Chancy

Folks,
I had to have an MUA and revision on my right TKR this past Tuesday, Jan 30th. I had hit a plateau form week 7 through week 12 at 116 deg passive flexation. During the MUA the doctor and his very strong assistant could not manipulate the leg enough to tear through the scar tissue/soft tissue adhesions. We had talked about this possibility befor surgery thus he went straight in and surgically removed the remaining scar tissue etc, made a adjustment to the femur component and put a slighty thinner pad. Have any of you had to have an MUA with a revision, or not and how did your recovery go.
Tailwinds,
Charlie

Speedskater

Manipulation Under Anesthesia After Total Knee Replacement

https://orthoinfo.aaos.org/en/treatm...er-anesthesia/

Chancy

Speedskater,
How much of a setback was it? Did it reset your recovery clock back to day 1? Did you regain your ROM quicker or with less pain? Sorry I just have a lot of questions.
Tailwinds.
Charlie

Speedskater

Wait.
I had to Google MUA.
That's all I know.

_ForceD_

I hadn’t heard of the MUA either and had to read up on the explanation posted above. I’m currently at 14 weeks post-op for TKR (24 Oct 2023). I’ve been feeling really pretty good with the exception of some stiffness just after prolonged sitting…but my ROM seems quite good. I began back riding just two days after the surgery…slow, indoor stationary the first week…and actually out on the road after that. I’ve been back to my regular distances and pace since then, and I’m thinking that it has helped prevent full onset of MUA. But, now after reading what it is, and how to prevent it…I’m going to double-up on stretching and ROM exercises. — Dan

Chancy

Dan,Yes MUA is not a common thing and discussed even less. According to an NIH study, 2.7% of people having TKRs go on to have an MUA. I suspect among active people the rate of needing an MUA would be less (but I have to data or expertise to back up my assumption). Usually an MUA is performed because the patient’s desired ROM has not been achieved. The study also says it is better to have an MUA sooner rather than later, i.e. having an MUA 12 weeks post TKR results were not as good as 12 weeks out or sooner. My rehab was going slow but good, and at 7 weeks out my passive ROM was 116-118°, yet I was still struggling to get full extension, it was only at 11°. I was walking well without a cane and could climb stairs correctly (alternating L-R or R-L) with just a little pain when descending. Yet I could not safely ride a bike outside. I could ride a recumbent at PT with the seat set way back and an old mountain bike on a trainer at home, again with the seat incredibly high, I had the seat so much higher than the bars it was uncomfortable to ride it for more than 10 minutes though. At PT they would set me up on the recumbent for 10 minutes although I felt like I could ride it forever. My doctor was pleased with this progress. By 11 weeks out I felt I had plateaued and sure enough measurements showed I was still at 116° passive ROM and 6° passive extension. Now my doctor is worried and was I. This whole time I was going to PT 3 days a week and doing home exercises. My doctor was quite surprised and a little disappointed (for as active as I have been, cycling, walking, taking multi-week bike tours in Europe, etc.) he said I was a candidate to breeze through rehab and by 12 weeks have good ROM, and returned to all my level of activity pre-TKR, especially riding.

We decided to go with the MUA and it alone did not achieve satisfactory results (which my doctor suspected might be the case). They opened up my knee and there considerable “tough” scar tissue wrapped around muscle, tendon everywhere. He removed the scar tissue with a scalpel and made an adjustment on the femur component and pad thickness to assist ROM).

Now I am basically back to post TKR day 1, except no home health. I started outpatient PT the day after surgery and I will be going 4 days a week. This is unchartered territory for me. Yes, people do have this revision but you can’t find out much on the net except for studies, and what reads like hospitals and doctors sales brochures. So just curious if others have been down this road, or know of some who has.

Tailwinds,
Charlie