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Myth busting: the "window of opportunity" JBJS

Discussion in 'Knees - TKR' started by Josephine, Aug 17, 2017.

  1. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
    Thread Starter

    Member Since:
    Jun 8, 2007
    The North
    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.

    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.

    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.

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