{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T06:47:23Z","timestamp":1787986043240,"version":"build-2784847793"},"reference-count":17,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T00:00:00Z","timestamp":1715644800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HSS Journal\u00ae: The Musculoskeletal Journal of Hospital for Special Surgery"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Manipulation under anesthesia (MUA) is a first-line treatment for stiffness after total knee arthroplasty (TKA), but predicting outcomes after MUA can be difficult.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>We sought to determine the association between pre-MUA range-of-motion (ROM) and the risk of repeat MUA and revision in patients who underwent primary TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a retrospective review of 543 MUAs for stiffness at a single institution. Mean age was 62.5 years, and 64% were female. Second MUA or revision TKA were considered failures of treatment. Penalized logistic regression models were used to assess risk factors for failures. The Kaplan-Meier survivorship was used to examine survivorship free from second MUA or revision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Before and after MUA, there was significant improvement in knee flexion (78.0\u00b0 vs 112.8\u00b0, respectively) and extension (4.1\u00b0 vs 0.8\u00b0, respectively); 6.4% of patients required repeat MUA and 5.3% required revision TKA. Survivorship free of second MUA was 90.9%, revision for stiffness was 92.4%, and all-cause revision was 88.2% at 2 years post-MUA. Patients with pre-MUA flexion contracture of \u22655\u00b0 were more likely to undergo second MUA revision for stiffness and any revision. There were significant improvements in patient-reported outcomes postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This retrospective chart review suggests that MUA is an effective treatment for post-TKA stiffness, with good early survivorship, and that worse pre-MUA ROM is associated with MUA failure and need for repeat MUA or revision. This information may have implications for patient counseling and management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15563316241254086","type":"journal-article","created":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T06:09:09Z","timestamp":1715666949000},"page":"166-173","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Range-of-Motion Predictors for Repeat Manipulation Under Anesthesia and Revision Surgery for Stiffness After Total Knee Arthroplasty"],"prefix":"10.1177","volume":"21","author":[{"given":"Eytan M.","family":"Debbi","sequence":"first","affiliation":[{"name":"Division of Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia K.","family":"Chandi","sequence":"additional","affiliation":[{"name":"Division of Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes D.","family":"Cororaton","sequence":"additional","affiliation":[{"name":"Biostatistics Core, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Biostatistics Core, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey H.","family":"Westrich","sequence":"additional","affiliation":[{"name":"Division of Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter K.","family":"Sculco","sequence":"additional","affiliation":[{"name":"Division of Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2094-3888","authenticated-orcid":false,"given":"Brian P.","family":"Chalmers","sequence":"additional","affiliation":[{"name":"Division of Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,5,14]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"Abdel MP Salmons HI Larson DR et al. The Chitranjan S. Ranawat award: manipulation under anesthesia (MUA) to treat postoperative stiffness after total knee arthroplasty: a multicenter randomized clinical trial [published online ahead of print February 26 2024]. J Arthroplasty. https:\/\/doi.org\/10.1016\/j.arth.2024.02.034.","DOI":"10.1016\/j.arth.2024.02.034"},{"key":"e_1_3_2_3_2","doi-asserted-by":"crossref","unstructured":"Brigati DP Huddleston J Lewallen D et al. Manipulation under anesthesia after total knee: who still requires a revision arthroplasty? J Arthroplast. 2020;35(6):S348\u2013S351. https:\/\/doi.org\/10.1016\/j.arth.2020.03.009.","DOI":"10.1016\/j.arth.2020.03.009"},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","unstructured":"Chalmers BP Goytizolo E Mishu MD Westrich GH. Manipulation under anaesthesia after primary total knee arthroplasty: minimal differences in intravenous sedation alone versus neuraxial anaesthesia. 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J Arthroplasty. 2018;33(5):1598\u20131605. https:\/\/doi.org\/10.1016\/j.arth.2017.11.054.","DOI":"10.1016\/j.arth.2017.11.054"},{"key":"e_1_3_2_10_2","doi-asserted-by":"crossref","unstructured":"Gu A Michalak AJ Cohen JS et al. Prognostic factors that predict failure of manipulation under anesthesia for the stiff total knee arthroplasty: a systematic review. J Orthop. 2018;15(3):842\u2013846. https:\/\/doi.org\/10.1016\/j.jor.2018.08.003.","DOI":"10.1016\/j.jor.2018.08.003"},{"key":"e_1_3_2_11_2","doi-asserted-by":"crossref","unstructured":"Knapp P Weishuhn L Pizzimenti N Markel DC Pizzimenti N. Risk factors for manipulation under anaesthesia after total knee arthroplasty. Bone Joint J. 2020;102(6):66\u201372. https:\/\/doi.org\/10.1302\/0301-620X.102B6.BJJ-2019-1580.R1.","DOI":"10.1302\/0301-620X.102B6.BJJ-2019-1580.R1"},{"key":"e_1_3_2_12_2","doi-asserted-by":"crossref","unstructured":"Martinez-Carranza N Pettas A Razzaz D Brostr\u00f6m E Hedstr\u00f6m M. Younger age is associated with increased odds of manipulation under anesthesia for joint stiffness after total knee arthroplasty. Orthop Traumatol Surg Res. 2019;105(6):1067\u20131071. https:\/\/doi.org\/10.1016\/j.otsr.2019.05.014.","DOI":"10.1016\/j.otsr.2019.05.014"},{"key":"e_1_3_2_13_2","doi-asserted-by":"crossref","unstructured":"Sambandam S Mounasamy V Wukich D. Patients undergoing manipulation after total knee arthroplasty are at higher risk of revision within 2 years. Eur J Orthop Surg Traumatol. 2022;32(1):145\u2013150. https:\/\/doi.org\/10.1007\/s00590-021-02943-z.","DOI":"10.1007\/s00590-021-02943-z"},{"key":"e_1_3_2_14_2","doi-asserted-by":"crossref","unstructured":"Smith EL Banerjee SB Bono JV. Supracondylar femur fracture after knee manipulation: a report of 3 cases. Orthopedics. 2009;32(1):18. https:\/\/doi.org\/10.3928\/01477447-20090101-22.","DOI":"10.3928\/01477447-20090101-22"},{"key":"e_1_3_2_15_2","unstructured":"Therneau TM. 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