Postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia.
Autor: | RANTASALO, Mikko T., PALANNE, Riku A., SAINI, Sukhdev, VAKKURI, Anne P., MADANAT, Rami, NOORA, Skants K. |
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Předmět: |
POSTOPERATIVE pain treatment
KNEE joint TOURNIQUETS NARCOTICS PATIENT aftercare TOTAL knee replacement ANESTHESIA RANGE of motion of joints CONFIDENCE intervals HOSPITAL emergency services AGE distribution HEALTH outcome assessment RETROSPECTIVE studies MANIPULATION therapy DESCRIPTIVE statistics QUESTIONNAIRES DRUG utilization ODDS ratio POSTOPERATIVE pain DISEASE risk factors |
Zdroj: | Acta Orthopaedica; 2022, Vol. 93, p432-437, 6p, 5 Charts |
Abstrakt: | Background and purpose -- Manipulation under anesthesia (MUA) is the first-choice treatment for stiffness following total knee arthroplasty (TKA) unresponsive to pain management and physiotherapy. Some of the predisposing factors and patient-reported outcome measures (PROMs) following MUA remain poorly studied. We retrospectively investigated the etiological risk factors and the outcomes of MUA. Patients and methods -- 391 TKA patients from a randomized trial comparing the use of a tourniquet and anesthesia (spinal or general) were analyzed, and patients needing MUA were identified (MUA group). We evaluated in-hospital opioid consumption, Oxford Knee Score (OKS), range of motion (ROM), and pain assessed by the Brief Pain Inventory-short form with a 1-year follow-up. Results -- 39 (10%) MUA patients were identified. The MUA patients were younger (60 years vs. 64 years, difference --4, 95% CI --6 to --1) and had higher postoperative oxycodone consumption (66 mg vs. 51 mg, median difference 11, CI 1--22) than the no-MUA patients. The proportion of MUA patients who contacted the emergency department within 3 months because of pain was larger than that of non-MUA patients (41% vs. 12%, OR 5, CI 3--10). At the 1-year follow-up, the ROM was improved by 39° following MUA, but the total ROM was worse in the MUA group (115° vs. 124°, p < 0.001). No difference was found in the OKS between the MUA and no-MUA patients. Interpretation -- Higher postoperative pain seems to predict MUA risk. MUA performed 3 months postoperatively offers substantial ROM improvement and comparable PROMs to no-MUA patients 1 year after TKA. [ABSTRACT FROM AUTHOR] |
Databáze: | Complementary Index |
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