The Effects of Perioperative Intra-Articular Corticosteroids During Manipulation Under Anesthesia after Total Knee Arthroplasty: A Retrospective Study.

Abstract

Postoperative stiffness after total knee arthroplasty (TKA) is uncommon, but may lead to major knee dysfunction. Manipulation under anesthesia (MUA) is an effective tool for improving postoperative stiffness. We hypothesized that intra-articular corticosteroid administration during MUA better preserves post-manipulation range of motion (ROM) compared to MUA without a glucocorticoid adjunct. A retrospective review of 103 MUAs by six arthroplasty surgeons at our institution from 2014 to 2023. Patients were included if they underwent MUA after a primary TKA for osteoarthritis (OA) or osteonecrosis (ON) and were excluded from analysis if they had bilateral MUA, MUA after revision TKA, or TKA for post-traumatic osteoarthritis. Patients were separated into groups based on whether they received a concurrent corticosteroid injection (CSI) during MUA. Age, sex, and time to MUA were similar between groups. Range of motion (ROM) was assessed before MUA, intraoperatively following MUA, and at 1-month, 3-month, 6-month, and 1-year follow-up visits. Validated patient-reported outcome measures (PROMs) collected relative to initial TKA were assessed pre-MUA and, three months, and one year after MUA. All patients were screened for complications and reoperations. Compared to patients undergoing MUA without CSI, patients receiving CSI had similar improvement in ROM at one, three, six, and 12 months post-manipulation. There were similar improvements in PROMs between the groups, with the largest improvements observed at one year in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function, Short Form-12 (SF-12) physical, and Knee Society Score (KSS) scores. Complications and reoperations were similar between the groups, and there were no infections associated with intra-articular CSI in our cohort. The use of CSI concurrently with MUA was not associated with improved ROM or PROMs, but demonstrated safety. The benefit of its use may be further elucidated by future randomized controlled trials.