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MUA 1-1/2 years post TKR

Posted by oceanspruce @oceanspruce, Feb 25 8:50am

I had a total knee replacement in August 2022. That surgery has left me with various complications I never had pre-surgery, including significant anterior (frontal patellar) tendinitis and significant posterior arthrofibrosis that restricts knee flexion to just over 90 degrees. Additionally, there's significant pain when the joint bends or rotates in very typical ways such as going up or down stairs, getting into or out of a car, or putting on or taking off pants and shoes. I'm currently scheduled to undergo an MUA (manipulation under anesthesia) three weeks from now to try to stretch the anterior tendons and potentially break up the posterior fibrous tissue in order to increase flexion. Does anyone have any idea whether this procedure has any chance of success so far out from surgery? Normally MUAs are performed within a three to six month window post TKR.

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Moderator
Justin McClanahan, Moderator | @JustinMcClanahan | Feb 26 9:23am

Hello @oceanspruce. This article might help provide a bit more information on the successes of MUA in relation to time from the original surgery, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9214639/.

It does state that "We found that ROM improved substantially after MUA. The gain in flexion decreased as the time between TKA and MUA increased." It is difficult to know the true outcome for each of us as we all heal so differently. I had my knee replaced in 2006 and had terrible issues with scar tissue formation. I underwent two MUAs with mixed results. I also attribute my poor recovery more to being young and not aggressive enough in my rehab. In 2006, I was told that manipulations were more successful in the first 12 months and after that there was some risk to bone fractures from the scar tissue becoming too strong for manipulation over time. This protocol may not apply to everyone and has possibly changed as 18 years in the medical field can be an eternity.

I'd like to invite @mpirruccel and @captjamesh to this discussion to share their experiences either with scar tissue and ROM issues or a MUA.

@oceanspruce - Were any other options discussed with you? I remember there being an option for surgical removal of the scar tissue, but ultimately I decided against the risk of infection and further surgery. Has this been discussed with you at all? Have the risks of an MUA this far out from your surgery been discussed as well?

REPLY
1 reply
oceanspruce | @oceanspruce | Feb 26 10:16am
In reply to @JustinMcClanahan "Hello @oceanspruce. This article might help provide a bit more information on the successes of MUA..." + (show)
@JustinMcClanahan

Hello @oceanspruce. This article might help provide a bit more information on the successes of MUA in relation to time from the original surgery, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9214639/.

It does state that "We found that ROM improved substantially after MUA. The gain in flexion decreased as the time between TKA and MUA increased." It is difficult to know the true outcome for each of us as we all heal so differently. I had my knee replaced in 2006 and had terrible issues with scar tissue formation. I underwent two MUAs with mixed results. I also attribute my poor recovery more to being young and not aggressive enough in my rehab. In 2006, I was told that manipulations were more successful in the first 12 months and after that there was some risk to bone fractures from the scar tissue becoming too strong for manipulation over time. This protocol may not apply to everyone and has possibly changed as 18 years in the medical field can be an eternity.

I'd like to invite @mpirruccel and @captjamesh to this discussion to share their experiences either with scar tissue and ROM issues or a MUA.

@oceanspruce - Were any other options discussed with you? I remember there being an option for surgical removal of the scar tissue, but ultimately I decided against the risk of infection and further surgery. Has this been discussed with you at all? Have the risks of an MUA this far out from your surgery been discussed as well?

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Thanks, Justin, for your helpful reply and attached article. I'll read the article as soon as I get out of work today.

My surgeon did discuss potential risks of MUAs, particularly the overstretching or tearing of soft tissues (i.e., tendons, ligaments) and the fracturing of the femur. He said the MUA wouldn't loosen the knee prosthetic, but that I'd likely leave the MUA appointment having to walk with a cane for a while and that I'd definitely have to restart physical therapy right afterwards.

He also discussed orthoscopic surgery. Four anterior incisions would be made to either side and above and below the patella to perform "tendon release" using rotary shaving tools. Just like you, my surgeon and I think the risk of infection with such surgery is reason for caution, so both he and I think an MUA might be the better option.

Scott

REPLY
ezas123 | @ezas123 | Feb 27 8:59am

Hi I had a mua with my first tkr I was at 65 flexion could not get anywhere with therapy I was 6 weeks out of surgery….. for me made it worse … two or three days after procedure therapy told me stay home I was so swollen and lost flexion….. after that went for second opinion found out my tkr was 2-3 sizes too big with year went got another tkr now I am at 105 almost full extension ….. I suffer from scar tissue having to have tkr twice so I do mfr, graston and a lot of exercise…. Always work in progress lol but so much happier now ….. but don’t give up …. Be prepared mua is tuff may have set back at first but hopefully after swelling passes you will have move flexion …..good luck

REPLY
1 reply
oceanspruce | @oceanspruce | Feb 27 10:17pm
In reply to @ezas123 "Hi I had a mua with my first tkr I was at 65 flexion could not..." + (show)
@ezas123

Hi I had a mua with my first tkr I was at 65 flexion could not get anywhere with therapy I was 6 weeks out of surgery….. for me made it worse … two or three days after procedure therapy told me stay home I was so swollen and lost flexion….. after that went for second opinion found out my tkr was 2-3 sizes too big with year went got another tkr now I am at 105 almost full extension ….. I suffer from scar tissue having to have tkr twice so I do mfr, graston and a lot of exercise…. Always work in progress lol but so much happier now ….. but don’t give up …. Be prepared mua is tuff may have set back at first but hopefully after swelling passes you will have move flexion …..good luck

Jump to this post

Thank you for your feedback. I appreciate learning of others' firsthand experiences with both TKRs and MUAs, whether they be positive or negative.

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