Manipulation under anaesthesia and/or lysis of adhesions prior to revision total knee arthroplasty increases the risk of subsequent revision.

Abstract

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. 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. 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]) (R² = 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. 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 III, retrospective comparative study.