MUA to Treat Postoperative Stiffness After Total Knee Arthroplasty

Stiffness is a potential complication following Total Knee Arthroplasty (TKA). While a
variety of factors have been cited as possible causes, such as component malrotation or
improper soft-tissue balancing, however, an etiology is not always appreciated. Histologic
and arthroscopic evidence of fibrosis suggests that an inflammatory process may contribute to
loss of knee range of motion following surgery. Manipulation under anesthesia remains
standard of care for stiffness following TKA. Manipulation shows improved range of motion for
stiffness after total knee arthroplasty, however, patients do not always achieve full range
of motion. Furthermore, repeat manipulation and manipulation greater than 8 weeks
post-surgically have shown limited improvements. Given a possible role of the host
inflammatory response and the importance of early gains in knee range of motion following
total knee arthroplasty, limiting the inflammatory response at the time of manipulation may
improve outcomes. Investigators would like to assess the role of anti-inflammatory
medications to optimize range of motion and outcome for manipulation under anesthesia for
stiffness following TKA.

Inclusion Criteria:

1. Subjects who have received a primary unilateral TKA for a diagnosis of osteoarthritis.

2. MUA's scheduled between 6-10 weeks postoperatively

Exclusion Criteria:

1. Intolerance to NSAIDs

2. Renal dysfunction

3. Age < 18 or > 90 years

4. Primary diagnosis of rheumatoid arthritis

5. Patients with a Glomerular Filtration Rate (GFR) <60 as the cut off for Chronic Kidney
Disease (CKD) (stage 3 CKD)