Pain & Manipulation Under Anesthesia After Total Knee Replacement
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- Опубліковано 5 січ 2021
- Pain, stiffness, and a manipulation under anesthesia are all discussed in this interview with Anthony Maritato, PT - physical therapist and Dr. James D Abbott, MD orthopedic surgeon.
One statistic states 20% of patients are not satisfied with the outcome following their total knee replacement.
A manipulation under anesthesia is an effective way to gain range of motion, reduce stiffness, and reduce pain following a knee replacement.
Listen to Dr. James D Abbott, MD talk about pain, stiffness, NSAIDs, and more.
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About the author:
Hi, my name is Anthony (Tony) Maritato, PT. I am a licensed physical therapist and owner of Total Therapy Solutions. I have specialized in helping clients recover from total knee replacement surgery since 2002 and have created this video to help YOU.
Total Therapy Solutions
5900 Long Meadow Dr
Middletown, OH 45005
Thank you for having an Orthopedic Surgeon on your channel. It’s good to hear what a lot of us needed to hear
I'm one of those people you described who's beating herself up because I feel like a baby, afraid of the pain and guarding too much. Your compassion is comforting; I appreciate all your videos. If I lived near you I'd be coming in for TKR therapy. I'm at just over 6 weeks out and at the same flexion as I was at 3 weeks. My doctor and PA say I'm on track and not to push it since I have done that and suffered for it. I was super-active before this and feel at times like I can't see how it will get much better. I've had quite a few setbacks where I've been unable to do any ROM exercises in a day. Sigh.
Thank you again for your kind words and excellent videos!
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Excellent discussion hitting so many relevant concerns of patients. Thank you!
Great advice thank you! I’m presently recovering at 3 weeks post op LTKJR, and a stretch of my RTKJR contemporaneously. I’m really pleased with the outcome of the stretching procedure since I was glum about the outcome, but I guess I was only at 7 months post op for the right one but saw no hope of improvement otherwise. Ie it was too scary to bend past a certain point due to pain over the lateral pole.
I have to say, the post op pain is almost overwhelming at times!. I’m so glad not to need a 3rd knee done since twice the experience within one year is a big thing. If you’re not tough beforehand you will probably find you need to be. Looking forward to diminishing pain and increased ROM!
Thanks again. I’ll be surfing again soon!
I'm scheduled for a MUA in two days and 12 weeks out from my 5th knee surgery. My original TKR was in December last year then due to infection and a fall that tore my quad tendon from the quad muscle, so in January this year an I & D and repair...still draining despite a picc line for 16 weeks total, so they took the prosthesis out in March replaced with an antibiotic-spacer. In May the new prosthesis, but by early June an even worse infection, very painful with a fever. Then an I & D again and finally started PT in late July. Worked hard, but stuck at nearly 90°. I'm not surprised there is a lot of scar tissue and I am optimistic this will really help. 🤞 My surgeons have been awesome and kind which really helps me push for maximum bend. Thanks for the information...it helps!
Thank you for this video. I am 9 weeks in with a lovely straight knee but only 70-80 degrees of bend and hard stiffness in the knee. My surgeon in the uk doesn’t want to see me before 12 weeks but I know I’m heading for the manipulation. I was thinking it was me but this has made me feel so much better. I’m very frustrated
Thank you for this interview
i literally couldnt start PT before 3 weeks or even at 3 weeks, the pain from my fracture & surgery was excruciating. i started at just before week 6 and went from 15 degrees to 50 degrees in just 3 sessions. idc what they doctors tell me about time frame and the progress im making. im just going to work at it everyday and im sure over time theres no way i wont make strides with my ROM
I am six months out of tkr. My stiffness and flexion has diminished since I went back to my retail job of walking and standing 30 hours per week. I am frightened to go to my surgeon. I feel I have let him down. I was at 110 degrees after 2 weeks and now not even 90 degrees and stiff every night.
How long before your able to return to work or feel better after this?
HELLO SIR. CAN I ASK IF IT IS OKAY TO DO BENDING THE KNEES IN THE MORNING WITH A PT AND ANOTHER IN THE AFTERNOON? THANKS. MOST VIDEOS RECOMMEND TO DO EXERCISES TWICE A DAY. HOPE U COULD ADVISE ME.THANKS
I had a Tkr 6 years ago never been any good my knee is stiff cant hardly walk now going in for Mua & asperation on 27th im worrying il need ubove knee amputation as im so fed up with being disabled
I am week 6 of total knee replacement exercises going well. I have good movement and I can go up and downstairs properly. But I now have an infection in and around my kneecap - can I still exercise or will that make it worse. I’m taking antibiotics
I need some help with this please
Can this be done 14 months after a TKR? When I had PT only had 16 sessions and only measured twice - I was never told anything about how much my knees should bend.
Where can you purchase the brace?
If you are talking about the JAS knee units, check out their website at www.jointactivesystems.com You will need a doctor's order to get it though. I checked directly with JAS and they confirmed that a doctor's order is needed for any of their devices.
I ruptured my quadricep tendon on april 24th, had surgery on april 27th, leg was hot swollen, red from the onset, spent 6 days i hospital asking to see anyone, for anti biotics as i believed it wasn't right, kept asking for them, i could not get any, i discharged myself, expected to be seen maybe a week later or 10 days, i got an appointment for staple removal and wound check on the 19th of may, i thought that is a long time, the leg was a 7/10 pain, it started discharging fluid around the 10th, i went to my local gp who said that was normal, i asked for anti biotics, the gp said they dont like us interfering, wouldnt even change the bandage, two days later i went back and said this isnt right it should be healing, its red hot agony, i was assured it was fine, got to the hospital on the 19th, straight away, thats infected, ofcourse it was, booked in for debridement which i got on the 21st of may, i thought all went well, discharged on the 26th, and its taken 4 plaster casts, with weekly and fortnightly wound checks for it to finally heal, it was a big incision, i got put in to a brace on the 13th of july, my leg has been in full extension since the 24th of april, ive tried bending the knee but its extremely tight, rock hard above the pateller, and just isn't working out. The surgeons and everyone else are passing the buck, these things happen, people often look for someone to blame when nobody is......hhhmmmmmmm 22 days left with a festering staph infection, nobody is to blame. Can anyone relate to this, because i keep reading about knee replacements, but nothing like my situation, am i ever going to get range of motion after 11 weeks on none, am i going to need manipulation under anaesthesia? Any advice would be helpful at the minute, everything that could go wrong has.
Hi - 7 weeks out of TKR, I'm currently around 90 degrees. Met with doctor yesterday and am supposed to get an MUA in 2 weeks if I can't get to 120 degrees. Since it sounds like extreme pain is goin to happen anyway, are there any alternative stretches I can do or can I just have someone push real hard to get to 120 degrees without having to get put to sleep. Is there any chance I can damage anything?
I have the same question… I think I have an infection in the kneecap that’s preventing me from going past 80° and I’m at eight weeks out. I do not want to have a manipulation under anesthesia due to the risk of bone fracture as I have osteoporosis and weak bones… Please let me know if you get an answer to your question. Thanks so much good luck.
Hi, it's been a long time. I ended up having the procedure and starting all over. At the end of the day, the exercise/stretch that made the difference for me, was riding my indoor bike. I cheated a bit at first, sliding up on the seat, but afterwards and even now, I ride every day and I truly believe it was the difference. The one memory, post surgery and post adjustment is that it's going to hurt a lot - I mean a real lot. Take your painkillers and ice a lot. Hope you have success, it's worth the pain.
This comment is an update… I actually went ahead and had the manipulation procedure… I have been doing well at PT the last two days however, my thigh and my kneecap are turning black and blue and are bruised and painful… Kind of like a delayed response? But I’m trying to push through that and I’m icing Several times a day! The pain though, is still excruciating following the MUA, which is disappointing as I was starting to sleep better before that! I think the manipulation is very helpful. However, it’s the side effects that I don’t like dealing with! And they actually keep you from pushing harder to keep your range of motion… A catch 22!
Hello, I had an mua 2 months after my tkr. I'm 5 days out and the plan with pt was to do aggressive treatment and go to pt everyday for 2 weeks. I went on the 4th day and did not have my normal pt. He pushed my knee so hard, that I was in tears, hitting the table to stop, said my hip was hurting it felt like a jack hammer. The pain was so bad, it kept me up and then I couldn't walk on my knee the next morning, so I had to cancel my pt appointment. IS THIS NORMAL OR WAS MY PT JUST BEING A JERK AND IGNORING WHAT I WAS TELLING HIM???
Thank you for any help
This happen to me o had a MUA on Monday the same day I went to the PT and she get me to 118 degrees yesterday she push me so hard and i reach 124 degrees but after that I wasn’t able to walk or stand in my feed it hurts so much I cry like a baby and I was screaming when she bend my knee, it was so painful, today i went to the therapy again she wasn’t there so other people did my therapy she massage my cuádriceps because it hurts so bath and under of my knee she bend my knee no as before because I was in a lot of Pat I only reach about 98 degrees, and she work on my extension because after the other therapy bend my knee in that wild way my extension was worse so today she help me with my extension but the pain is so bad
I am 12 weeks past sugurey and still have pain and some stiff knee. .I have 135 raign of motion. And 0 flatness .I still have a hard time sleeping. I take 1000 mg pain relief 3x aday.i do think I am getting better each day it is just slow.
Kenneth Price how many months do you still feel the pain in your knee? Just like yours i'm kind of disappointment what happening in my recovery. What din you do to make it feel better?
After having two MUA's, I can tell you that the cracking that is heard can also be heard by the patient after the MUA. I've heard the crackling that is mentioned on this video. Another patient who was at PT with me, said he heard it as well. So it seems that the scar tissue continues to "break" even after the MUA is done. While I was able to achieve 130 degrees and 0 degrees in the OR, right out of it, I was getting to the low 90's on the first MUA (from the mid 70's) and then in the low 100 range after the second MUA. But with more Physical Therapy, I got to 130 degrees when pushed very hard. But without assistance, I got to 117 degrees. My extension though went from 20 degrees to 10 degrees. Today with the help of my JAS knee unit, I am around 8 degrees today and 120+ unassisted. So, the MUA's do help, but you do need to continue to work hard in exercises and therapy afterwards. Thanks for the video and thanks for interviewing me a couple of weeks ago! :)
Russ the next time you talk to the JAS company you should consider asking them if, they could make an affordable model that all total knee patients could purchase without an RX from a DR. Range of motion is a big challenge for every total knee patient that I have talked to...Problem is most total knee replacement patients have gone through the torn menus problems and it is counter intuitive to move you knee and allow it to make noises and not feel like you are damaging your knee. Thanks Russ and Thanks Anthony Maritato, PT - physical therapist and Dr. James D Abbott, MD orthopedic surgeon for great information!!! I guess this is why former patients are reluctant to talk about their surgery because only people like Dr. James knows what is really going on.
@@markmolkenbur5165 Not sure why you would not want your doctor involved in getting a medical device, but to answer your question, I did have an exchange with JAS and was told that their devices fall under FDA Class II medical device which means the products have much more direct patient contact and therefore require stricter controls like prescriptions. The FDA defines Class II as “devices for which general controls are insufficient to provide reasonable assurance of the safety and effectiveness of the device.” So, it needs a doctor's approval.
Good info! Thanks Russ!
Thanks for the info @Russ is Right.
What is the pain like after MUA? I am worried I might be a candidate. Sixth week begins tomorrow and only at 63 degrees. Still very swollen. PT is very painful. .
I just had MUA done last Tuesday. It is like I am almost starting over, having to take pain meds and muscle relaxers. Hoping I can get 120 degrees, doing PT again.
@@loydeneward6613 Thanks. I’ve decided I’m NOT doing MUA. I really only want to be able to walk, climb stairs and swim in the pool. I’ll keep doing PT, but forget anything surgical. My leg was at least twice the size. I cried again at PT today. They got me to 70. Now it’s swelling, painful, and I can barely walk it’s so stiff. This has been a very painful, depressing 6 weeks and I refuse to go along with MUA. I know my leg will go back to square one. 😩
After I read your comment I asked two of my patients about the pain after their MUA. Both said it was more the fear of pain that more actual pain. Too often patients blame themselves for needing an MUA but the reality is it is out of your control much of the time. There are pain control options for MUA, talk to your surgeon.
I just had the MUA last week… And the pain seem to get worse as the days went on… Perhaps because the steroid shot he gave me wore off? And the fact that my thigh is burning in pain and my kneecap is black and blue, and very stiff! However, with pain meds before I go to PT, I am able to Get to 100°, which I couldn’t before the manipulation… So I’m hopeful that the swelling and bruising will go away and I will be able to keep pushing through to get my range of motion back! Don’t be afraid to do the manipulation… It will break up the scar tissue and help you achieve your range of motion, rather than staying stuck!
Hi Tony, I ordered a knee straightening device called idealknee on amazon because I am having a hard time getting my leg straight. What do you think about this device? Im going to try this out on my off days from therapy.
Lola, did the device work?
@@cathyalford8674 it helps but it think it would work better if i was able to sit on the floor and use it or on a table like the ones at the physical therapy clinic. Im not able to get down on the floor because of my knee. I used it on the bed but since it is a soft surface when i would push down on the handle to straighten i couldn’t get as much tension. I used it mostly in the sitting position.
@@Lila77722 I'm 3 months out of a TKR and I can't seem to get it straight it's been painful and locking on me.
my Dr gave me so many pills after surgery. too many? because week 7 after all pills have been over I still have bad stomach
But why my stupid doctor after 10 weeks still didn't do my manipulation. And ism almost 4 months still same .in pain and range of motion is not good