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Manipulation under anaesthesia and/or lysis of adhesions prior to revision total knee arthroplasty increases the risk of subsequent revision #MMPMID41353733
PURPOSE: The purpose of this study was to determine if prior manipulation under anaesthesia (MUA) and/or lysis of adhesions (LOA) was associated with an increased risk of re-revision following index revision total knee arthroplasty (TKA) in patients that had a diagnosis of arthrofibrosis. METHODS: The PearlDiver Mariner database was queried by Current Procedural Terminology (CPT) and International Classification of Disease (ICD) codes to identify patients who had a diagnosis of arthrofibrosis at the time of revision TKA. Patients were divided into two groups: those with prior MUA and/or LOA and those without prior MUA and/or LOA. The groups were 1:3 propensity score matched by age, gender, anemia, and Elixhauser Comorbidity Index (ECI). The primary outcome was incidence of re-revision TKA at 5 years. Secondary outcomes included periprosthetic joint infection (PJI) at 6 months and 5 years, 90-day hospital readmission, and the incidence of deep vein thrombosis (DVT), blood transfusion, and acute kidney injury (AKI) at 6 months. Logistic regression was used to determine predictors of re-revision TKA. RESULTS: After propensity matching, 2622 patients with a diagnosis of arthrofibrosis underwent index revision TKA without prior MUA and/or LOA and 874 patients underwent index revision after a prior LOA and/or MUA. The incidence of re-revision TKA at 5 years in patients with prior MUA and/or LOA (20% vs. 14%; OR 1.5, 95% confidence interval [CI] [1.3-1.9], p < 0.001) was significantly higher compared to patients with no prior MUA and/or LOA. Predictors of re-revision were age, ECI, and prior MUA and/or LOA (OR: 1.5, 95% CI [1.2-1.9]) (R(2) = 0.21; p < 0.01). No significant differences were observed between groups for PJI at 6 months and 5 years, 90-day hospital readmission, or DVT, blood transfusion, and AKI at 6 months. CONCLUSION: A history of prior MUA and/or LOA, older age, and ECI are associated with a significantly higher risk of re-revision TKA in patients that have a diagnosis of arthrofibrosis at the time of index revision TKA. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
Knee+Surg+Sports+Traumatol+Arthrosc 2025 ; ? (?): ?
