Page 1 of 3 A New Non-Surgical Alternative to Manipulations Under Anesthesia Following Knee Replacement D Carl Freeman 1 * and Robert J Ference 2 1 Department of Biological Sciences, Wayne State University, USA 2 DMC Harper University Hospital, USA Introduction Arthrofibrosis of the knee, stiff knee, is a common complication of knee surgery, with an incidence rate of 2% to 23% [1]. Stiff knee is usually defined as an inability to flex the knee to 90° [2]. Risk factors for stiff knee include being African American, female, less than 60 years old, nicotine use [3] and multiple surgeries [4]. LaHaise et al. [5] report that discharge range of motion (ROM) is a reliable predictor of stiff knee. However, they also report that BMI is negatively related to the frequency of stiff knee. Whereas Gadinsk et al. [6] report that BMI is strongly positively related to the frequency of stiff knee. These conflicting results suggest there is the possibility of confounding factors involved and that very large sample sizes will be needed to resolve the issue. Recently, Arshi et al. [7] report that patients undergoing outpatient total knee arthroplasty are 28% more likely to have a stiff knee than patients undergoing inpatient knee arthroplasty. Interestingly, Pamilo et al. [8] found that fast-tracked TKA patients did not have an increase in stiff knee (manipulation under anesthesia) rates compared to inpatient total knee replacements. Treatment options available for treating stiff knee, range from physical therapy, manipulation under anesthesia (MUA), arthroscopic lysis, to open lysis, with MUA having the largest gains in ROM [2], especially when performed early and open lysis having the least gain in ROM [2]. MUA is the most common treatment for stiff knee [2,3] and is usually recommended if patients have not achieved 90° of flexion, though the time span for making the assessment ranges from two weeks to over three months post- surgery [2]. Typically, MUAs resulted in patients having 101° of flexion, if performed after six weeks post-surgery [1,4] However Newman et al.4 found that for MUAs performed before six weeks the patients achieved 106.7° ROM. Nevertheless, the average of ROMs failed to reach the 110° of flexion required to perform most activities of daily living [9]. Desai et al. [10], found that 24% of their patients required a second MUA, unfortunately these second MUAs did not lead to gains in ROM. Our purpose here is to introduce the new non-surgical, low pain alternative to MUAs, the in home X10 knee rehabilitation machine (Figure 1). This computer-controlled device has a robotic arm that is moved by pressure to incrementally increase the range of motion. Once the patient has established their maximum pressure threshold, the machine will use that amount of force to move the patient’s leg (controllable to within one pound of pressure and one degree of flexion). However, as the session progresses the pressure needed to reach a given degree of flexion declines, enabling the patient to increase their flexion and then gradually increase the *Corresponding author : D. Carl Freeman, Department of Biological Sciences, Wayne State University, Detroit MI 48202, USA. Received Date: November 28, 2019 Published Date: December 05, 2019 ISSN: 2687-816X DOI: 10.33552/GJOR.2019.02.000528 Global Journal of Orthopedics Research Research Protocol Copyright © All rights are reserved by D. Carl Freeman This work is licensed under Creative Commons Attribution 4.0 License GJOR.MS.ID.000529. Abstract Stiff knee occurs in between 2% and 23% of total knee arthroplasty patients. Resolution of a stiff knee is critical for patients’ quality of life following a TKA. Historically, treatment options include physical therapy, manipulation under anesthesia, arthroscopic lysis, and open lysis. Excluding physical therapy, the other options all require anesthesia, with procedures usually being done in a hospital or surgical center. Here, we report on a new non-surgical alternative that is done in patients’ homes and is as efficacious as a manipulation under anesthesia. Keywords: Stiff knee; Manipulation under anesthesia; X10; Total knee arthroplasty; Flexion