Manipulation under anesthesia after unicompartmental knee arthroplasty: incidence and risk factors.

Manipulation under anesthesia (MUA) is an undesirable outcome after total knee arthroplasty (TKA). Black patients have higher odds of MUA than White patients. Social deprivation is also linked to worse TKA outcomes. We examined the associations between an area- and person-level indicator of social deprivation and odds of MUA within 1 year after TKA. This retrospective cohort study included fee-for-service Medicare beneficiaries 65+ (Medicare Limited Data Set, 5% claims) undergoing unilateral inpatient or outpatient primary elective TKA in 2016 to 2020 with an accompanying diagnosis of knee osteoarthritis. Area-level social deprivation was assessed using the county-level Social Deprivation Index (SDI). Person-level social deprivation was operationalized as dual Medicare/Medicaid eligibility. We assessed the relationship between social deprivation and 1-year MUA in separate mixed effects generalized linear models with a binary distribution and logit link. We report adjusted odds ratios (OR) and 95% confidence intervals (CI). Our cohort included 34,749 TKA patients (median age: 73 [interquartile range (IQR): 69-77]; 63.4% women). Median SDI was 42 (IQR: 20-66); 4.7% were dual-eligible. There were 748 cases of MUA (2.2%). Median time to MUA was 63.5 days (IQR: 49-91). Odds of MUA receipt were significantly lower for the most deprived quintile compared with the second most deprived quintile (OR: 0.77; 95% CI: 0.60-0.98; p = 0.04), the middle quintile (OR: 0.76; 95% CI: 0.59-0.99; p = 0.04), and the second least deprived quintile (OR: 0.70; 95% CI: 0.55-0.91; p = 0.01). Dual eligibility wasn't significantly associated with receipt of MUA (OR: 0.74, 95% CI: 0.50-1.10, p = 0.13). There were no significant differences for the person-level indicator of deprivation. The most socially deprived quintile had lower odds of MUA receipt than patients in less socially deprived quintiles. While this could be viewed as a positive, alternatively, it may reflect a challenge with postoperative care access and should be further examined.

Background:Sex-related differences in outcomes after adolescent anterior cruciate ligament reconstruction (ACLR) remain inadequately characterized in the literature. Preliminary studies suggest potential sex-based differences in postoperative complications, although findings regarding specific adverse outcomes remain inconsistent.Purpose:To evaluate sex-specific differences in postoperative complications after adolescent ACLR in a multicenter cohort with propensity matching and 2-year follow-up.Study Design:Cohort study; Level of evidence, 3.Methods:Data were retrospectively extracted from the TriNetX Research Network. Adolescents aged between 12 and 19 years who underwent ACLR were identified using Current Procedural Terminology codes. Male and female cohorts were propensity score-matched (1:1) for age, obesity, and concomitant meniscal repair. Outcomes at 3, 6, 12 months, and 2 years included subsequent ACLR revision, subsequent meniscal surgery, and other postoperative complications. Odds ratios with 95% CIs were calculated.Results:A total of 7793 adolescents per sex were propensity-matched. At 3 months, male adolescents had greater rehabilitation utilization (33.7% vs 31.1%; P = .003). At 6 months, female adolescents had higher manipulation under anesthesia (MUA), and lysis of adhesions (all, P < .001), whereas rehabilitation use remained higher in male adolescents (P = .02). At 1- and 2-year follow-up, female patients experienced higher rates of MUA and lysis of adhesions (all, P < .001). No differences were observed in subsequent ACLR, meniscal surgery, or any knee reoperation.Conclusion:Distinct postoperative complication profiles were observed between male and female adolescents after ACLR. Female patients consistently demonstrated a higher likelihood of postoperative stiffness requiring secondary procedures. In contrast, no sex-based differences were identified in subsequent meniscal surgery or revision ACLR. These findings highlight postoperative stiffness as a sex-specific complication in adolescents and underscore the importance of incorporating sex-based considerations into postoperative monitoring and future outcome-focused research.

Distinct Risk Profiles After Conversion Total Knee Arthroplasty: Prior High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty.

Postoperative stiffness remains a significant complication following total knee arthroplasty (TKA), affecting functional recovery and patient satisfaction. Manipulation under anesthesia (MUA) is commonly employed when conservative measures fail, yet the impact on patient-reported outcomes remains unclear. This systematic review evaluated functional outcomes following MUA, focusing on the Knee Society Score (KSS), Oxford Knee Score (OKS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. A comprehensive search of PubMed, Embase, Scopus, and the Cochrane Library was conducted up to February 1, 2026, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Six studies, including retrospective and prospective cohorts and a systematic review, were included. Early MUA (<8-12 weeks) consistently achieved a superior range of motion (ROM) gains (+25° to +34°) compared to delayed interventions. Functional outcomes showed modest short-term improvements with sustained long-term benefits, and complications were rare. While ROM gains were reliably achieved, patient-perceived functional recovery depended on pain control, rehabilitation adherence, and individual factors. Early and standardized MUA is effective for improving mobility and functional recovery after TKA. Future high-quality prospective studies are warranted to refine timing, standardize techniques, and clarify the relationship between mechanical improvements and patient-centered outcomes.

Incidence, Timing, and Implications of Postoperative Manipulation Under Anesthesia (MUA) Following Cemented Versus Cementless Total Knee Arthroplasty (TKA).

Obesity Severity and Stiffness After Total Knee Arthroplasty Revisited: A Contemporary Analysis of Patients Requiring Manipulation Under Anesthesia.

knee stiffness is a common complication following total knee replacement (TKA), causing important morbidity. Although manipulation under anesthesia (MUA) is a safe method for the treatment of stiffness, its benefits over long-term and for large cohorts are not precisely known. The aim of this retrospective study was to assess clinical and functional outcomes and patients satisfaction after MUA over 5 years of follow-up. Our hypothesis was that range of motion (ROM) improvement would be superior to 30° and would be sustained at 5 years follow-up leading to a patient satisfaction rate exceeding 70%. This was an observational retrospective study organized with 14 French centers implied in the SOFCOT. Three hundred and forty four patients who underwent MUA following TKA were reviewed between January 2023 and June 2024. Among the cohort, patients who underwent a second MUA were analyzed separately. The collected data included patient demographics, Devane activity, ASA score, functional scores, knee amplitudes and satisfaction rates. Statistical analysis was performed with EasyMedStat. The mean time between TKA and MUA was 2.9 ± 6.9 months and the mean follow-up was 5.5 ± 2.5 years. In comparison with the ROM at stiffness diagnosis (66.6°± 21.0°), at 5 years post-MUA, the ROM was improved by 36.0° ± 26.1 (p < 0.001), at a mean of 102.2° ± 22.6°. The subgroup of patients having a second MUA had a ROM gain of 16.8° ± 12.3° at 5-years post-MUA. The global complication rate after MUA was 2.3% (n = 8) including hematoma, wound dehiscence, infection, tibial tubercle fracture and patellar tendon rupture. At last follow-up, OKS was 35.4 ± 9.6. The KOOS for all subscales ranged from 38.5 ± 30.9 to 57.5 ± 33.8 and the mean FJS was 35.0 ± 14.3. A high satisfaction rate was recorded (77.5%). The improvement in ROM was substantial throughout the 5-year follow-up period. MUA was associated with low complication rates and high patient satisfaction, suggesting that it is an effective treatment for knee stiffness. III; multicenter retrospective cohort study.

Increased Opioid Consumption Following Total Knee Arthroplasty Is Associated With an Increased Risk of Manipulation Under Anesthesia.

Influence of Conscious Sedation Versus Spinal Anesthesia on Range of Motion and Pain Scores Following Manipulation Under Anesthesia After Total Knee Arthroplasty.

Background Imageless robotic-assisted total knee arthroplasty (TKA) relies on intraoperative landmark acquisition and gap balancing to guide implant positioning and polyethylene insert selection. While prior studies have demonstrated high accuracy in achieving planned alignment and resection targets, limited data exist evaluating the predictability of polyethylene insert thickness using standardized pre-resection planning strategies. This study evaluated the accuracy of a standardized 10-mm polyethylene planning strategy in imageless robotic-assisted TKA and assessed whether deviation from the planned insert thickness was associated with postoperative interventions. Methods A retrospective review of a prospectively maintained, single-surgeon series of 400 primary TKAs performed using the imageless ROSA robotic system between 2021 and 2023 was conducted. A kinematic alignment strategy targeting a balanced 22-mm flexion and extension gap corresponding to a planned 10-mm insert was used in all cases. Exact accuracy was defined as a final 10-mm insert; acceptable accuracy was defined as ±1 mm (10–11 mm). Associations between insert thickness, intraoperative re-resection, manipulation under anesthesia (MUA), revision, and learning curve effects were analyzed. Results A 10-mm insert was used in 73% of cases, and 88% achieved insert thickness within ±1 mm of the planned target. Intraoperative re-resection occurred in 8% of cases, with 94% consisting of 2-mm adjustments. The overall revision rate was 5.8%, and the MUA rate was 10.3%. No statistically significant association was identified between insert thickness, re-resection, and revision or MUA ( P &gt; 0.05). Learning curve analysis of the first 30 cases demonstrated similar insert distribution and intervention rates. Conclusion Imageless robotic-assisted TKA using standardized 10-mm pre-resection planning demonstrated reproducible polyethylene insert selection. Deviation from planned thickness and minor intraoperative re-resections were not associated with increased postoperative intervention, supporting the reliability of imageless robotic workflows in primary TKA.

Fellowship Training in Adult Reconstruction Is Associated With Decreased Complications up to Two Years Following Total Knee Arthroplasty.

Aspirin Versus Potent Venous Thromboembolism Chemoprophylaxis in Total Knee Arthroplasty: Reduced Postoperative Pain and Complications With Aspirin Use.

Failure Incidence and Predictors Following Manipulation Under Anesthesia for the Stiff Total Knee Arthroplasty.

The stiff total knee arthroplasty (TKA) remains a major driver of dissatisfaction after primary implantation. Persisting myofibroblasts and a transforming growth factor-beta (TGF-β)-driven scar matrix underlies painful limitations in flexion/extension, either independent of or in addition to mechanical problems. A pragmatic diagnostic pathway includes structured history and examination, conventional radiographs, mandatory exclusion of periprosthetic joint infection, and targeted three-dimensional computed tomography (3D-CT) and single-photon emission computed tomography (SPECT-CT) for malposition/overstuffing; metal artifact reduction sequence MRI (MARS-MRI) supports soft-tissue-predominant pathology. Management is time-critical: early multimodal, opioid-sparing analgesia, strict oedema control, and pain-adapted physiotherapy; if flexion remains <90-95° by week 6-8, manipulation under anaesthesia (MUA) (ideally ≤12 weeks) with immediate remobilization is indicated. Persistent adhesions are treated arthroscopically or openly; mechanical causes or failure warrant revision, including rotating-hinge strategies in selected cases. Early risk stratification, a stepwise algorithm, and tightly controlled rehabilitation stabilize range-of-motion gains and reduce reinterventions, although patient-reported outcomes may remain limited.

Equivalent Functional Outcomes in Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty for Knee Osteoarthritis with Severe Fixed Flexion Deformity: A Propensity Matched-Pair Analysis.

Effects of Ankylosing Spondylitis on Total Knee Arthroplasty Outcomes and Postoperative Manipulation Under Anesthesia Rates.

Although previous studies have examined total joint arthroplasties (TJA), research on the association between the Area Deprivation Index (ADI) and outcomes following unicompartmental knee arthroplasty (UKA) remains limited. This study evaluates outcomes following UKA and whether patients with higher ADIs (indicating greater socioeconomic disadvantage) are at increased risk for implant-related complications. A retrospective analysis was performed using a nationwide claims database from 2010 to 2022. The ADI was used to categorize patients into high and low ADI groups. A total of 26,058 primary UKA patients for osteoarthritis were 1:1 propensity-score matched by age, gender, and Elixhauser Comorbidity Index (ECI). Primary endpoints included 2-year implant-related complications and costs. Multivariable logistic regression models computed the odds ratios (OR) for the association between ADI and 2-year implant complications. P values < 0.001 were significant. Patients undergoing UKA with higher ADIs experienced no difference in the incidence and odds of implant-related complications within 2 years compared to those with lower ADIs. Periprosthetic fractures were less common in the high ADI group (0.21% versus 0.40%; OR: 0.53, P = 0.008). Periprosthetic joint infections (PJIs) (1.27% versus 1.33%; OR: 0.95, P = 0.701), aseptic loosening (1.14% versus 1.05%; OR: 1.08, P = 0.512), manipulations under anesthesia (MUA) (1.10% versus 0.92%; OR: 1.20, P = 0.153), or all-cause revisions (3.04% versus 2.86%; OR: 1.07, P = 0.378) were similar between groups. Patients in the higher ADI cohort had significantly higher day of surgery ($5,336 vs. $4,118;P < 0.0001) and 90-day costs ($7,462 vs. $6,431; P < 0.0001) after propensity-matching and adjustment for measured comorbidities. Patients undergoing UKA of higher ADIs did not experience significant differences in implant-related complications compared to those of lower ADIs. Socioeconomic disadvantage alone is not a major determinant of early implant-related outcomes following UKA. These findings support equitable patient selection and treatment decisions based on clinical indications rather than socioeconomic proxies of patient complexity. III.

Manipulation under anesthesia is independently associated with development of prosthetic joint infection within 1 year of total knee arthroplasty.

Arthrofibrosis can be a major source of dissatisfaction for patients undergoing total knee arthroplasty (TKA). Manipulation under anesthesia (MUA) may be offered to improve motion in selected cases. Advancements in computer-navigated and robotic-assisted technology have been championed to improve component positioning with fewer soft tissue releases. We sought to investigate whether these technologies impact MUA rates. An institutional retrospective review was conducted on 18,815 patients who underwent a primary, elective, unilateral TKA between January 2010 and December 2022. Patients were stratified into conventional (n = 12,659), computer-navigated (n = 4,071), or robotic-assisted TKA (n = 2,085) cohorts. Patient demographics and implant data, including mode of fixation and level of constraint (cruciate-retaining [CR] vs. posterior-stabilized) were collected. MUA rates were the primary outcome. Data were analyzed using analysis of variance with Tukey post hoc testing and multivariate logistic regression analysis. We report a 1.7% overall MUA rate, with a rate of 1.6% for conventional and 1.5% for navigated TKA, which were significantly lower than robotic-assisted TKA at 3.2% (p < 0.001). However, on multivariate analysis, there was no difference in MUA rates for navigated and robotic-assisted when compared with conventional techniques. Cementless and hybrid fixation and CR implant designs were higher with robotic-assisted compared with conventional and navigated TKA. Multivariate regression revealed that TKA with fully cementless (odds ratio [OR]: 1.80 [95% confidence interval [CI]: 1.16-2.78]; p = 0.008) or hybrid fixation (OR: 2.92 [95% CI: 1.77-4.81]; p < 0.001) increased the risk for future MUA. Constraint also significantly influenced MUA rates, with CR designs yielding higher MUA rates (OR: 1.51 [95% CI: 1.16-1.96]; p = 0.002). When controlling for confounding factors, navigated and robotic-assisted TKA generated comparable odds for MUA when compared with conventional techniques. However, robotic-assisted TKA were more likely to utilize cementless or hybrid fixation and CR implant constraint, each of which were independently associated with increased odds of MUA. These operative factors should be considered when risk-stratifying and counseling patients on the likelihood of MUA. LEVEL OF EVIDENCE: III.