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Michael A. Mont - One of the best experts on this subject based on the ideXlab platform.

  • Does Manipulation under Anesthesia Increase the Risk of Revision Total Knee Arthroplasty? A Matched Case Control Study.
    The journal of knee surgery, 2017
    Co-Authors: Todd P Pierce, Kimona Issa, Anthony Festa, Anthony J Scillia, Vincent K Mcinerney, Michael A. Mont
    Abstract:

    Manipulation under Anesthesia (MUA) can help patients regain an adequate range of motion (ROM) following total knee arthroplasty (TKA). Although there are studies reporting that MUA can assist in improving ROM, there is a paucity of studies regarding whether requiring an MUA is associated with an increased risk of revision. The purpose of this study was to assess the: (1) incidence of revision TKA and (2) outcomes of those undergoing MUA and compare it with a matched cohort who did not require MUA. A prospectively collected database of two high-volume institutions was assessed for patients who required a single MUA following TKA between 2005 and 2011. We found a total of 138 knees with a mean 8.5-year follow-up post-MUA. We compared this with a matched cohort (1:1) who underwent TKA during this same time period but did not require an MUA. Incidence of revision surgery and clinical outcomes were compared between the two cohorts. Within the MUA cohort, nine knees underwent revision, which was similar to the matched cohort that had seven revisions (93 vs. 95%; p = 0.6). The mean KSS-functional (88 vs. 90 points; p = 0.15) and clinical scores (87 vs. 89 points; p = 0.1) were similar between the two cohorts. undergoing an MUA was not associated with an increased risk of revision TKA. If patients require MUA, they may still achieve satisfactory outcomes. This information can be used in educating patients so they may be able to formulate their expectations following their MUA.

  • Innovative Multi-Modal Physical Therapy Reduces Incidence of Manipulation under Anesthesia (MUA) in Non-Obese Primary Total Knee Arthroplasty.
    Surgical technology international, 2016
    Co-Authors: Tanner Mcginn, Morad Chughtai, Anil Bhave, Anton Khlopas, Osman Ali, Prathik Mudaliar, Steven F. Harwin, Michael A. Mont
    Abstract:

    Introduction Patients may experience knee stiffness following total knee arthroplasty (TKA). Non-operative measures, such as more physical therapy and special splints are warranted in such cases. In the event of failure of these measures to restore knee range of motion, more invasive procedures with higher risks, such as Manipulation under Anesthesia (MUA) or repeat surgery, can be utilized. Thus, it becomes essential to optimize their non-operative measures in order to avoid more invasive, riskier options. Therefore, the purpose of this study was to evaluate and compare: 1) range of motion, and 2) the rate of MUA in patients who either underwent a multi-modal physical therapy regimen (IMMPT) or standard-of-care post-operative therapy (standard) following primary total knee arthroplasty. Materials and methods We analyzed all non-obese patients who underwent primary TKAs between January 2013 and December 2014 at our institution who started an outpatient physical therapy program within six weeks of their surgery (n = 127 knees). There were 86 women and 41 men who had a mean age of 67 years (range, 42 to 88 years). This cohort was stratified into those who underwent an IMMPT regimen at our institution (n= 47) and those who underwent standard therapy at an outside institution (N = 80). The range of motion and rate of Manipulation between the two groups was compared by using Chi-square and Student's t-test, as appropriate. Results There were similar proportions of those who had an optimal range of motion (≥110 degrees flexion and ≤5 degrees extension) in the IMMPT group as compared to the standard physical therapy cohort (81% vs. 82%). The IMMPT cohort had a significantly lower proportion of patients who underwent MUA as compared to the standard therapy cohort (2% vs. 13%). Conclusions This study shows an IMMPT protocol utilizing Astym® therapy (Performance Dynamics, Inc. Muncie, Indiana) is able to significantly reduce the rate of Manipulation following a total knee arthroplasty. Furthermore, this IMMPT approach was also able to achieve similar range of motion to the standard physical therapy group while reducing the rate of Manipulation, which may indicate similar efficacy in restoring range of motion. Comparative randomized studies are needed to determine the true benefit of this IMMPT protocol.

  • The Effect of Timing of Manipulation under Anesthesia to Improve Range of Motion and Functional Outcomes Following Total Knee Arthroplasty
    2016
    Co-Authors: Ronald E. Delanois, Michael A. Mont
    Abstract:

    Background: Manipulation under Anesthesia has been reported to improve range of motion when other rehabilitative efforts fail to obtain adequate motion after total knee arthroplasty. The purpose of this study was to evaluate the effects of the timing of the Manipulation on knee range of motion and clinical outcomes

  • Innovative Multimodal Physical Therapy Reduces Incidence of Repeat Manipulation under Anesthesia in Post-Total Knee Arthroplasty Patients Who Had an Initial Manipulation under Anesthesia.
    The journal of knee surgery, 2016
    Co-Authors: Morad Chughtai, Tanner Mcginn, Anil Bhave, Sabahat Khan, Megha Vashist, Anton Khlopas, Michael A. Mont
    Abstract:

    Manipulation under Anesthesia (MUA) is performed for knee stiffness following a total knee arthroplasty (TKA) when nonoperative treatments fail. It is important to develop an optimal outpatient physical therapy protocol following an MUA, to avoid a repeat procedure. The purpose of this study was to evaluate and compare: (1) range of motion and (2) the rate of repeat MUA in patients who either underwent innovative multimodal physical therapy (IMMPT) or standard-of-care physical therapy (standard) following an MUA after a TKA. We performed a retrospective database study of patients who underwent an MUA following a TKA between January 2013 to December 2014 (N = 57). There were 16 (28%) men and 41 (72%) women who had a mean age of 59 years (range, 32-81 years). The patients were stratified into those who underwent IMMPT (n = 22) and those who underwent standard physical therapy (n = 35). The 6-month range of motion and rate of repeat Manipulation between the two cohorts was analyzed by using Student t-test and Chi-square tests. In addition, we performed a Kaplan-Meier analysis of time to repeat MUA. The IMMPT cohort had a statistically significant higher proportion of TKAs with an optimal range of motion as compared with the standard cohort. There was statistically significant lower proportion of patients who underwent a repeat MUA in the IMMPT as compared with the standard cohort. There was also a significantly lower incidence and longer time to MUA in the IMMPT cohort as compared with the standard cohort in the Kaplan-Meier analysis. The group who underwent IMMPT utilizing Astym therapy had a significantly higher proportion of patients with optimal range of motion, which implies the potential efficacy of this regimen to improve range of motion. Furthermore, the IMMPT cohort had a significantly lower proportion of repeat Manipulations as compared with the standard cohort, which implies that an IMMPT approach could potentially reduce the need for a repeat MUA. These findings warrant further investigation into outcomes of different rehab approaches.

  • The effect of timing of Manipulation under Anesthesia to improve range of motion and functional outcomes following total knee arthroplasty.
    The Journal of bone and joint surgery. American volume, 2014
    Co-Authors: Kimona Issa, Ronald E. Delanois, Samik Banerjee, Mark Kester, Harpal S. Khanuja, Michael A. Mont
    Abstract:

    Background: Manipulation under Anesthesia has been reported to improve range of motion when other rehabilitative efforts fail to obtain adequate motion after total knee arthroplasty. The purpose of this study was to evaluate the effects of the timing of the Manipulation on knee range of motion and clinical outcomes. Methods: All 2128 total knee arthroplasties performed at our institution from 2005 to 2011 were reviewed to determine the number of patients who had undergone Manipulation under Anesthesia. A total of 144 Manipulations in eighty-eight women and forty-five men were reviewed. Manipulations under Anesthesia that were performed within the first twelve weeks after total knee arthroplasty were considered early and those after that period were considered late. Patients were further substratified according to the timing of the Manipulation: Group I included those who had the Manipulation within six weeks; Group II, at seven to twelve weeks; Group III, at thirteen to twenty-six weeks; and Group IV, after twenty-six weeks. Outcomes evaluated included gains in flexion and final range of motion, and Knee Society objective and function scores between early and late Manipulation, using various adjusted multivariable regression models and at a mean follow-up of fifty-one months (range, twelve to eighty-one months). Mediation analysis was used to investigate whether gains in range of motion from the Manipulations under Anesthesia alone had mediated the effect between the timing of the Manipulation and the clinical outcomes. Results: Patients who underwent early Manipulation had a significantly higher mean gain in flexion (36.5° versus 17°), higher final range of motion (119° versus 95°), and higher Knee Society objective (89 versus 84 points) and function scores (88 versus 83 points) than those who had late Manipulation under Anesthesia. There were no significant differences in the outcomes of Groups I and II. Manipulations after twenty-six weeks resulted in unsatisfactory clinical outcomes. Multivariable regression analyses confirmed significantly better clinical outcomes with early Manipulation. Mediation analysis showed that the timing of Manipulation independently had significantly contributed to the outcomes. Conclusions: Orthopaedic surgeons should have a low threshold for performing early Manipulations with the patient under Anesthesia within twelve weeks after an arthroplasty, to achieve higher knee range of motion and improved clinical outcomes. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Peter K. Sculco - One of the best experts on this subject based on the ideXlab platform.

  • Prognostic factors that predict failure of Manipulation under Anesthesia for the stiff total knee arthroplasty: A systematic review.
    Journal of orthopaedics, 2018
    Co-Authors: Adam J. Michalak, Jordan S. Cohen, Jeffrey G. Stepan, Neil D. Almeida, Alexander S. Mclawhorn, Peter K. Sculco
    Abstract:

    Abstract Purpose Prognostic factors associated with Manipulation under Anesthesia (MUA) failure remain unknown. Methods A systematic review of the literature was performed to identify studies that reported prognostic factors associated with MUA for postoperative stiffness. Results 7 studies analyzing prognostic factors associated with MUA outcomes were included. Several studies note pre-MUA ROM to be a significant prognostic factor affecting post-MUA ROM at final follow-up. Knees with 70°. Conclusions The strongest prognostic factor for decreased ROM after MUA is severe pre-MUA stiffness.

  • Type of Anticoagulant Used After Total Knee Arthroplasty Affects the Rate of Knee Manipulation for Postoperative Stiffness.
    The Journal of bone and joint surgery. American volume, 2018
    Co-Authors: Cynthia A. Kahlenberg, Shawn S. Richardson, William W. Schairer, Peter K. Sculco
    Abstract:

    BACKGROUND The aim of this study was to perform a population-level analysis on the effect of different types of anticoagulation on postoperative stiffness after total knee replacement, requiring Manipulation under Anesthesia. We hypothesized that patients receiving warfarin would have a higher rate of Manipulation under Anesthesia compared with patients receiving low-molecular-weight heparin. We also hypothesized that aspirin, direct factor Xa inhibitors, and fondaparinux would have no effect on the rate of Manipulation under Anesthesia. METHODS Using the PearlDiver patient database, we analyzed 32,320 patients who underwent a primary unilateral total knee replacement from 2007 to 2015. Patients were included if they filled a prescription for anticoagulation medication within 2 days of their discharge and were excluded if they were taking a prescription anticoagulation medication (except for aspirin) in the 3 months before total knee replacement. The primary outcome was Manipulation under Anesthesia performed within 6 months after a primary total knee replacement. RESULTS The most commonly prescribed postoperative anticoagulation was warfarin (38.0%), followed by low-molecular-weight heparin (33.8%). There were 1,178 patients (3.64%) who underwent Manipulation under Anesthesia within 6 months of total knee replacement. In multivariable analysis using low-molecular-weight heparin as a comparison group and accounting for age, sex, comorbidities, and length of stay, there was a significant increase in the risk of Manipulation under Anesthesia for patients who received warfarin (hazard ratio [HR], 1.17 [95% confidence interval (CI), 1.01 to 1.36]; p = 0.032), direct factor Xa inhibitors (HR, 1.42 [95% CI, 1.20 to 1.66]; p < 0.001), or fondaparinux (HR, 1.33 [95% CI, 1.01 to 1.72]; p = 0.038). Although patients who received aspirin had the same risk estimate as patients who received warfarin, there was not a significantly increased risk of Manipulation under Anesthesia in patients who received aspirin compared with low-molecular-weight heparin (HR, 1.17 [95% CI, 0.72 to 1.80]; p = 0.493). CONCLUSIONS We found an increased rate of Manipulation under Anesthesia after total knee replacement in patients who received oral anticoagulants including warfarin, direct factor Xa inhibitors, and fondaparinux, in comparison with patients who received aspirin or low-molecular-weight heparin. We recommend that patients receiving oral anticoagulants after total knee replacement should be counseled about associated stiffness. Furthermore, surgeons should take these data into account when selecting thromboprophylaxis for patients after total knee replacement. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  • Efficacy of Manipulation under Anesthesia for Stiffness Following Total Knee Arthroplasty: A Systematic Review.
    The Journal of arthroplasty, 2017
    Co-Authors: Adam J. Michalak, Jordan S. Cohen, Neil D. Almeida, Alexander S. Mclawhorn, Peter K. Sculco
    Abstract:

    Abstract Background Knee stiffness following primary total knee arthroplasty can lead to unsatisfactory patient outcomes secondary to persistent pain and loss of function. Manipulation under Anesthesia (MUA) remains a viable option for treatment of post-operative stiffness. However, the optimal timing and clinical efficacy of Manipulation of Anesthesia remains unknown. Methods A systematic review of the literature was performed to identify studies that reported clinical outcomes for patients who underwent MUA for post-operative stiffness treatment. Repeat MUA procedures were included in the study but were analyzed separately. Results Twenty-two studies (1488 patients) reported on range of motion (ROM) after MUA, and 4 studies (81 patients) reported ROM after repeat MUA. All studies reported pre-MUA motion of less than 90°, while mean ROM at last follow-up exceeded 90° in all studies except 2. For studies reporting ROM improvement following repeat MUA, the mean pre-Manipulation ROM was 80° and the mean post-Manipulation ROM was 100.6°. Conclusion MUA remains an efficacious, minimally invasive treatment option for post-operative stiffness following TKA. MUA provides clinically significant improvement in ROM for most patients, with the best outcomes occurring in patients treated within 12 weeks post-operatively. Prospero Registration Number CRD42016052215.

Timo Pohjolainen - One of the best experts on this subject based on the ideXlab platform.

  • Manipulation under Anesthesia with home exercises versus home exercises alone in the treatment of frozen shoulder: a randomized, controlled trial with 125 patients.
    Journal of shoulder and elbow surgery, 2007
    Co-Authors: Jorma Kivimäki, Timo Pohjolainen, Antti Malmivaara, Mikko Kannisto, Jacques Guillaume, Seppo Seitsalo, Maunu Nissinen
    Abstract:

    We aimed to determine the effect of Manipulation under Anesthesia in frozen shoulder patients. A blinded randomized trial with a 1-year follow-up was performed at 3 referral hospitals in Southern Finland. We randomly assigned 125 patients with clinically verified frozen shoulder to the Manipulation group (n = 65) or control group (n = 60). Both the intervention group and the control group were instructed in specific therapeutic exercises by physiotherapists. Clinical data were gathered at baseline and at 6 weeks and 3, 6, and 12 months after randomization. The 2 groups did not differ at any time of the follow-up in terms of shoulder pain or working ability. Small differences in the range of movement were detected in favor of the Manipulation group. Perceived shoulder pain decreased during follow-up equally in the 2 groups, and at 1 year after randomization, only slight pain remained. Manipulation under Anesthesia does not add effectiveness to an exercise program carried out by the patient after instruction.

  • Manipulation under Anesthesia for frozen shoulder with and without steroid injection
    Archives of physical medicine and rehabilitation, 2001
    Co-Authors: Jorma Kivimäki, Timo Pohjolainen
    Abstract:

    Abstract Kivimaki J, Pohjolainen T. Manipulation under Anesthesia for frozen shoulder with and without steroid injection. Arch Phys Med Rehabil 2001;82:1188-90. Objective: To study the effect of manipulating a shoulder with adhesive capsulitis (frozen shoulder) under Anesthesia with and without corticosteroid injection. Design: Randomized trial. Setting: Hospital. Participants: Twenty-four patients referred for Manipulation of a frozen shoulder. Intervention: The patients were randomized into 2 groups. One group received an injection of corticosteroid and Manipulation; the other was only administered Manipulation during Anesthesia. Main Outcome Measures: The degree of shoulder mobility and pain before and after the Manipulation. Results: Manipulation under Anesthesia increased the mobility of the affected shoulder. Injection with lidocaine and betamethason did not enhance the effect of the Manipulation. Conclusion: Manipulation under Anesthesia without intraarticular corticosteroids is recommended as the therapy for frozen shoulder. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Michael J. Bronson - One of the best experts on this subject based on the ideXlab platform.

  • CORR Insights®: Do Various Factors Affect the Frequency of Manipulation under Anesthesia After Primary Total Knee Arthroplasty?
    Clinical orthopaedics and related research, 2014
    Co-Authors: Michael J. Bronson
    Abstract:

    T he gold standard for the surgical treatment of patients with advanced arthritis remains TKA. Its reliability in relieving pain and improving function in the shortand long-term is well proven. Despite our best efforts, however, joint replacement surgery is not without its complications. In particular, the development of arthrofibrosis can be substantially disabling to the 1% to 12% [2, 6, 9] of patients who develop it. The etiology is multifactorial, often unknown, and frequently resistant to treatment. There is a large quantity of literature on arthrofibrosis. Recent studies [11] have identified both patient-dependent and independent risk factors, which include limited ROM preoperatively, prior knee surgery, complex regional pain syndrome, lack of patient compliance with therapy, and diminished patient pain threshold. Other patientrelated factors associated with the development of arthrofibrosis include nonwhite race younger than 65 years of age, diabetes, hypercholesterolemia, and smoking [5]. Technical factors include ‘‘overstuffing’’ the knee (both tibiofemoral and patellofemoral compartments), component malalignment in all planes, instability, balance flexion-extension gap failure, joint line elevation, infection, and heterotopic ossification [10]. But even when these risk factors are absent, some patients can still develop the condition through an exaggerated fibroblastic response, tissue metaplasia, or revision interventions [4]. Numerous treatments options have been used, but their results are inconsistent. These options include Manipulation under Anesthesia with or without arthroscopic intervention, open arthrolysis, and revision surgery [3].

  • How to Treat the Stiff Total Knee Arthroplasty?: A Systematic Review
    Clinical orthopaedics and related research, 2010
    Co-Authors: Sean E. Fitzsimmons, Edward A. Vazquez, Michael J. Bronson
    Abstract:

    Background Multiple modalities have been used to treat the stiff TKA, including Manipulation under Anesthesia (MUA), arthroscopy, and open arthrolysis.

Tain-hsiung Chen - One of the best experts on this subject based on the ideXlab platform.

  • comparison of idiopathic post trauma and post surgery frozen shoulder after Manipulation under Anesthesia
    International Orthopaedics, 2007
    Co-Authors: Jung-pan Wang, Tung-fu Huang, Shih-chieh Hung, Tain-hsiung Chen
    Abstract:

    Manipulation under Anesthesia (MUA) has been used to speed up the recovery of frozen shoulder, which is said to be a self-limiting process. We would like to elucidate the short- and long-term results of the treatment of frozen shoulders by Manipulation under Anesthesia and compare the results of idiopathic, post-trauma and post-surgery frozen shoulders. We applied an adjusted Constant score (Constant score after excluding the 25 points allocated for the assessment of muscle strength) to assess all patients. In our series, 47 cases with 51 frozen shoulders were collected and evaluated retrospectively. The adjusted Constant score at pre-Manipulation was on average 22.8±4.9 (10–31) points. The score from the 3-week follow-up was 52.6±9.2 (31–67) points on average. The score from the averaged 82-month follow-up was on average 70.1±6.2 (54–75) points, with 23 shoulders scored for a maximum point number of 75. The score at the early and late follow-ups was significantly lower for the post-surgery group (63.2±6.7) when compared to the other two groups (P<0.001). Our results revealed that Manipulation under anestheia is a very simple and noninvasive procedure for shortening the course of an apparently self-limiting disease and can improve shoulder function and symptoms within a short period of time. However, we found less improvement in post-surgery frozen shoulders, especially in residual pain and limited range of motion (ROM), which may be influenced by the initial injury or initial surgery. Although less improvement in pain and ROM was noted, Manipulation is still a good and simple way to treat post-surgery frozen shoulders.

  • Comparison of idiopathic, post-trauma and post-surgery frozen shoulder after Manipulation under Anesthesia
    International orthopaedics, 2006
    Co-Authors: Jung-pan Wang, Tung-fu Huang, Shih-chieh Hung, Tain-hsiung Chen
    Abstract:

    Manipulation under Anesthesia (MUA) has been used to speed up the recovery of frozen shoulder, which is said to be a self-limiting process. We would like to elucidate the short- and long-term results of the treatment of frozen shoulders by Manipulation under Anesthesia and compare the results of idiopathic, post-trauma and post-surgery frozen shoulders. We applied an adjusted Constant score (Constant score after excluding the 25 points allocated for the assessment of muscle strength) to assess all patients. In our series, 47 cases with 51 frozen shoulders were collected and evaluated retrospectively. The adjusted Constant score at pre-Manipulation was on average 22.8±4.9 (10–31) points. The score from the 3-week follow-up was 52.6±9.2 (31–67) points on average. The score from the averaged 82-month follow-up was on average 70.1±6.2 (54–75) points, with 23 shoulders scored for a maximum point number of 75. The score at the early and late follow-ups was significantly lower for the post-surgery group (63.2±6.7) when compared to the other two groups (P