Previous studies of early versus late manipulation under anesthesia (MUA) do not report on postoperative opioid utilization or revisions and focused on small single-institution retrospective cohorts. The PearlDiver Research Program (www.pearldiverinc.com), which uses an all-inclusive insurance database, was used to identify patients undergoing primary total knee arthroplasty (TKA) who received (1) late MUA (>12 weeks), (2) early MUA (≤12 weeks), or (3) TKA only. To develop the control group cohort of TKA-only patients, 3:1 matching was conducted using 11 risk factor variables deemed significant by chi-squared analysis. Complications and opioid utilization were compared through multivariate regression analysis, controlling for age, gender, and Charlson Comorbidity Index. The risk of TKA revision was assessed through Cox-proportional hazards modeling and Kaplan–Meier survival analysis with log-rank test. Between 2011 and 2017, 2,062 TKA patients with early MUA, 1,112 TKA patients with late MUA, and a control cohort of 8,327 TKA-only patients were identified in the database. The percent of patients registering opioid use decreased from 54.6% 1 month pre-MUA to 4.6% (p < 0.0001) 1 month post-MUA following early MUA, whereas only from 32.6 to 10.4% (p < 0.0001) following late MUA. Late MUA was associated with higher risk of repeat MUA at 6 months (adjusted odds ratio [aOR] = 2.74, p < 0.0001), 1 year (aOR = 2.66, p < 0.0001), and 2 years (aOR = 2.63, p < 0.0001) following index MUA. Hazards modeling and survival analysis showed increased risk of TKA revision following late MUA (adjusted hazard ratio [aHR] = 3.50, 95% confidence interval [CI]: 2.77–4.43, p < 0.0001) compared to early MUA (aHR = 2.15, 95% CI: 1.72–2.70, p < 0.0001), with significant differences in survival to revision curves (p < 0.0001). When compared to early MUA at 1 year, late MUA was associated with a significantly increased risk of prosthesis explantation (aOR = 2.89, p = 0.0026 vs. aOR = 0.93, p = 0.8563). MUA within 12 weeks after index TKA had improved pain resolution and significant curtailing of opioid use. Furthermore, late MUA was associated with prolonged opioid use, increased risks of revision, as well as prosthesis explantation, supporting screening and early intervention in cases of slow progression and stiffness. The level of evidence of this study is III.

先前对麻醉下早期与晚期操作（MUA）的研究没有报告术后阿片类药物的使用或修改，而是集中于小型单机构回顾性队列。PearlDiver 研究计划（www.pearldiverinc.com），使用全包保险数据库，用于识别接受初次全膝关节置换术 (TKA) 的患者，这些患者接受 (1) 晚期 MUA（>12 周）、(2) 早期 MUA（≤12 周）或 ( 3) 仅限全膝关节置换术。为了建立仅接受 TKA 患者的对照组队列，使用卡方分析认为显着的 11 个危险因素变量进行 3:1 匹配。通过多变量回归分析比较并发症和阿片类药物的使用，控制年龄、性别和查尔森合并症指数。TKA 翻修风险通过 Cox 比例风险模型和 Kaplan-Meier 生存分析及对数秩检验进行评估。2011 年至 2017 年间，数据库中确定了 2,062 名患有早期 MUA 的 TKA 患者、1,112 名患有晚期 MUA 的 TKA 患者以及由 8,327 名仅接受 TKA 的患者组成的对照队列。早期MUA 后，登记阿片类药物使用的患者百分比从 MUA 前 1 个月的 54.6% 降至 MUA 后 1 个月的4.6% ( p < 0.0001)，而晚期 MUA 后仅从 32.6% 降至 10.4% ( p <  0.0001)。晚期 MUA 与 6 个月（调整后比值比 [aOR] = 2.74， p <  0.0001）、1 年（aOR = 2.66，p <  0.0001）和 2 年（aOR = 2.63，p < 0.0001）时重复 MUA 的风险较高相关。 0.0001) 以下索引 MUA。 风险建模和生存分析显示，与早期 MUA (aHR = 2.15, 95) 相比，晚期MUA 后 TKA 翻修的风险增加（调整后风险比 [aHR] = 3.50，95% 置信区间 [CI]：2.77–4.43，p < 0.0001 ） % CI：1.72–2.70，p <  0.0001），生存曲线与翻修曲线存在显着差异（p <  0.0001）。与 1 年早期 MUA 相比，晚期 MUA 与假体外植风险显着增加相关（aOR = 2.89，p  = 0.0026 对比 aOR = 0.93，p  = 0.8563）。指数 TKA 后 12 周内的 MUA 改善了疼痛缓解并显着减少了阿片类药物的使用。此外，晚期 MUA 与阿片类药物使用时间延长、翻修风险增加以及假体移出有关，在进展缓慢和僵硬的情况下支持筛查和早期干预。本研究的证据级别为III级。