College of Medicine, California Northstate University, Elk Grove, California.
Department of Orthopedic Surgery, Samaritan Health System, Corvallis, Oregon.
J Arthroplasty. 2024 Nov;39(11):2872-2879. doi: 10.1016/j.arth.2024.05.059. Epub 2024 May 24.
Stiffness following total knee arthroplasty (TKA) is often treated with manipulation under anesthesia (MUA). However, there is debate regarding the timing of MUA, with many recommending against MUA beyond 3 months after TKA. Therefore, the purpose of this systematic review was to evaluate the functional and clinical outcomes of early versus delayed MUA for stiffness following TKA.
A search following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was performed in the PubMed, Embase, Scopus, and Cochrane databases in November 2023. Data regarding study characteristics, demographics, knee flexion and extension, patient-reported outcomes, complications, and revisions were collected. A quality assessment was performed using the Methodological Index for Non-randomized Studies. Included were 14 studies analyzing 13,445 knees, 72.1% of which underwent early MUA and 27.8% of which underwent delayed MUA. Of the 14 studies, 10 defined early MUA as being performed within 3 months of the index TKA.
Pre-MUA and post-MUA knee flexion for the early/delayed groups was 71.3°/77.9° and 103.0°/96.1°, respectively. Upon meta-analysis, pre-MUA knee flexion was significantly higher in the delayed group (P = .003), whereas post-MUA flexion was similar in both groups (P = .36). The mean gain in knee flexion for the early and delayed groups was 32.0°/19.2°. The surgical complication and revision TKA rates for the early and delayed groups were 4.9%/10.3% and 5%/9%, respectively. A meta-analysis found the risk of surgical or medical complications and revision TKA to be significantly higher in the delayed MUA group (P < .00001 and = .002, respectively).
Although post-MUA knee flexion was similar in patients undergoing early and delayed MUA following TKA, the mean gain in flexion for early patients was nearly double that of delayed patients. Delayed patients also had significantly higher risks of surgical or medical complications and revision TKA following MUA.
全膝关节置换术后（TKA）后的僵硬通常采用麻醉下手法松解（MUA）治疗。然而，对于 MUA 的时机存在争议，许多人建议在 TKA 后超过 3 个月不进行 MUA。因此，本系统评价的目的是评估 TKA 后僵硬的早期与延迟 MUA 的功能和临床结果。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，于 2023 年 11 月在 PubMed、Embase、Scopus 和 Cochrane 数据库中进行了搜索。收集了有关研究特征、人口统计学、膝关节屈伸、患者报告的结果、并发症和翻修的数据。使用非随机研究方法学指数对质量进行了评估。共纳入了 14 项研究，分析了 13445 个膝关节，其中 72.1%接受了早期 MUA，27.8%接受了延迟 MUA。在 14 项研究中，有 10 项将早期 MUA 定义为在指数 TKA 后 3 个月内进行。
早期/延迟组的术前和术后膝关节屈曲分别为 71.3°/77.9°和 103.0°/96.1°。荟萃分析显示，延迟组的术前膝关节屈曲明显更高（P=0.003），而两组的术后膝关节屈曲相似（P=0.36）。早期和延迟组的膝关节屈曲平均增加 32.0°/19.2°。早期和延迟组的手术并发症和翻修 TKA 率分别为 4.9%/10.3%和 5%/9%。荟萃分析发现，延迟 MUA 组的手术或医疗并发症和翻修 TKA 的风险明显更高（P<0.00001 和 P=0.002）。
尽管 TKA 后早期和延迟 MUA 后患者的术后膝关节屈曲相似，但早期患者的屈曲平均增加量几乎是延迟患者的两倍。延迟患者在 MUA 后还存在更高的手术或医疗并发症和翻修 TKA 的风险。
