Background

Stiffness following total knee arthroplasty (TKA) is a disabling complication and manipulation under anesthesia (MUA) is often performed as an early intervention. Few studies have focused on the revision risk, infection risk, demographics, and clinical outcomes in Medicare patients undergoing MUA following primary TKA.

Methods

We reviewed 142,440 patients who had primary TKA from a national database and identified 3,652 patients (2.6%) who underwent MUA. Patient demographics and comorbid conditions were evaluated to identify risk factors. Incidence of revision and periprosthetic joint infection (PJI) at 1-, 2-, and 5-year time points in a cohort of MUA patients was compared to patients who did not undergo MUA. Multivariate Cox regressions were used for statistical analyses.

Results

The incidence of MUA was higher in Black versus White individuals (4.1 versus 2.5%, P < .001). Revision risk was significantly greater in the MUA group at 1-, 2-, and 5-year time points with a hazard ratio (HR) of, 3.81, 3.90, and 3.22 respectively, P < .001. One- and 2-year revision risk was significantly greater when MUA occurred at 6 to 12 months post-TKA when compared to <3 months, P < .05. Risk of PJI was significantly greater in the MUA group with a HR of 2.2, 2.2, and 2.1 at 1, 2, and 5 years, respectively P < .001.

Conclusion

The incidence of MUA was 2.6%. There was an increased incidence of revision surgery and PJI in patients undergoing MUA. Patients at increased risk for stiffness following TKA should be closely monitored and treated with early intervention to minimize risk of poor outcomes.

中文翻译：

---

初次全膝关节置换术后的操作与感染率和翻修率增加有关

背景

全膝关节置换术 (TKA) 后的僵硬是一种致残并发症，麻醉下操作 (MUA) 通常作为早期干预措施进行。很少有研究关注初次 TKA 后接受 MUA 的 Medicare 患者的翻修风险、感染风险、人口统计学和临床​​结果。

方法

我们从国家数据库中审查了 142,440 名初次接受 TKA 的患者，并确定了 3,652 名 (2.6%) 接受了 MUA 的患者。评估患者人口统计学和合并症以确定风险因素。将一组 MUA 患者与未接受 MUA 的患者在 1 年、2 年和 5 年时间点的翻修和假体周围关节感染 (PJI) 的发生率进行比较。多变量 Cox 回归用于统计分析。

结果

黑人与白人相比，MUA 的发病率更高（4.1 对 2.5%，P < .001）。MUA 组在 1 年、2 年和 5 年时间点的翻修风险显着更高，风险比 (HR) 分别为 3.81、3.90 和 3.22，P < .001。当 MUA 发生在 TKA 术后 6 至 12 个月时，一年和 2 年的翻修风险显着高于 <3 个月，P < .05。MUA 组发生 PJI 的风险显着更高，1 年、2 年和 5 年时的 HR 分别为 2.2、2.2 和 2.1，P < .001。

结论

MUA 的发生率为 2.6%。在接受 MUA 的患者中，翻修手术和 PJI 的发生率增加。应密切监测 TKA 后僵硬风险增加的患者并进行早期干预，以尽量减少不良后果的风险。