Perioperative Angiotensin-receptor Blocker Use Shows Decreased Rates of Manipulation Under Anesthesia and Revisions After Total Knee Arthroplasty: A Systematic Review

Background: The purpose of this study was to compare rates of manipulation under anesthesia (MUA) and revision total knee arthroplasty (TKA) in patients undergoing TKA with and without perioperative use of an angiotensin-receptor blocker (ARB). Materials and Methods: Embase and PubMed/MEDLINE were searched, and peer-reviewed studies with a minimum follow-up period of 90 days comparing rates of MUA and revision surgery in patients undergoing TKA with and without perioperative use of an ARB were included. Studies that were not available in English and/or used animal models or cadavers, as well as case reports, non-full text articles, review articles, letters to the editor, and studies reporting data that was non-comparative or lacked outcome measures were excluded. Included studies were evaluated for quality using the Methodological Index for Non-Randomized Studies criteria. Patient demographics, comorbidities, and outcomes were extracted from the included studies. Results: Six studies consisting of 997,086 control patients and 129,874 patients who received perioperative ARB were included. All included studies were at level III evidence. Patients taking an ARB had higher rates of diabetes (42% vs 28%), hypertension (87% vs 58%), obesity (34% vs 23%), and hypercholesterolemia (63% vs 35%) compared to the control groups. The rate of MUA across control patients ranged from 2.8% to 7.6%, compared to 2.5% to 6% in patients taking an ARB. The rate of revision TKA across control patients ranged from 1.4% to 7.6%, whereas the rate for patients taking an ARB ranged from 1.14% to 1.3%. Conclusion: Perioperative ARB use may decrease rates of MUA and revisions after TKA. This study can guide risk stratification and counseling for patients undergoing TKA. Higher-level studies need to be conducted to determine whether ARBs should be prescribed for the sole purpose of preventing arthrofibrosis.