Cementless total knee arthroplasty (TKA) is thought to facilitate durable, biological fixation between the bone and implant. However, the 4-12 weeks required for osseointegration coincides with the optimal timeframe to perform a manipulation under anesthesia (MUA) if a patient develops postoperative stiffness. This study aims to determine the impact of early MUA on cementless fixation by comparing functional outcomes and survivorship of cementless and cemented TKAs. A consecutive series of patients who underwent MUA for postoperative stiffness within 90 days of primary, unilateral TKA at 2 academic institutions between 2014 and 2018 were identified. Cases involving extensive hardware removal were excluded. Cementless TKAs undergoing MUA (n = 100) were propensity matched 1:1 to cemented TKAs undergoing MUA (n = 100) using age, gender, body mass index, and year of surgery. Both groups had comparable baseline Knee Injury and Osteoarthritis Outcome Scores (KOOS), Short Form (SF)-12 Physical, and SF-12 Mental scores. MUA-related complications as well as postoperative KOOS and SF-12 scores were compared. MUA-related complications were equivalently low in both groups ( = .324), with only 1 patella component dissociation in the cementless group. No tibial or femoral components acutely loosened in the perioperative period. Postoperative KOOS ( = .101) and SF-12 Mental scores ( = .380) were similar between groups. Six-year survivorship free from any revision after MUA was 98.0% in both groups ( = 1.000). Early postoperative MUA after cementless TKA was not associated with increased MUA-related complications or worse patient-reported outcomes compared to cemented TKA. Short-term survivorship was also comparable, suggesting high durability of the bone-implant interface.

中文翻译：

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非骨水泥全膝关节置换术后麻醉下操作是安全的：一项多中心研究

无骨水泥全膝关节置换术（TKA）被认为有助于骨骼和植入物之间持久的生物固定。然而，如果患者术后出现僵硬，骨整合所需的 4-12 周正好是在麻醉下进行操作 (MUA) 的最佳时间范围。本研究旨在通过比较非骨水泥和骨水泥全膝关节置换术的功能结果和存活率，确定早期 MUA 对非骨水泥固定的影响。 2014 年至 2018 年间，在 2 个学术机构进行初次单侧 TKA 后 90 天内连续接受 MUA 治疗的患者。涉及大量硬件拆除的情况被排除在外。使用年龄、性别、体重指数和手术年份，将接受 MUA 的非骨水泥 TKA (n = 100) 与接受 MUA (n = 100) 的骨水泥 TKA 进行 1:1 倾向匹配。两组的基线膝损伤和骨关节炎结果评分 (KOOS)、简表 (SF)-12 身体评分和 SF-12 心理评分具有可比性。比较 MUA 相关并发症以及术后 KOOS 和 SF-12 评分。两组中 MUA 相关并发症的发生率相当低 (= .324)，无骨水泥组中仅有 1 例髌骨成分分离。围手术期无胫骨或股骨假体严重松动。术后 KOOS ( = .101) 和 SF-12 心理评分 ( = .380) 组间相似。两组 MUA 后未进行任何翻修的六年生存率为 98.0% (= 1.000)。与骨水泥 TKA 相比，非骨水泥 TKA 术后早期 MUA 与 MUA 相关并发症增加或患者报告的结果较差无关。短期存活率也相当，表明骨-植入物界面具有很高的耐用性。