MUA: the ineffectiveness of early MUA JBJS

Here are a couple of contrasting papers about MUAs

http://www.orthosupersite.com/view.aspx?rid=40071
Published June 2009 USA

FIRST STUDY (sorry link no longer available)
Clinic records of 37 manipulations in 767 consecutive primary total knee arthroplasties (TKAs) were analyzed to identify any predictors of manipulation outcome.

Factors studied were sex, age, body mass index, tibiofemoral alignment, surgical history, smoking history, range of motion before TKA and manipulation, intraoperative lateral release, implant design and manufacturer, and manipulation interval. Measures of outcome were gains in extension and flexion from manipulation and range of motion at 1-year follow-up.

Patients gained an average of
- 4° of extension and 22° of flexion after manipulation
- resulting in average extension of 1° and average flexion of 105° at 1 year follow-up.
- Restored flexion was similar to that measured pre-operatively.

Manipulation was most effective in patients who were:
- manipulated within 8 weeks
- with full extension and less than 90° of flexion prior to manipulation
- and those receiving a lateral release during arthroplasty



However, in the second study study, things seem not so cut and dried:

SECOND STUDY
http://www.slideshare.net/Struijs/beverland-d-surgical-factors-influencing-rom
Published 2006 UK

Between April 2000 and May 2007, this surgeon did 2,762 Total Knee Replacements
During that time he did 30 MUAs (1.086%)

He proposed the question "What if these patients hadn't had an MUA?"

He cited one patient
- pre-op ROM = 0°/130°
- 12 wks post-op = 25°/70°
- Refused MUA.
- at 12 months = -5°/120°!

Also Physio or no physio? A randomised trial:

Had physio - 71 patients in study
--- Pre-op passive = 98.3°
--- Post-op passive = 108° at 12 months

No physio - 72 patients in study
--- Pre-op passive = 100.2°
--- Post-op passive = 108.1° at 12 months

NO SIGNIFICANT CHANGE IN OUTCOMES!