Areti Aruni, Ratcliff Terrul, Perake Vinayak, Sambandam Senthil N
Baylor College of Medicine, 1 Baylor Plz, Houston, TX, 77030, USA.
UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Arch Orthop Trauma Surg. 2025 Jan 23;145(1):138. doi: 10.1007/s00402-025-05758-3.
Manipulation under anesthesia (MUA) is a standard and effective treatment to correct stiffness and improve range of motion (ROM) following total knee arthroplasty (TKA). Delayed MUA has been associated with increased rates of revision surgeries and infections. Early MUA has been shown to double the mean gain in flexion compared to delayed interventions. To identify candidates early and effectively, this study aimed to evaluate various risk factors influencing the likelihood of undergoing MUA after TKA using statistical analysis.
Data from 1973 to 2023 were collected from TriNetX, reviewing 245,567 unique patients. Current Procedural Terminology (CPT) codes identified those who had undergone TKA and MUA. ICD-9 and ICD-10 codes identified preoperative comorbidities and complications. Univariate and multivariate analyses assessed the association between preoperative risk factors and MUA likelihood. Independent sample t-tests, Levene's test, and effect size analyses examined age differences between MUA and non-MUA cohorts. The study included 6,867 patients (2.8%) in the MUA cohort and 238,700 patients (97.2%) in the non-MUA cohort.
Among 245,567 TKA patients, 6,867 (2.8%) required MUA. Univariate analysis showed significant associations with age < 65 (OR = 2.49 [CI: 2.37-2.61], p < 0.001), Black race (OR = 2.04 [CI: 1.91-2.18], p < 0.001), SCD (OR = 2.96 [CI: 2.01-4.35], p < 0.001), and cannabis-related disorders (OR = 2.38 [CI: 1.29-4.38], p = 0.004). Multivariate analysis confirmed significant predictors: age < 65 (OR = 2.39 [CI: 2.26-2.53], p < 0.001), Black race (OR = 1.65 [CI: 1.51-1.81], p < 0.001), SCD (OR = 1.51 [CI: 1.00-2.26], p = 0.048), and female sex (OR = 1.13 [CI: 1.07-1.18], p < 0.001). The average age was 61.94 years in the MUA cohort and 67.09 years in the non-MUA cohort, with a significant mean difference of 5.14 years (p < 0.001).
Our study demonstrates that younger age, female sex, and Black race are significant predictors of MUA after TKA. Additionally, novel risk factors such as peripheral artery disease (PAD), chronic kidney disease (CKD), and sickle cell disease (SCD) were identified, with SCD notably increasing the likelihood of MUA. This study uniquely highlights reduced likelihoods of MUA in PAD and CKD patients, contrasting with prior literature. The significant association of SCD with MUA, alongside these novel findings, emphasizes the value of demographic and comorbidity-specific predictors in refining postoperative risk stratification.
麻醉下手法治疗（MUA）是全膝关节置换术（TKA）后纠正僵硬和改善活动范围（ROM）的一种标准且有效的治疗方法。延迟进行MUA与翻修手术和感染率增加有关。与延迟干预相比，早期MUA已显示出可使平均屈曲增益加倍。为了早期有效地识别候选患者，本研究旨在使用统计分析评估影响TKA后接受MUA可能性的各种风险因素。
从TriNetX收集了1973年至2023年的数据，回顾了245,567例独特患者。当前操作术语（CPT）代码确定了那些接受过TKA和MUA的患者。ICD-9和ICD-10代码确定了术前合并症和并发症。单因素和多因素分析评估了术前风险因素与MUA可能性之间的关联。独立样本t检验、Levene检验和效应量分析检查了MUA组和非MUA组之间的年龄差异。该研究包括MUA组中的6,867例患者（2.8%）和非MUA组中的238,700例患者（97.2%）。
在245,567例TKA患者中，6,867例（2.8%）需要MUA。单因素分析显示与年龄<65岁（OR = 2.49 [CI：2.37 - 2.61]，p < 0.001）、黑人种族（OR = 2.04 [CI：1.91 - 2.18]，p < 0.001）、镰状细胞病（SCD）（OR = 2.96 [CI：2.01 - 4.35]，p < 0.001）以及大麻相关障碍（OR = 2.38 [CI：1.29 - 4.38]，p = 0.004）存在显著关联。多因素分析确认了显著的预测因素：年龄<65岁（OR = 2.39 [CI：2.26 - 2.53]，p < 0.001）、黑人种族（OR = 1.65 [CI：1.51 - 1.81]，p < 0.001）、SCD（OR = 1.51 [CI：1.00 - 2.26]，p = 0.048）以及女性（OR = 1.13 [CI：1.07 - 1.18]，p < 0.001）。MUA组的平均年龄为61.94岁，非MUA组为67.09岁，平均差异显著为5.14岁（p < 0.001）。
我们的研究表明，年龄较小、女性和黑人种族是TKA后MUA的显著预测因素。此外，还确定了外周动脉疾病（PAD）、慢性肾脏病（CKD）和镰状细胞病（SCD）等新风险因素，其中SCD显著增加了MUA的可能性。本研究独特地强调了PAD和CKD患者接受MUA的可能性降低，这与先前的文献形成对比。SCD与MUA的显著关联以及这些新发现强调了人口统计学和特定合并症预测因素在完善术后风险分层中的价值。
