Ladymayin
new member
Saw my doc today, one year after TKR. Recommends manipulation. I can flex between 95 and 100. Appreciate any input regarding manipulation outcomes, pain after, and how to continue exercise. Thanks to all who respond.
MUA Manipulation after one year TKR
- Thread starter Ladymayin
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maryo52
Former BoneSmart staff member
Hi ladymayin. Well you've been through a lot of frustration, I imagine. I had < 90 ROM for 4-5 months and felt pretty low about it.
When an ortho does a manipulation, they put you under and, I'm told, grab the leg just below the knee and gentle push the leg to bend, to break adhesions. It takes minutes or less. Ideally it's a fairly gentle effort and only pushed as necessary to break those adhesions. Those muscles have had a limited life all this time and so you will get the essence of muscle strain out of the deal, which can be treated with ice, elevation and NSAIDs, and narcotic pain med as needed.
It' tempting to then try to push the leg to bend but most people here have found that you have to go gently. There is an initial backlash (swelling, pain) after MUA and limited ROM (although the OS may have gotten a good number during the procedure). Eventually when things settle down you can slowly work on better ROM.
I'm curious about the PT efforts to get bend over the past year. It would provide some possibly important background to know. Interesting also that many orthos will not perform this procedure at this point. I'm guessing you have a pretty conservative ortho, which is a good thing.
If it weren't for pain and guarding, these could be done in the office (!!) My ortho said when he first practiced that's what they did.
So fear not. This is the best next step to make things better for you.
When an ortho does a manipulation, they put you under and, I'm told, grab the leg just below the knee and gentle push the leg to bend, to break adhesions. It takes minutes or less. Ideally it's a fairly gentle effort and only pushed as necessary to break those adhesions. Those muscles have had a limited life all this time and so you will get the essence of muscle strain out of the deal, which can be treated with ice, elevation and NSAIDs, and narcotic pain med as needed.
It' tempting to then try to push the leg to bend but most people here have found that you have to go gently. There is an initial backlash (swelling, pain) after MUA and limited ROM (although the OS may have gotten a good number during the procedure). Eventually when things settle down you can slowly work on better ROM.
I'm curious about the PT efforts to get bend over the past year. It would provide some possibly important background to know. Interesting also that many orthos will not perform this procedure at this point. I'm guessing you have a pretty conservative ortho, which is a good thing.
If it weren't for pain and guarding, these could be done in the office (!!) My ortho said when he first practiced that's what they did.
So fear not. This is the best next step to make things better for you.
Ladymayin
new member
Went to PT for 3 months post TKR, mostly pool therapy. Ended with PT pushing knee to 105 with extreme pain. Ortho conservative and felt as longer as I did not slip back would not manipulate. I was surprised also that he waited a full year to evaluate. Ortho did not send me to PT after initial 3 months and gave me home exercise(bike and general pushing for flexion).
Scared of pain and swelling aftermath of MUA. Pretty tired of this and just hoping this will improve.
Thanks for response. Need the encouragement.
Scared of pain and swelling aftermath of MUA. Pretty tired of this and just hoping this will improve.
Thanks for response. Need the encouragement.
maryo52
Former BoneSmart staff member
The word "discouraged" found new meaning when my ROM was limited (it never got beyond 85 until intervention). I didn't even feel like me for those months. I definitely understand.
Since your tissues have had a year to heal, then I would not fret too much about MUA. Most of us have MUA when the knee is still swollen and inflamed from surgery. There is still another recourse for poor flexion which I underwent, arthroscopic removal of scar tissue. Just think of these as options or perhaps opportunities.
It really sounds as if you have a conservative, thoughtful surgeon. I know when I went through my ROM saga I often questioned my surgeon. I went and got a second opinion after my arthroscopy (because for three weeks after I did not gain ROM), and then went to top orthopedic hospitals to be evaluated again 1.5 years post-TKR. Those other opinions helped me see things a little clearer and to learn that I really did like and trust my surgeon, although if I need another TKR I will seek a more expert surgeon (my knee has excess laxity). Sorry to be so long-winded saying this, but why not exercise your option to get a second opinion if you're not sure to go with MUA? Just make sure to find a doctor whose specialty is problem knee replacements. If finding one is a challenge, we can help you.
Since your tissues have had a year to heal, then I would not fret too much about MUA. Most of us have MUA when the knee is still swollen and inflamed from surgery. There is still another recourse for poor flexion which I underwent, arthroscopic removal of scar tissue. Just think of these as options or perhaps opportunities.
It really sounds as if you have a conservative, thoughtful surgeon. I know when I went through my ROM saga I often questioned my surgeon. I went and got a second opinion after my arthroscopy (because for three weeks after I did not gain ROM), and then went to top orthopedic hospitals to be evaluated again 1.5 years post-TKR. Those other opinions helped me see things a little clearer and to learn that I really did like and trust my surgeon, although if I need another TKR I will seek a more expert surgeon (my knee has excess laxity). Sorry to be so long-winded saying this, but why not exercise your option to get a second opinion if you're not sure to go with MUA? Just make sure to find a doctor whose specialty is problem knee replacements. If finding one is a challenge, we can help you.
Not a problem at all. You will do fine. Read this article by another member who had an MUA more than one year later It's Worth the Wait for ROM.
KathyH
post-grad
Ladymayin, I had my MUA almost four months after my TKR. I am so glad I did. I had no pain afterwards (apart from immediately after the procedure, but painkillers sorted that out immediately). I stayed in hospital overnight and was on a CPM all night. I gather they only bent my knee to 90 degrees during the MUA and I could not get passed 70 before that.
For about three days after my knee felt achey (certainly not painful) and was quite swollen, but I had no trouble walking. Christmas was only a few days after and I had the usual houseful of family. I had no trouble coping with the housework and cooking. From then on it just improved.
I now have ROM of 105. Reached a plateau I think, but am confident I can still improve the bend as time goes on.
Upshot is TKR and then ROM are the best decisions I ever made
For about three days after my knee felt achey (certainly not painful) and was quite swollen, but I had no trouble walking. Christmas was only a few days after and I had the usual houseful of family. I had no trouble coping with the housework and cooking. From then on it just improved.
I now have ROM of 105. Reached a plateau I think, but am confident I can still improve the bend as time goes on.
Upshot is TKR and then ROM are the best decisions I ever made
robynhood
Sr Bonesmartie
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I have just returned from a visit to an advanced physio because of my lack of ROM at six month. She said MUA was not needed as she seemed to think it was lack of supervised physio ( only ever had 3 appointments then discharged ) she is referring me to a weekly knee session group for exercises and advised more exercises at home and to lose some weight. My ROM this morning was JUST 90 so have a lot of work to do. Good Luck with your MUA. I know from people on this forum they have no regrets at all from having it done.
Ladymayin
new member
Thanks to everyone for encouragement. MUA scheduled for May 30th. Scared, but still looking forward to progress.
KathyH
post-grad
Try not to be scared. I was absolutely petrified of my TKR, never having had an op before. However, it was fine and by the time I had my MUA, I wasn't scared any more. In fact I looked forward to the rest in hospital 
and I will actually describe it as a doddle. Recovery is absolutely nothing like a TKR.
Keep posting for support. Trust me, you will be fine
and this comes from a coward 
and I will actually describe it as a doddle. Recovery is absolutely nothing like a TKR.Keep posting for support. Trust me, you will be fine
and this comes from a coward Knitter4444
BoneSmart Staff
Had MUA three months after spacer replacements in both knees. Was in hospital for 2 days for pain control and went to PT right from the hospital..It was painful but not like after the surgery. And it helped soooooo much. I could not flex in one knee beyond 57 degrees. On CPM at home. Be sure that it is adjusted properly and if not call them back. I had to do that. PT was so great the first time coz I was so drugged. They had just turned off the PCA and then I left..PT was a breeze. (until I went back the next day)..
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