File
S. Ejstrup1,2,3, B. Gram2, C. Juhl1
1University of Southern Denmark, Department of Sport Science and Clinical Biomechanics, Odense, Denmark, 2Hospital of South West Jutland, Research Unit of Health Science, Esbjerg, Denmark, 3Hospital of South West Jutland, Department of Occupational Therapy and Physiotherapy, Esbjerg, Denmark
Background: Total knee arthroplasty (TKA) is one of the most commonly performed orthopaedic operations worldwide, with over 700.000 primary TKAs performed in the United States of America. Despite a good prognosis some patients experience reduced knee range of motion (ROM) after rehabilitation. The treatment is intensive physiotherapy and in case of insufficient effect, manipulation under anesthesia (MUA) followed by a combination of continuous passive motion (CPM) and physiotherapy.
Purpose: To investigate the effect of MUA followed by CPM and physiotherapy on knee ROM after TKA.
Methods: Patients were identified from electronical records using diagnostic code KNGT19 for MUA between December 2014 and December 2019 at Hospital of South West Jutland, Denmark. The following data was extracted: use of CPM, ROM before MUA, at discharge and follow-up. Assuming missing data were at random, a multiple imputation was performed. Analysis were performed in Stata 16.1.
Results: Of 97 patients identified, 27 were excluded as MUA was performed in an addition to other surgical procedures. Mean age of the remaining 70 patients were 58 years (SD: 9) and 63% were women.
Before MUA extension deficit was 5 degrees (95% CI: 3 to 6) and flexion 80 degrees (95% CI: 77 to 83). At discharge the extension deficit was 7 degrees (95% CI: 5 to 9) and flexion 105 degrees (95% CI: 103 to 108).
Extension deficit increased with 0.6 degrees (95% CI: -2.8 to 1.9) and flexion increased with 17 degrees (95% CI: 12 to 21) at follow-up.
Twenty-three patients received a regime with CPM from 7 a.m. to 22 p.m., and 7 patients used CMP for 48 hours, with only 3-4 hours break at night. The difference between the groups were at follow-up 2 degrees extension deficit (95% CI: -2 to 6) and 11 degrees flexion (95% CI: -24 to 2), in favors of the intensive group.
Before MUA extension deficit was 5 degrees (95% CI: 3 to 6) and flexion 80 degrees (95% CI: 77 to 83). At discharge the extension deficit was 7 degrees (95% CI: 5 to 9) and flexion 105 degrees (95% CI: 103 to 108).
Extension deficit increased with 0.6 degrees (95% CI: -2.8 to 1.9) and flexion increased with 17 degrees (95% CI: 12 to 21) at follow-up.
Twenty-three patients received a regime with CPM from 7 a.m. to 22 p.m., and 7 patients used CMP for 48 hours, with only 3-4 hours break at night. The difference between the groups were at follow-up 2 degrees extension deficit (95% CI: -2 to 6) and 11 degrees flexion (95% CI: -24 to 2), in favors of the intensive group.
Conclusion(s): MUA combined with CPM improved knee flexion with 17 degrees, but no reduction in extension deficit was seen. Results show no difference between the groups, which may be due to lack of statistical power.
Results may be biased by using different type of measurement tool (goniometric or visual), and it was not always clear if ROM were active or passive. Additionally, there were no adjustments for potential confounders like age and sex.
Results may be biased by using different type of measurement tool (goniometric or visual), and it was not always clear if ROM were active or passive. Additionally, there were no adjustments for potential confounders like age and sex.
Implications: An increased knee flexion with 17 degrees, from 80 to 97 degrees, means that it is possible to do more demanding acticitivities like stairclimbing which requires 95 degress knee flexion. Despite this, you still need to have a knee flexion over 100 degrees to be able to get up from a chair or ride a bicycle.
Due to lack of statistical power it is not possible to give clear implications for physiotherapy pratice. Future research need to investigate how intensiv the use of CPM need to be to get clinical relevant improvement.
Due to lack of statistical power it is not possible to give clear implications for physiotherapy pratice. Future research need to investigate how intensiv the use of CPM need to be to get clinical relevant improvement.
Funding, acknowledgements: The abstract is unfunded.
Keywords: continuous passive motion, manipulation under anesthesia, knee range of motion
Topic: Orthopaedics
Did this work require ethics approval? No
Institution: Hospital of South West Jutland
Committee: The Regional Committees on Health Research Ethics for Southern Denmark
Reason: The study was a register study and an ethics approval is therefore not required
All authors, affiliations and abstracts have been published as submitted.
