Hinged Joint Revision after 4 years of problems

Craig1

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Looking for some help. Two years ago I had a TKR on my left knee and have struggled with flexion since. My bend was measured at 60 degrees and I have been asked to consider an MUA to try and get a greater degree of flexion. I would like to know if anyone here has had this done and if it has worked.

Left TKR 10 September 2013
 
Welcome to BoneSmart! We have many members who have had MUA. Unfortunately it's not possible to predict the outcome as every person reacts differently to the procedure.

Here's a link to a list of threads from members who have had MUA. I'm also going to tag our medical expert here @Josephine for her input on having MUA 2 years out.
 
Hi Craig and welcome to BoneSmart!

Well, an MUA at 2 years unusual, that's for sure,though I've known many at 1 year. Is it your original surgeon who is suggesting this? If so, why has he waited so long?

There's no reason to suppose an MUA at 2 years won't be successful but it could be difficult and may even be very painful afterwards for about 1-3 weeks. But as my friend Jaycey has said, each MUA is different so it's really impossible to know for sure.
 
@Josephine thank you very much for your reply. In answer to your questions yes it is the original surgeon who has suggested this and has actually done two mua's previously, one after nine months and another in December last year.
 
Really? What were the outcomes of those?

btw, would you be so kind as to put all your surgery dates in your signature for us?
 
@Josephine thanks for your reply. The first MUA took me from 45 degrees to 60 the second from 60 to 90 in theatre but has dropped back to 60 again.
 
Wow. Sounds like you could do with something more adventurous like an open lysis procedure which is open surgery to remove adhesions.
I'll get Kelly @skigirl to come and explain what that is.

If you have problems getting your surgeon to consider this, I can try and suggest other chaps.
 
I was told by my surgeon that an MUA was not possible at a year because he would break my leg!
 
@Josephine and @denpucc thanks for your replies. I look forward to what @skigirl can advise. Denpucc you now have me a bit worried as I am two years out from my TKA I wonder if Josephine has an opinion on this happening. Can I as you denpucc what you had done instead of MUA?
 
I was told by my surgeon that an MUA was not possible at a year because he would break my leg!
I hear this from time to time but I have also seen MUAs that were done anything up to 2 years post-op without any problems. Of course this is a 'worst case scenario' caveat and he is right to mention it but it's a risk not an inevitability! In all my 50+ years of practice and having been involved literally hundreds of MUAs, I have never seen a case where the leg got broken! Nor even heard of one. A good surgeon knows how to do these things, how much pressure is safe and what the risks are. That comment speaks to me of a surgeon who is either has little or no confidence in his skills or is saying that to just blow you off about it! My guess is the latter! :wink:
 
I also have had issues with adhesions (scar tissue) I ended up having an "Open Lysis of Adhesions" which is a scar tissue removal surgery. It worked in my case---I stayed in the hospital the night of the surgery and went home the next day. I had three or four days of pain and then moved on to misery.

My PT took extra time---no pt for three weeks, then only table exercises---leg lifts, heel slides, clam shells until 8 weeks. At eight weeks, I began to gently strengthen my leg. My OS cautioned me multiple times that If you aggressively exercise a hot and inflamed knee you Cause adhesions to grow.

After an extremely long time, my knee is much better---it is not perfect, but I have a rom of 135. I really got bored, but stuck with the long recovery. My PT said, often, we will do everything right, then if it does not work, at least we will know that we tried everything. he was very helpful.

I will give you a list at the bottom of this post of doctors who specialize in arthrofibroses, I see you are in New Jersey, so you will have access to some of them if you want to try and see what they say. Most of the doctors I have read about stress to have arthroscopic lysis of adhesions rather than open lysis. They also stress that you need to cauterize the adhesions and not just shave them off, which causes bleeding in the joint and apparently bleeding in the joint is one of the causes of adhesions. I know that my knee bleed excessively the first two days.

I want you to know that I just posted a lot of this info for a woman from New Jersey who has a thread;
Scar Tissue keeps Forming on this forum. I am going to copy the information that I just gave her.

First let me say that I have a friend who has gone through the same experience that you are having. She is beside herself as well. She is a ski instructor and has gone through a lot of pain. Her knee was at 70 degrees recently.

This summer, she had some metal testing at a lab in Colorado. They found that she was allergic to Nickel . She ended up having her Stryker knee removed and in its place they put in a Smith and Nephew knee that is made from Oxinium. She is one month out, still in pain, but when has a rom of 100.

I am going to tag @1ELISEA who will be able to tell you about the metal testing lab.

Then, is is not necessarily a metal allergy---which is also rare. It is possible that your system just makes too much scar tissue---but I think you will want to explore every avenue. I am going to give you a list of Doctors who specialize in arthrofibrosis (that is the 1% of knee replacement people who make too much scar tissue).

In addition, I am going to tag @RunA42K who has had successful removal of extensive scar tissue like yours. I see that you are in New Jersey and she is in Texas, but she is using a compounded cream to prevent the regrowth of adhesions. Bonnie has never given up and I hope you will not either---there is an answer out there for you, you just have to find it.

I just got an email from Lori my ski instructor friend and her doctor found that she is infected with
Propionibacterium acnes: An Underestimated Pathogen in Implant-Associated Infections and he thinks that is the reason that she has had so much scar tissue.

Most of all, I will tell you not to give up, you will have to fight and find information and someone who can help you. here are the doctors.

Dr. Colin Eakin, Palo Alto Medical Foundation, California

Dr. Steadman, Steadman-Hawkins Clinic, Vail, Colorado

Dr. Peter Millet, Steadman Hawkins, Vail (as of 10/1/05)

Dr. Lonnie Paulos, Salt Lake City

Dr. Frank Noyes, Cincinnati Sports Clinic, Ohio

Dr. Wojitys, Ann Arbor, Michigan

Dr. Jason Folk Steadman-Hawkins Clinic of the Carolinas Greenville, SC

Dr. Shelbourne, Indianapolis, IN

Dr. Flandry, Hughston Clinic, Georgia, Alabama

Dr. Gill Boston Mass. General Hosptial and An asst. Prof at harvard

Dr. Tomas Sculco HSS

Dr. Answorth Allen HSS

Dr. Henry A Finn Weiss Memorial Hospital Chicago

Dr. Charles Bush-Joseph---Rush University Med Center.

Dr. Michael A. Terry Northwestern U Feinberg School of Medicine

Dr. Juan J. Rodrigo Baylor Schott and White Hilcrest Medical Center Waco, TX

Dr. Thomas N Lindenfeld Cincinnati Sportsmedicine and Orthopaedic Center

Dr. Friedrich Boettner HSS New York and the United Kingdom

Dr. Ajai Cadambi Texas Hip and Knee Center Forth Worth, TX

Dr. (Mr) Glyn Evans London Orthopedic clinic

Dr. Simon Tan St. Vincent's Sprotsmed Darlinghurst, Australia

Dr. Philipp Traut Bad Oeynhausen, Germany

If you google Frank Noyes, he has a series of articles on Adhesions. (scar tissue) . Also Peter Millet is one of the men who does not think you should have an open Lysis of adhesions. Steadman treats arthrofibrosis, but they will not treat it after a TKR

Also Dirk Kokmeyer, Pt wrote tutorials on Arthrofibrosis Rehab that I found really useful
 
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@skigirl thank you very much for your detailed response. Unfortunately I live in the UK and the list you have provided is no good to me. I am scheduled for an MUA in December and it is that which I am really worried about especially as I am two years out from TKR.
 
Well, I will just point out that Dr. (Mr) Glyn Evans London Orthopedic clinic is in the UK. He has quite a good reputation. Jo know him as well, if you are at all interested. I see that you are in Scotland, but I know that in Europe you have a marvelous train system.
 
Craig1 I hope you will get the answer and have the issue sorted out. Just don,t give up. @skigirl i admire your takes time to help our Bonesmarties. Craig1 I think you may find @Nana moon 27 ,s thread helpful.
 
@Josephine thanks for the reassurance I had visions of a broken leg to deal with! I think I am going to go ahead with the MUA! @skigirl thanks for your input and hopefully the MUA will get me more flexion

@Birdy I won't give up, however my poor knee needs a bit of a break.
 
MUA scheduled for 6 November. Hopefully this will result in better rom. @Josephine do you think at this late stage my rom will increase significantly. Could I also ask for my status to be changed to MUA.
 
Ummmm .... can't say - my crystal ball is broken!

But seriously, I really do hope and pray that it does, for your sake.
 
Craig, did you get better rom in August when you had a MUA?
 
Thank you @Josephine I sincerely hope so too!!
@skigirl my MUA in August took me from 60 degrees to 90 degrees and it's now dropped back to 60 degrees!
 
I know that RunA42K has had many of the same issues. Her thread is
Never give up, keep trying, don't settle - that's me, Bonnie, She is now getting a revision to a Smith and Nephew knee for her metal allergies. Read her thread, it will be informative for you.
 

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