Aaron A. Hofmann
ORLANDO — Eliminating knee swelling with elevation of the leg or a directed exercise program is a first step to managing knee stiff in a patient after total knee arthroplasty. After that, manipulation under anesthesia may be considered, according to a presenter at the Current Concepts in Joint Replacement Winter Meeting.
“You’ve got to get rid of the swelling if you’re going to get rid of the stiffness,” Aaron A. Hofmann, MD, said.
He noted about 3% of his TKA patients undergo manipulation under anesthesia (MUA) at about 6 to 12 weeks postoperatively.
“Earlier than 6 weeks, my experience has been that you get a recurrence of the swelling. You bleed into the joint. That’s not good,” he said. “After 12 weeks, you are assumed to be at a higher risk of infection.”
Hofmann said when he performs MUA after TKA, the patient is under complete paralysis which is achieved either with a femoral nerve or adductor block. Patients are admitted to the hospital for 23 hours, including an overnight stay, and their knees are well iced following the procedure, which takes about 5 minutes to complete, he said.
“You can get complications doing late manipulations and sometimes a second manipulation is needed,” he said.
For example, fractures can occur.
“You certainly need to warn your patients of that. Usually, it is beyond the 12-week period of time when that occurs,” Hofmann said. However, Hofmann said in his 35 years of performing MUA, only three post-MUA fractures have occurred in his patients.
Furthermore, Hofmann said he is a proponent of using continuous passive motion equipment in patients with stiff knees.
“We send patients home with it,” he said. – by Susan M. Rapp
Hofmann AA. Paper 100. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 11-14, 2019; Orlando.
Disclosure: Hofmann reports he receives royalties from Zimmer Biomet.