Manipulation under anesthesia is independently associated with development of prosthetic joint infection within 1 year of total knee arthroplasty.

Abstract

Prosthetic joint infection (PJI) is a devastating complication after total knee arthroplasty (TKA). Manipulation under anesthesia (MUA) is a treatment used to address post-operative stiffness following TKA. Association between MUA and development of PJI is controversial. A national claims database (PearlDiver®) was used to isolate TKA and MUA within 4 months of TKA cases using the Current Procedural Terminology (CPT) codes from 2010 to 2022. PJI cases within 1 year of TKA and previously validated risk factors were identified using International Classification of Disease, 9th &10th (ICD-9&10) codes. Chi-square and logistic regression were used for univariable and multivariable analyses respectively. A total of 1,660,301 TKA cases were isolated. MUA within 16 weeks of TKA was performed in 57,113 cases. PJI within 1 year of TKA was diagnosed in 3302 cases. Rate of PJI among patients undergoing MUA (0.26%; n = 146) was significantly (p = 0.002) higher than rate of PJI among patients not undergoing MUA (0.197%; n = 3156). Multivariable analysis showed MUA within 16 weeks to be independently associated with PJI within 1 year of TKA (OR = 1.34; 95% CI: 1.13-1.58; p < 0.001). Male gender (OR = 2.36; 95%CI: 1.7-3.29; p < 0.001), deficiency anemia (OR = 1.75; 95%CI: 0.98-2.93; p = 0.044), rheumatoid arthritis (OR = 3.23; 95%CI: 1.44-6.26; p = 0.002) and blood transfusion (OR = 7.26; 95%CI: 4.28-11.67; p < 0.001) were identified as independent risk factors for development of PJI in this cohort. The ROC-AUC for the model was 0.7. MUA within 16 weeks of TKA is independently associated with development of PJI within 1 year, on multivariable analysis. Further studies will help delineate whether MUA is causative of infection or if stiffness is an early symptom of an already existing, indolent infection.