John D. Burrow, DO
In Parts I and II, you learned about Knee Joint Manipulation, why it is necessary, how it is performed in the OR, and the risks for the procedure. In this installment, I’m going to discuss what happens if the first MUA isn’t successful, what options a patient has and how I help them to make that decision as their surgeon.
According to researchers, 25% of those patients who had one MUA procedure will have to have another. This is due to a variety of issues which are mostly the same as the with the first MUA:
- Lack of consistent patient effort during rehabilitation
- Protective Muscle Guarding
- Scar Tissue/Adhesion formation around the surgical site
Some patients who didn’t do well the first time with their knee replacement rehabilitation, also fail after their first MUA because of the fear of pain, protective muscle guarding (PMG) and simply not wanting to go through the discomfort necessary to achieve the desired range of motion in their knee. I typically try to have a heart-to-heart talk with these patients about how they want to live for the rest of their lives, and the work that’s necessary to achieve a better range of motion in their replaced knee.
Of course, I have patients who do everything correctly after their first knee manipulation under anesthesia. They are determined to make it work. They follow my instructions to the letter, they give 100% at their Physical Therapy sessions, they walk, exercise, and stretch repeatedly at home and work. They use their stationary bike at home while they are watching TV and yet, still have a stiff and swollen knee without the range of motion necessary to do their normal activities of daily living.
Typically, we are talking about a short window of time – usually within the first three to six months after the initial knee replacement surgery, where we can perform MUA procedures. So, what are the options for a patient who has had one MUA, but still has a swollen and stiff knee after knee replacement?
Option 1 – another closed MUA procedure; however, there are drawbacks – see above
Option 2 – arthroscopic surgery to remove scar tissue/adhesions with another MUA; this surgery has additional risks and complications of its own; again, recovery will require rehabilitation and intensive physical therapy
Option 3 – learn to live with a stiff and swollen knee
Here we get into a cycle of wash, rinse and repeat – of doing the same thing over and over, but with diminishing returns or maybe the same results. Do I think it is beneficial for a patient to have four MUAs if they aren’t committed to their rehabilitation? Not at all. Would it be worthwhile for a patient to have a second MUA because they are highly motivated to travel the world and be as active as possible? Absolutely. As an orthopaedic surgeon, it is my job to recommend the best course of action for each patient based on their medical history, activity level, goals, and dedication to the long-term outcome of their knee replacement.