{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T11:26:20Z","timestamp":1782386780298,"version":"3.54.5"},"reference-count":12,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>Stiffness following total knee arthroplasty (TKA) is a common complication that can result in unsatisfactory outcomes. Manipulation under anesthesia (MUA) has been widely employed to treat this problem. It is uncertain whether an association exists between range of motion (ROM) at discharge and need for MUA following primary TKA.<\/jats:p><jats:p>A retrospective review of an institutional joint registry identified cases of primary TKA performed by three surgeons at a single institution over a 22-month period. A logistic regression model was used to examine the association between ROM at discharge and subsequent MUA controlling for confounding variables related to patient demographics and perioperative details. Of the 1,546 cases identified, 113 (7.3%) cases underwent subsequent MUA. As discharge ROM increased, manipulation rates decreased. Patients with discharge flexion &lt;65\u2009degrees were more likely to undergo MUA than those with flexion &gt;90\u2009degrees (odds ratio [OR]\u2009=\u200917.57, 95% confidence interval [CI] [7.97, 38.73], p\u2009&lt;\u20090.0001). The largest differential in odds of MUA was observed between the &lt;65\u2009degrees at discharge group (OR\u2009=\u200917.57) and the 65\u2009\u2264\u200975\u2009degrees at discharge group (OR\u2009=\u20097.89). At discharge ROM of 80\u2009\u2264\u200990\u2009degrees of flexion, patients had more than a twofold increase in odds of MUA relative to those in the &gt;90\u2009degrees group (OR\u2009=\u20092.22, 95% CI [1.20, 4.10], p\u2009=\u20090.011). The results of this study suggest that there is an association between lower ROM at discharge and greater risk of MUA post primary TKA. Counseling patients in regard to discharge ROM and associated risk of MUA may optimize gains in ROM during recovery.<\/jats:p>","DOI":"10.1055\/s-0039-1694024","type":"journal-article","created":{"date-parts":[[2019,8,5]],"date-time":"2019-08-05T06:30:31Z","timestamp":1564986631000},"page":"187-191","source":"Crossref","is-referenced-by-count":5,"title":["Range of Motion at Discharge Predicts Need for Manipulation following Total Knee Arthroplasty"],"prefix":"10.1055","volume":"34","author":[{"given":"Kristen M.","family":"LaHaise","sequence":"additional","affiliation":[{"name":"Department of Research, New England Baptist Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel V.","family":"Vargo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo A.","family":"Barrazueta","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James G.","family":"Nairus","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James V.","family":"Bono","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl T.","family":"Talmo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2019,8,2]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.arth.2013.07.046","article-title":"Clinical, objective, and functional outcomes of manipulation under anesthesia to treat knee stiffness following total knee arthroplasty","volume":"29","author":"K Issa","year":"2014","journal-title":"J Arthroplasty"},{"issue":"08","key":"ref2","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/S0883-5403(98)90196-6","article-title":"Relationship between length of stay and manipulation rate after total knee arthroplasty","volume":"13","author":"D R Mauerhan","year":"1998","journal-title":"J Arthroplasty"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.arth.2015.01.061","article-title":"Manipulation under anesthesia after total knee arthroplasty is associated with an increased incidence of subsequent revision surgery","volume":"30","author":"B C Werner","year":"2015","journal-title":"J Arthroplasty"},{"issue":"08","key":"ref4","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1007\/s00264-014-2421-z","article-title":"How often is functional range of motion obtained by manipulation for stiff total knee arthroplasty?","volume":"38","author":"H-R Choi","year":"2014","journal-title":"Int Orthop"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1186\/1471-2474-12-184","article-title":"Arthrofibrosis after TKA\u2014influence factors on the absolute flexion and gain in flexion after manipulation under anaesthesia","volume":"12","author":"I Ipach","year":"2011","journal-title":"BMC Musculoskelet Disord"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.arth.2017.08.002","article-title":"Risk factors, outcomes, and timing of manipulation under anesthesia after total knee arthroplasty","volume":"33","author":"E T Newman","year":"2018","journal-title":"J Arthroplasty"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.knee.2009.07.001","article-title":"The incidence and results of manipulation after primary total knee arthroplasty","volume":"17","author":"R A Rubinstein Jr","year":"2010","journal-title":"Knee"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"282","DOI":"10.2106\/00004623-200702000-00008","article-title":"Manipulation after total knee arthroplasty","volume":"89","author":"E M Keating","year":"2007","journal-title":"J Bone Joint Surg Am"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1016\/j.arth.2017.11.047","article-title":"Identifying risk factors for the development of stiffness after revision total knee arthroplasty","volume":"33","author":"S B Dowdle","year":"2018","journal-title":"J Arthroplasty"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"164","DOI":"10.5435\/00124635-200405000-00004","article-title":"Stiffness after total knee arthroplasty","volume":"12","author":"M R Bong","year":"2004","journal-title":"J Am Acad Orthop Surg"},{"issue":"07","key":"ref11","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1055\/s-0037-1603793","article-title":"Early outpatient physical therapy may improve range-of-motion in primary total knee arthroplasty","volume":"30","author":"T McGinn","year":"2017","journal-title":"J Knee Surg"},{"issue":"08","key":"ref12","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1016\/j.arth.2010.12.004","article-title":"Effect of body mass index on range of motion and manipulation after total knee arthroplasty","volume":"26","author":"N E Gadinsky","year":"2011","journal-title":"J Arthroplasty"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0039-1694024.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T23:34:08Z","timestamp":1611272048000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0039-1694024"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,2]]},"references-count":12,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2021,1,21]]},"published-print":{"date-parts":[[2021,1]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0039-1694024","relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,2]]}}}