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Introduction Stiffness following total knee arthroplasty (TKA) is an incapacitating complication. The prevalence and causes leading to stiffness are not clearly determined. The aim of the study was to ascertain the prevalence, determine the influencing factors, and evaluate the efficacy of manipulation under anaesthesia (MUA) as a treatment option. Method Retrospective review of consecutive series of 1350 primary TKA over a 28-month period. For the purpose of the study, stiffness was defined as flexion contracture of >15 degrees and/or flexion of <75 degrees. Demographic data included co-morbidities, previous knee surgery, pre-operative and post-operative range of movement, anaesthetic techniques and use of nerve blocks, type of prosthesis, ligament balancing including release, mobility post-surgery, patient motivation, physiotherapy, complications, and final range of motion post-MUA. Results Of the 1350 patients evaluated, 33 (2.44%) had stiffness defined by the above-outlined criteria and required intervention. Thirty-one patients (2.29%) underwent MUA as a first-line treatment. No complications arose following MUA. One patient (0.07%) required arthroscopic arthrolysis while another patient (0.07%) required revision arthroplasty due to patellar mal-tracking. Following manipulation, mean flexion contracture decreased from 8 degrees to 3.6 degrees, and mean flexion improved from 51.8 degrees to 93.2 degrees. Arc of motion improved in 100% of patients but it is important to note that multiple manipulations were performed in seven patients. Conclusion Stiffness after TKA can be difficult to treat and can result in prolonged morbidity and dissatisfaction. This retrospective study highlights the effectiveness of manipulation under anaesthesia as a first-line treatment option leading to improved outcomes especially if done early., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Archunan et al.)

Limb amputations are carried out for a number of reasons, which include trauma, vascular disorders, infection, oncology and congenital abnormalities. These patients can develop multiple complications postoperatively with phantom limb pain being a well-recognised issue. That being said, phantom radiculopathy is far less encountered and can therefore be easily overlooked. There are limited cases described in literature and as a result pathophysiology is poorly understood. In this report, we present a patient who had developed phantom radiculopathy decades after his left above knee amputation surgery, which was performed after a road traffic accident. However, we were successfully able to treat the patient with foraminal epidural corticosteroid injection., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)