It seems based on what very little I know that Theresa's situation is unusual in that she represents the more active and often younger patient who wishes a range of motion that matches her desired life-style. There is a bell curve in all of this and although she MAY have a greater range of motion over time, one does not know where she is on the bell curve and any
hasty generalization about her condition based on the experience of others seems risky: one person's experience is not that of another and without reference to a body of literature (and that itself is a problem for active and especially younger TKR patients) about improved range of motion over time, then how can Theresa be advised?
Her surgeon is the one who has to has to perform the procedure and she is the one who has to accept the results. And, I would guess his/her experience about when to do such a procedure is based on his/her clinical experience and probably what science exists about the expected gains in ROM for her situation. It does not take much searching of the literature to find examples that would suggest an earlier MUA For example,
"Stiffness following total knee arthroplasty is a disabling complication. One of the management options of stiffness includes manipulation under anaesthesia, but no real consensus exist on appropriate timing of intervention, and the timing and results of the manipulation under anaesthesia (MUA) are under debate in the literature. Our aim was to determine the efficacy of single and multiple manipulations under anaesthesia following total knee arthroplasty and to determine the most appropriate timing for manipulation.
We retrospectively reviewed 86 patients who underwent manipulation for stiffness following primary total knee replacement with at least 1-year follow-up. Range of motion before surgery, at the time of the MUA, immediately after MUA and at 6 weeks and 1 year post-MUA were recorded. At the end of 1 year post-manipulation, manipulations performed at less than 20 weeks, following primary total knee arthroplasty, showed 31° of flexion gain as compared to only 1.5° of flexion gain when manipulation was undertaken after 20 weeks.
Of the 86 patients, 21 had multiple manipulations with no significant difference in flexion gain after the second manipulation. Patients on warfarin (26 %) had an increased incidence of stiffness and poor flexion gain. This study showed that better results were achieved when manipulation was performed at less than 20 weeks (particularly between 12 and 14 weeks) from primary surgery with no added benefit from re-manipulations."
It would be useful to know about Celle statement:
"There is no time limit to when a MUA can be done and nothing to be lost by waiting longer than 7-9 weeks."
No doubt there is some evidence to support this, but I think it is not too hard to find work that suggests a shorter rather than longer time period for an MUA is more desirable, for example the above 2014 publication.
Ultimately, we choose a surgeon and work with them based on their clinical experience and our assessment of how that experience tracks with our needs. If Theresa needs/wants more ROM and her surgeon believes that it can best be achieved by an MUA at this point in her recovery, then where is the science to contradict moving forward?
One value of Bonesmart is the sharing of experiences so that we can understand what we share and what is unique to our condition. It helps to make sense of what is happening to us and what we need to do to achieve the quality of life that we desire after knee replacement.
United States
