ROM）的有效干预措施，在我们机构中，2%至 3%的初次 TKA 患者需要进行 MUA。由于关于不同麻醉方法的 MUA 结果的数据很少，我们试图比较静脉（IV）镇静和椎管内麻醉下接受 MUA 治疗的患者的结果。
我们从 2016 年 3 月至 2019 年 7 月确定了 548 例初次 TKA 后的 MUA（136 例 IV 镇静，412 例椎管内麻醉加 IV 镇静）。该队列的平均年龄为 62 岁（35 至 88 岁），平均体重指数为 31kg/m²（18 至 49）。从初次 TKA 到 MUA 的平均时间为 10.2 周（6.2 至 24.3）。两组患者 MUA 前 ROM 相似；总体平均 MUA 前伸为 4.2°（p=0.452），平均 MUA 前屈为 77°（p=0.372）。我们比较了这些组之间的骨科并发症、视觉模拟量表（VAS）疼痛评分、住院时间（LOS）以及即刻和三个月随访时的膝关节 ROM。
MUA 后，接受 IV 镇静的患者 VAS 疼痛评分平均为 5.2（SD=1.8），而椎管内组为 4.1（SD=1.5）（p<0.001）。接受 IV 镇静的患者 LOS 较短（9.5 小时（4 至 31）），而接受椎管内麻醉的患者 LOS 较长（11.9 小时（4 至 51））（p=0.009），但每组的意外过夜留观时间相似（8.6%）。IV 镇静组即刻 MUA 后 ROM 为 1°至 121°，椎管内组为 0.9°至 123°（p=0.313）。IV 镇静组三个月随访时 ROM 为 2°至 108°，椎管内麻醉组为 1.9°至 110°（p=0.325），两组患者在三个月时的 ROM 平均损失 13°（范围从 5°增加到 60°损失）。两组均无患者发生并发症。
初次 TKA 后，单独使用 IV 镇静和椎管内麻醉均为 MUA 的有效麻醉方法。外科医生和麻醉师应根据患者的具体需求提供这些麻醉技术，因为骨科结果相似。此外，患者应被告知，MUA 后的 ROM 可能会随着时间的推移而减少。
