Manipulation under anaesthesia and/or lysis of adhesions prior to revision total knee arthroplasty increases the risk of subsequent revision
Year: 2025
Type: article
Study design: Observational Study
Abstract: Purpose The purpose of this study was to determine if prior manipulation under anaesthesia (MUA) and/or lysis of adhesions (LOA) was associated with an increased risk of re‐revision following index revision total knee arthroplasty (TKA) in patients that had a diagnosis of arthrofibrosis. Methods The PearlDiver Mariner database was queried by Current Procedural Terminology (CPT) and International Classification of Disease (ICD) codes to identify patients who had a diagnosis of arthrofibrosis at the time of revision TKA. Patients were divided into two groups: those with prior MUA and/or LOA and those without prior MUA and/or LOA. The groups were 1:3 propensity score matched by age, gender, anemia, and Elixhauser Comorbidity Index (ECI). The primary outcome was incidence of re‐revision TKA at 5 years. Secondary outcomes included periprosthetic joint infection (PJI) at 6 months and 5 years, 90‐day hospital readmission, and the incidence of deep vein thrombosis (DVT), blood transfusion, and acute kidney injury (AKI) at 6 months. Logistic regression was used to determine predictors of re‐revision TKA. Results After propensity matching, 2622 patients with a diagnosis of arthrofibrosis underwent index revision TKA without prior MUA and/or LOA and 874 patients underwent index revision after a prior LOA and/or MUA. The incidence of re‐revision TKA at 5 years in patients with prior MUA and/or LOA (20% vs. 14%; OR 1.5, 95% confidence interval [CI] [1.3–1.9], p < 0.001) was significantly higher compared to patients with no prior MUA and/or LOA. Predictors of re‐revision were age, ECI, and prior MUA and/or LOA (OR: 1.5, 95% CI [1.2–1.9]) ( R 2 = 0.21; p < 0.01). No significant differences were observed between groups for PJI at 6 months and 5 years, 90‐day hospital readmission, or DVT, blood transfusion, and AKI at 6 months. Conclusion A history of prior MUA and/or LOA, older age, and ECI are associated with a significantly higher risk of re‐revision TKA in patients that have a diagnosis of arthrofibrosis at the time of index revision TKA. Level of Evidence Level III, retrospective comparative study.
DOI: 10.1002/ksa.70211
Authors: Kevin D. Plancher, Elias Schwartz, Carlo Mannina, Karen K. Briggs, Stephanie C. Petterson
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4417094961