Acquired Idiopathic Stiffness after Contemporary Total Knee
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Acquired idiopathic stiffness (AIS) remains a common failure mode of contemporary TKAs. The current study investigated the incidence of AIS and manipulation under anesthesia (MUA) at a single institution over time, determined outcomes of MUAs, and identified risk factors associated with AIS and MUA.

Researchers identified 9,771 patients who underwent primary TKAs with cemented, modular metal-backed, posterior-stabilized implants. Mean age was 68 years, 57% were female, and mean BMI was 33 kg/m2. Demographic, surgical, and comorbidity data were investigated via univariate Cox proportional hazard models and fit to an adjusted multivariate model to access risk for AIS and MUA. Mean follow-up was 7 years.

Results:
--During the study period, 456 knees developed AIS and 336 knees underwent MUA.

--Range of motion (ROM) increased a mean of 34° after the MUA; however, ROM for patients treated with MUA was inferior to patients without AIS at final follow-up (102° vs. 116°).

--Significant risk factors included younger age (HR 2.3), increased tourniquet time (HR 1.01), general anesthesia (HR 1.3), and diabetes (HR 1.5).

A group of patients receiving primary TKAs has continued to have a substantial negative effect on their outcomes due to acquired idiopathic stiffness. MUA increased mean ROM by 34° when used, but patients treated with MUA still had lower ROM than patients without AIS. Researchers discovered a number of important risk factors linked to AIS and subsequent MUA.

Sources: https://www.sciencedirect.com/science/article/abs/pii/S088354032100334X?dgcid=rss_sd_all
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