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Introduction: Manipulation under anesthesia (MUA) is a first-line treatment for stiffness after total knee arthroplasty (TKA), but predicting outcomes after MUA can be difficult., Purpose: We sought to determine the association between pre-MUA range-of-motion (ROM) and the risk of repeat MUA and revision in patients who underwent primary TKA., Methods: We conducted a retrospective review of 543 MUAs for stiffness at a single institution. Mean age was 62.5 years, and 64% were female. Second MUA or revision TKA were considered failures of treatment. Penalized logistic regression models were used to assess risk factors for failures. The Kaplan-Meier survivorship was used to examine survivorship free from second MUA or revision., Results: Before and after MUA, there was significant improvement in knee flexion (78.0° vs 112.8°, respectively) and extension (4.1° vs 0.8°, respectively); 6.4% of patients required repeat MUA and 5.3% required revision TKA. Survivorship free of second MUA was 90.9%, revision for stiffness was 92.4%, and all-cause revision was 88.2% at 2 years post-MUA. Patients with pre-MUA flexion contracture of ≥5° were more likely to undergo second MUA revision for stiffness and any revision. There were significant improvements in patient-reported outcomes postoperatively., Conclusions: This retrospective chart review suggests that MUA is an effective treatment for post-TKA stiffness, with good early survivorship, and that worse pre-MUA ROM is associated with MUA failure and need for repeat MUA or revision. This information may have implications for patient counseling and management., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SC, MD, and ADC, MS, declare no potential conflicts of interest. EMD, MD, PhD, declares relationships with DePuy and Ortho Development. JN, MPH, declares relationships Journal of Women’s Sports Medicine and The American Journal of Sports Medicine. GHW, MD, declares relationships with Ethicon, Exactech, Inc, Stryker, Think Surgical, Eastern Orthopedic Association, and The Knee Society. PKS, MD, declares relationships with DePuy, EOS Imaging, Intellijoint Surgical, Lima Corporate, Parvizi Surgical Innovation, and Zimmer. BPC, MD, declares relationships with Orthodevelopment, Smith & Nephew, HSS Journal, and Journal of Arthroplasty., (© The Author(s) 2024.)

Historically, total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been associated with significant perioperative blood loss and a relatively high rate of allogeneic blood transfusions. However, in recent years, tranexamic acid (TXA), a competitive inhibitor of tissue plasminogen activator, inhibiting fibrinolysis of existing thrombi, has substantially decreased the need for blood transfusion in THA and TKA. Various administration strategies have been studied, but there remains a lack of consensus on an optimal route and dosing regimen, with intravenous and topical regimens being widely used. A growing body of literature has demonstrated the safety and efficacy of TXA in primary and revision THA and TKA to reduce blood loss, allogeneic transfusions, and complications; it is associated with lowered lengths of stay, costs, and readmission rates., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: B.P.C. reports relationships with Smith and Nephew, OrthoDevelopment, HSS Journal, and JOA Editorial Board. E.M.D. reports relationships with Ortho Development, DePuy, A Johnson & Johnson Company, and Think Surgical. E.B.G. reports relationships with BICMD, Zimmer, Stryker, American Association of Hip and Knee Surgeons, and International Orthopaedic Education Network. The other authors declared no potential conflicts of interest., (© The Author(s) 2023.)

While total hip arthroplasty (THA) remains effective for improvement of pain and function in patients with osteoarthritis and avascular necrosis, there remain areas of continued pursuit of excellence, including decreasing rates of dislocation, leg length discrepancy, implant loosening, and infection. This review article covers several bearing surfaces and articulations, computer-assisted navigation and robotic technology, and minimally invasive surgical approaches that have sought to improve such outcomes. Perhaps the most significant improvement to THA implant longevity has been the broad adoption of highly cross-linked polyethylene, with low wear rates. Similarly, navigation and robotic technology has proven to more reproducibly achieve intraoperative component positioning, which has demonstrated clinical benefit with decreased risk of dislocation in a number of studies. Given the projected increase in THA over the coming decades, continued investigation of effective incorporation of technology, soft tissue-sparing approaches, and durable implants is imperative to continued pursuit of improved outcomes in THA., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Eytan M. Debbi, MD, reports relationships with Ortho Development and DePuy, a Johnson & Johnson Company. Jason L. Blevins, MD, reports relationships with Globus Medical, KCI, LimaCorporate, and Smith+Nephew. Brian P. Chalmers, MD, reports relationships with Ortho Development and Smith+Nephew. The other authors declare no potential conflicts of interest., (© The Author(s) 2023.)