Understanding rates,risk factors,and complications associated with manipulation under anesthesia after total knee arthroplasty (TKA): An analysis of 100,613 TKAs |
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| Affiliation: | 1. Cleveland Clinic Foundation, Department of Orthopaedic Surgery, Cleveland, OH 44195, USA;2. Case Western Reserve University, Department of Population and Quantitative Health Sciences, Cleveland, OH 44106, USA;1. Department of Orthopedic Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA;2. Department of Clinical Operations, Mount Sinai Health System, USA;1. Division of Pediatric Orthopedic Surgery, Children’s Hospital Zagreb, Zagreb, Croatia;2. Department of Orthopedic Surgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia;3. Department of Technology, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia;4. Department of Forensic Medicine and Criminology, School of Medicine, University of Zagreb, Croatia;5. Department of Materials, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia;1. Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore;2. Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore 169865, Singapore;3. Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore 308232, Singapore;1. Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, United States;2. University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States;3. Department of Orthopaedic Surgery, Johns Hopkins, Columbia, MD, United States |
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| Abstract: | BackgroundConsidering the growing adoption of technology-assisted total knee arthroplasties (TKA), previous database studies evaluating post-operative stiffness may be outdated. The present study aimed to: (1) evaluate the incidence of manipulation under anesthesia (MUA) after primary TKA; (2) determine independent risk factors for MUA; and (3) assess complications after MUA.MethodsPrimary TKAs, with at least 6-month follow-up, were identified from the Florida State Inpatient Database (January 2016–June 2018) and linked to outpatient records from the Florida State Ambulatory Surgery and Services Database. Multivariable regression analyses were performed to compare patient factors and complications (e.g., mechanical, non-mechanical, infectious) associated with MUA, while adjusting for baseline demographics, comorbidities, use of robotic- and computer-technologies, time to MUA (0–3, 3–12, or >12 months), and need for repeat MUA (one-time vs >1).ResultsThe MUA rate was 2.8% (2821 of 100,613). Being younger, a woman, Black or Hispanic; having private or self-pay insurance; and conventional TKA were associated with significantly higher odds of undergoing MUA. Higher rates of mechanical complications and acute posthemorrhagic anemia were observed in the MUA cohort. Time to MUA, repeat MUA, and baseline demographics were not associated with complication rates among the MUA cohort.ConclusionOverall, 1 in 36 patients underwent MUA after primary TKA. Several non-modifiable patient characteristics, such as Black or Hispanic race, female sex, and younger age were associated with an increased risk of MUA. However, technology-assisted TKA might help to decrease the risk of MUA. |
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| Keywords: | Knee stiffness MUA Robotic-assisted Computer-assisted Safety |
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