The results of knee manipulation for stiffness after total knee arthroplasty with or without an intra-articular steroid injection

Background: Stiffness after total knee arthroplasty (TKA) requiring manipulation has a reported incidence of 1.3-54%. The purpose of this study was to compare the incidence of stiffness warranting manipulation using two different pain management protocols. We also studied the effect of an intra-articular injection of local anesthetic and steroid given at the time of manipulation on the range-of-motion (ROM) at last follow-up. Materials and Methods: A total of 286 TKAs (248 patients between January 2002 and December 2003) were compared to a second group of 292 TKAs (251 patients between January 2004 and March 2006). The first group received patient-controlled analgesia (PCA) for postoperative pain management. The second group had a peri-articular injection of a steroid-containing local anesthetic at the time of surgery, but no postoperative PCA. All patients undergoing manipulation in the second group also received a similar intra-articular injection at the time of manipulation as well. Only patients with minimum 12 months follow-up after manipulation were included in the study. Results: The overall incidence of stiffness requiring manipulation in both groups was similar at 2.4% and 2.1%, respectively ( P = 0.1). The end results of manipulation with and without injection showed a significantly higher final ROM in patients who had had an injection at the time of manipulation ( P = 0.001). The difference was due to the fact that patients who had an injection lost no motion from that achieved at the time of manipulation. Conclusion: We were unable to demonstrate a significant reduction in the incidence of stiffness after TKA using a modern pain management protocol. However, injection of a local anesthetic and steroid at the time of manipulation did have a significant influence on preserving the ROM that was obtained at the time of manipulation.