None listed
Conditions
Brief summary
Stiffness post Total Knee Replacement (TKR) can cause quite significant disability in patients and is associated with persistent pain and inability to perform activities of daily living. Stiffness post TKR has been reported between 8 to 25 percent. The standard management for stiffness is aggressive physiotherapy followed by manipulation under anaesthesia (MUA) predominantly when patients' flexion range of movement (ROM) is restricted to less than or equal to 90degrees. MUA entails forced flexion and extension of the knee under anaesthesia to break the scar tissue causing stiffness, resulting in significant acute improvement usually around 5 to 6 weeks post primary total knee replacement. We propose decreasing that threshold of acceptable range of movement post total knee replacement in patients whom would otherwise deal with the restrictions and would not qualify for MUA under current guidelines. Patients will assessed 5-6 week post total knee replacement and those who have a flexion range less than or equal to "'pre-operative flexion' minus 20 degrees" will be included into the study. Patients selected for participation will be primary TKR patients that fall between 90 degrees and the "new range". Participants meeting selection criteria will be randomised into one of two groups; either 'intervention' or 'control' groups Results analysis will focus on range of movement and patient reported outcomes. We intend to follow up patients and record data for a period of 12 months. This will ensure capture of patients that require late manipulation for worsening function, depicted by manual assessment, patient outcome scores and other complications.
Interventions
Patients will assessed 5-6 week post total knee replacement and those who have a flexion range less than or equal to "'pre-operative flexion'- 20 degrees" will be included into the study.
The patients that fit in this group will be randomised into a manipulation or no- manipulation group and we will review the natural progression of their range and function.
The intervention group will undergo manipulation under anaesthesia. This entails an anaesthetic in a surgical theatre environment and, o
Patients will assessed 5-6 week post total knee replacement and those who have a flexion range less than or equal to "'pre-operative flexion'- 20 degrees" will be included into the study. The patients that fit in this group will be randomised into a manipulation or no- manipulation group and we will review the natural progression of their range and function. The intervention group will undergo manipulation under anaesthesia. This entails an anaesthetic in a surgical theatre environment and, once anaesthetised, the patients will have their affected knee flexed and extended by the surgeon to achieve better range of movement by tearing through scar tissue that has developed since their total knee replacement. The surgery should only take 30 mins. The choice of anaesthetic used will be decided by the anaesthetist and the surgeon. It usually includes a sedation agent and mild muscle relaxant. Post-op, they will then undergo physiotherapy as inpatients and on discharge.
Sponsors
Orthopaedic Research Institute of Queensland
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
45 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
Patients selected for participation will be primary TKR patients that fall between 90 degrees and the minimum redefined range. This range will be calcuted by (pre-op flexion-20) expressed in degrees They must be well and fit for the second smaller anaesthetic
Exclusion criteria
Flexion similar to pre-operative range Flexion less than 90 degrees Unfit for second anaesthetic
Outcome results
None listed