When and How to Mobilize Under Anesthesia After TKA?

Stiffness following total knee arthroplasty is a devastating complication that leads to significant pain, functional limitation, and morbidity. Several risk factors are related to this considerable complication and can be divided into patient-related conditions, intraoperative technical errors, and postoperative causes. Diagnosis of stiffness is based on clinical and radiological evaluation. Primarily, infection and implant malposition should be excluded. Multiple strategies have been proposed to manage stiffness, ranging from conservative treatment to surgery. Manipulation under anesthesia is a safe, reliable, and low-risk treatment option for treating a stiff knee following total knee arthroplasty. There is no clear recommendation for the timing of the procedure. However, it seems more beneficial within 3 months from implantation. Manipulation under anesthesia should be done cautiously and progressively, without excessive force, to avoid complications such as periprosthetic femoral fracture.