Watch 2020 JRAD Videos

Myth busting: the "window of opportunity" JBJS

Josephine

NURSE DIRECTOR EMERITUS
Nurse Director
Joined
Jun 8, 2007
Messages
84,937
Age
78
Location
The North
Gender
Female
Country
United Kingdom United Kingdom
MUAs in TKRs
Esler, Lock, Harper and Gregg JB&JS (UK)
NB. This was an unrandomised study conducted in 1999.
It should therefore be taken in the context of it being an old work.

Study
As part of a prospective study of 476 total knee replacements the use of MUA (manipulation under anaesthesia) was assessed in 47 knees. (incidence of 0.1%)
MUA was considered when intensive physiotherapy failed to increase flexion to more than 80°.
Mean time from surgery to MUA was 11 weeks.

Minimal requirements
Laubenthal, Smidt and Kettelkamp assessed the amount of flexion necessary for everyday activities and found that the mean flexion required to climb stairs, to sit, and to tie a shoelace was 83°, 93° and 106°, respectively.

MUAs
The long-term benefits of manipulation under anaesthesia (MUA) after TKR have been questioned.
The known complications of manipulation, including supracondylar fracture, avulsion of the patellar tendon, myositis ossificans and wound breakdown, may further compromise poor results.
These occur, however, in fewer than 3% of patients.
Our aim was to evaluate the use of MUA in patients whose maximum flexion was less than 80° despite intensive physiotherapy.

At MUA, they achieved a mean gain in flexion of 37°, but one week later only 17° of this remained.
After one year, the mean gain in flexion was only 13°.
A retrospective study of 17 patients who had bilateral TKRs but MUA in only one knee led them to conclude that the procedure did not increase the ultimate range of flexion after TKR.

CPM machines
Several studies have shown that the use of a CPM machine immediately after arthroplasty does not affect the ultimate ROM but does increase the rate at which flexion is regained.
 

New

Active Antibacterial

BoneSmart #1 Best Blog

Staff online

Members online

Forum statistics

Threads
51,504
Messages
1,382,628
BoneSmarties
32,240
Latest member
Pulvermacher
Recent bookmarks
0

Top Bottom