ArticleActa orthopaedica2026
Risk factors for manipulation under anesthesia after total knee arthroplasty and subsequent revision arthroplasty: a Finnish register-based study of 154,883 patients.
Article in Acta orthopaedica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
background and purposeStiffness after total knee arthroplasty (TKA) is a common early complication and multiple risk factors are recognized. We aimed to investigate the risk factors for manipulation under anesthesia after primary TKA and for the subsequent revision TKA in patients requiring manipulation using national healthcare registers.
methodsWe used the comprehensive register data of the PERFECT project that included data from the Finnish arthroplasty register (FAR) and the Care Register of Health Care (CRHC). We excluded patients under 40 years old. The Aalen-Johansen estimator and Cox proportional hazards regression model were used in the risk assessment.
results154,883 patients had primary TKA in Finland in 1999-2020 , of which 3,861 patients required manipulation within 1 year of primary TKA. The 1-year cumulative incidence of manipulation was 2.5%. In the multivariable analysis, female sex (hazard ratio [HR] 1.53, CI 1.42-1.64), diabetes mellitus (HR 1.19, CI 1.08-1.31), coronary artery disease (HR 1.25, CI 1.12-1.39), and hypercholesterolemia (HR 1.16, CI 1.06-1.28) were associated with an increased risk of manipulation. Increasing age was associated with a decreased risk of manipulation (multivariable HR 0.94 per year, CI 0.94-0.94). Patients requiring manipulation within 1 year of primary TKA had a significantly increased risk of revision TKA (HR 2.26, CI 2.05-2.50). The 10-year cumulative risk of revision TKA after manipulation was 15% (CI 14-16).
conclusionManipulation was more likely to be performed for females, relatively younger patients, and patients with diabetes mellitus, coronary artery disease, or hypercholesterolemia. Patients who had manipulation within 1 year of primary TKA had an increased risk of revision with a 10-year cumulative risk of revision of 15%.
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