@WFD My surgeon now wants to do another MUA. Have booked an appt with Dr. Robinson at Panorama Ortho for 2nd opinion. Really want to find a doc local that uses irradiation though.
The surgeon with whom I am booked for arthroscopic LOA and MUA on March 7th said he wouldn't do radiation because:
1) There are no good studies that show it is any better than no radiation. All studies to date are pretty much anecdotal, have no controls, and are not blinded.
2) He is concerned about interaction between the radiation and the existing metal parts in the knee.
3) He is concerned about the potential for an increase in long term cancer risk due to the level of radiation used, which has to be powerful enough to damage the tissue and make the scar tissue not grow. This is a lot more power than is used for x-rays for example.
In the end I agreed with him and decided not to pursue radiation. The potential benefits are unproven and the risks are genuine and concerning.
What I think is more important is the following:
1) A plain MUA without arthroscopic LOA is not good. The torn scar tissue will bleed inside the joint and the blood will not be drained (at least not without aspirating the joint at some later point in time), leading to a high likelihood of immediate development of scar tissue and adhesions. If you are as prone to arthrofibrosis as I am, I expect this cure would be worse than the disease.
2) The desirable surgery is an primarily an arthroscopic LOA using an electrocautery tool instead of a debriding tool. The standard debriding tool has metal teeth that chew away at the scar tissue and cause a lot of bleeding. An electrocautery tool burns away the scar tissue with an electrically heated tip. The scar tissue is automatically cauterized, reducing the bleeding.
Not every surgeon uses this tool so you should ask.
3) The MUA that is done along with the arthroscopic LOA is done partly for diagnostic purposes and partly to remove adhesions the surgeon cannot otherwise get to. Because this is done during the surgical procedure, any bleeding can be drained immediately.
4) The post-surgical recovery process is extremely important, which of course everyone on this site already recognizes. The procedure I hope to follow will be modeled on one documented by user JakeM over at KneeGuru. Do a search for
"kneeguru" "JakeM" "How to beat Arthrofibrosis"
and it should come up as the first hit. That page also includes a link to his log that documents his recovery and the following 15 years, which is really helpful and inspiring.
My surgeon trained at the Steadman clinic which is one reason why he is up on the best practices for treating arthrofibrosis. If you can find another Steadman alum in your area that might be one approach.
Hope this helps. If you have any trouble finding JakeM's page, PM me and I'll send a link.