Early and Late Manipulation Improve Flexion After Total Knee Arthroplasty

Manipulations have been considered effective only in the early postoperative period. From a total joint registry containing 9640 primary total knee arthroplasties (TKAs), 195 patients who underwent manipulation under anesthesia (MUA) were identified. A total of 102 had MUA within 90 days (early), and 93 more than 90 days (late) after TKA. Average pain (10-point scale), satisfaction (10-point scale), flexion (degrees), and extension (degrees) were recorded before and after MUA. Flexion was significantly improved after MUA for both groups: early MUA from 68.4° (±17.2°) to 101.4° (±16.15°), P < .001; late MUA from 81.0° (±13.3°) to 98.0° (±18.0°), P = .001. Pain decreased significantly with early MUA from 4.92 (±2.25) to 3.34 (±2.67) and with late MUA from 4.51 (±2.62) to 3.44 (±2.78), P = .048. Extension improved only in the early MUA group from 7.15 (±10.1) to 2.50 (±4.98). Satisfaction scores were not improved. Both early and late manipulation can improve TKA pain and flexion.