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Postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia

BACKGROUND AND PURPOSE: Manipulation under anesthesia (MUA) is the first-choice treatment for stiffness following total knee arthroplasty (TKA) unresponsive to pain management and physiotherapy. Some of the predisposing factors and patient-reported outcome measures (PROMs) following MUA remain poorl...

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Autores principales: RANTASALO, Mikko T, PALANNE, Riku A, SAINI, Sukhdev, VAKKURI, Anne P, MADANAT, Rami, NOORA, Skants K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medical Journals Sweden, on behalf of the Nordic Orthopedic Federation 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9008578/
https://www.ncbi.nlm.nih.gov/pubmed/35419610
http://dx.doi.org/10.2340/17453674.2022.2272
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author RANTASALO, Mikko T
PALANNE, Riku A
SAINI, Sukhdev
VAKKURI, Anne P
MADANAT, Rami
NOORA, Skants K
author_facet RANTASALO, Mikko T
PALANNE, Riku A
SAINI, Sukhdev
VAKKURI, Anne P
MADANAT, Rami
NOORA, Skants K
author_sort RANTASALO, Mikko T
collection PubMed
description BACKGROUND AND PURPOSE: Manipulation under anesthesia (MUA) is the first-choice treatment for stiffness following total knee arthroplasty (TKA) unresponsive to pain management and physiotherapy. Some of the predisposing factors and patient-reported outcome measures (PROMs) following MUA remain poorly studied. We retrospectively investigated the etiological risk factors and the outcomes of MUA. PATIENTS AND METHODS: 391 TKA patients from a randomized trial comparing the use of a tourniquet and anesthesia (spinal or general) were analyzed, and patients needing MUA were identified (MUA group). We evaluated in-hospital opioid consumption, Oxford Knee Score (OKS), range of motion (ROM), and pain assessed by the Brief Pain Inventory-short form with a 1-year follow-up. RESULTS: 39 (10%) MUA patients were identified. The MUA patients were younger (60 years vs. 64 years, difference –4, 95% CI –6 to –1) and had higher postoperative oxycodone consumption (66 mg vs. 51 mg, median difference 11, CI 1–22) than the no-MUA patients. The proportion of MUA patients who contacted the emergency department within 3 months because of pain was larger than that of non-MUA patients (41% vs. 12%, OR 5, CI 3–10). At the 1-year follow-up, the ROM was improved by 39° following MUA, but the total ROM was worse in the MUA group (115° vs. 124°, p < 0.001). No difference was found in the OKS between the MUA and no-MUA patients. INTERPRETATION: Higher postoperative pain seems to predict MUA risk. MUA performed 3 months postoperatively offers substantial ROM improvement and comparable PROMs to no-MUA patients 1 year after TKA.
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spelling pubmed-90085782022-04-20 Postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia RANTASALO, Mikko T PALANNE, Riku A SAINI, Sukhdev VAKKURI, Anne P MADANAT, Rami NOORA, Skants K Acta Orthop Article BACKGROUND AND PURPOSE: Manipulation under anesthesia (MUA) is the first-choice treatment for stiffness following total knee arthroplasty (TKA) unresponsive to pain management and physiotherapy. Some of the predisposing factors and patient-reported outcome measures (PROMs) following MUA remain poorly studied. We retrospectively investigated the etiological risk factors and the outcomes of MUA. PATIENTS AND METHODS: 391 TKA patients from a randomized trial comparing the use of a tourniquet and anesthesia (spinal or general) were analyzed, and patients needing MUA were identified (MUA group). We evaluated in-hospital opioid consumption, Oxford Knee Score (OKS), range of motion (ROM), and pain assessed by the Brief Pain Inventory-short form with a 1-year follow-up. RESULTS: 39 (10%) MUA patients were identified. The MUA patients were younger (60 years vs. 64 years, difference –4, 95% CI –6 to –1) and had higher postoperative oxycodone consumption (66 mg vs. 51 mg, median difference 11, CI 1–22) than the no-MUA patients. The proportion of MUA patients who contacted the emergency department within 3 months because of pain was larger than that of non-MUA patients (41% vs. 12%, OR 5, CI 3–10). At the 1-year follow-up, the ROM was improved by 39° following MUA, but the total ROM was worse in the MUA group (115° vs. 124°, p < 0.001). No difference was found in the OKS between the MUA and no-MUA patients. INTERPRETATION: Higher postoperative pain seems to predict MUA risk. MUA performed 3 months postoperatively offers substantial ROM improvement and comparable PROMs to no-MUA patients 1 year after TKA. Medical Journals Sweden, on behalf of the Nordic Orthopedic Federation 2022-04-14 /pmc/articles/PMC9008578/ /pubmed/35419610 http://dx.doi.org/10.2340/17453674.2022.2272 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
spellingShingle Article
RANTASALO, Mikko T
PALANNE, Riku A
SAINI, Sukhdev
VAKKURI, Anne P
MADANAT, Rami
NOORA, Skants K
Postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia
title Postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia
title_full Postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia
title_fullStr Postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia
title_full_unstemmed Postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia
title_short Postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia
title_sort postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9008578/
https://www.ncbi.nlm.nih.gov/pubmed/35419610
http://dx.doi.org/10.2340/17453674.2022.2272
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