The following link and abstract is from a recent study. I do not have the ability to evaluate the validity of the study nor fully parse the nuances. My understanding is the Journal of Bone and Joint surgery is a go to source for many surgeons. It appears that the conclusions do not quite match up to what I think is a loose consensus on BoneSmart
(and mildly contradicts some input I gave in an earlier post). I know my OS had more of a go for ROM early philosophy, but I was at 90-95 at three weeks
(TKR #1) so if I recall correctly, we were looking out at something like 12 weeks if I was stuck there. Of course, I was on drugs when we discussed this.
Basically, the study shows better results from MUA before 12 weeks (Groups I & II) than after. I think the results reflect a general grouping study (no breakdowns for age, gender, weight, pre-activity level, etc), and I think somewhere in the full text there was a nod to this. The sample size appears somewhat small, but the ratio of women to men was almost 2-1 (women).
Jan. 15 is about 7.5 weeks out and I assume it will take a few days to schedule. If you have confidence in your surgeon, and make sure to ask the questions you have, I think you will make the best possible decision you are able to make.
broken link removed: https://jbjs.org/content/96/16/1349
ABSTRACT
Background: Manipulation under anesthesia has been reported to improve range of motion when other rehabilitative efforts fail to obtain adequate motion after total knee arthroplasty. The purpose of this study was to evaluate the effects of the timing of the manipulation on knee range of motion and clinical outcomes.
Methods: All 2128 total knee arthroplasties performed at our institution from 2005 to 2011 were reviewed to determine the number of patients who had undergone manipulation under anesthesia. A total of 144 manipulations in eighty-eight women and forty-five men were reviewed. Manipulations under anesthesia that were performed within the first twelve weeks after total knee arthroplasty were considered early and those after that period were considered late. Patients were further substratified according to the timing of the manipulation: Group I included those who had the manipulation within six weeks; Group II, at seven to twelve weeks; Group III, at thirteen to twenty-six weeks; and Group IV, after twenty-six weeks. Outcomes evaluated included gains in flexion and final range of motion, and Knee Society objective and function scores between early and late manipulation, using various adjusted multivariable regression models and at a mean follow-up of fifty-one months (range, twelve to eighty-one months). Mediation analysis was used to investigate whether gains in range of motion from the manipulations under anesthesia alone had mediated the effect between the timing of the manipulation and the clinical outcomes.
Results: Patients who underwent early manipulation had a significantly higher mean gain in flexion (36.5° versus 17°), higher final range of motion (119° versus 95°), and higher Knee Society objective (89 versus 84 points) and function scores (88 versus 83 points) than those who had late manipulation under anesthesia. There were no significant differences in the outcomes of Groups I and II. Manipulations after twenty-six weeks resulted in unsatisfactory clinical outcomes. Multivariable regression analyses confirmed significantly better clinical outcomes with early manipulation. Mediation analysis showed that the timing of manipulation independently had significantly contributed to the outcomes.
Conclusions: Orthopaedic surgeons should have a low threshold for performing early manipulations with the patient under anesthesia within twelve weeks after an arthroplasty, to achieve higher knee range of motion and improved clinical outcomes.
Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
FOOTNOTES
- Investigation performed at the Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
- Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.
- Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated
United States
