KNEE ARTHRITIS - Total Knee Replacement :

Manipulation after TKR & Broken Femur - - Posted by bf7jy8t (bf7jy8t), 26 May 2004

3.5 months after my TKR I had manipulation under anaesthesia to improve flexion in my knee.  I suffered a broken femur during the manipulation and then had ORIF surgery to insert a rod in the femur.  Doing ok, still not as much flexion as I need but it's coming along slowly.  Questions: Dr. does not know why femur broke - no osteoporosis or other problem seen.  Can some types of knee prosthesis tend to cause this outcome?  Should I ever consider manipulation again (I will be getting a TKR for the other knee at some point)?
Posted by hmaxwell (Heather M.), 27 May 2004

What an awful experience.  It sounds very painful!

This is why my surgeon does not do closed manipulation under anesthesia or MUA (i.e. just bending under anesthesia, no surgery).  My viewpoint is if the surgeon breaks your LEG during a procedure meant to increase flexion, he/she was using too much force.   A better choice would be to do an open MUA, which I've had several times.  This includes an arthroscopy to remove the scar tissue and THEN doing the manipulation on the knee.  It is surgery, so the recovery can be longer than a closed MUA without complications, but the risks of breaking something that shouldn't be broken are reduced to nearly zero.  

As to your OS not knowing why the leg broke...this seems a little disingenuous to me.  It broke because he applied too much pressure.  Perhaps he underestimated the number and strength of your adhesions?  Were you more than 10-12 weeks post-op?  If so, MUA is not usually recommended for just this reason--the adhesions are very strong and fibrotic, and are difficult to rupture manually.  Other structures in the leg are much weaker than the adhesions at this point, and are at risk of breaking or rupturing.  

You're very lucky it was 'only' a broken leg, though it sounds like a major fracture if you had a rod put in!  Some people have had their patellar tendon ruputured, along with other ligaments and tendons, leading to serious issues and disability.  While a break is certainly no fun, bone heals much better than soft tissue.  Hopefully you will be able to recovery without complication from your break.

You are well within your rights to see a 2nd opinion and perhaps consult an attorney over malpractice.  I've been left with much worse problems since my first surgery (out of 4 total, before that OS gave up on me), but I never sued my OS because the problem is me--I produce way too much scar tissue.  There's an imbalance in my immune system or something.  So you can see, I'm not litigation happy, but there's something wrong with the surgeon breaks your leg!  There is another board member who is in a similar situation, it may help to talk to her.  Hopefully she will post.

Good luck in your recovery.  And if I were you, not only would I not ever do another closed manipulation, I would see another doctor for the current and future TKR.  One who understands scar tissue a bit better....

Take care.

Heather
Posted by Helena (Helena KTF), 27 May 2004

OMG!!

The femur is the strongest bone in the whole body and your OS broke it doing an MUA?? Sorry but either he's veru brutal (which i hope he isn't) or you have an underlying problem (as mentioned osteoporosis could be possible, or a tumor or a weak spot in the bone but sounds not the case). A lot of force is needed to # (fracture) the femur. It's mostly following a car or motorcycle accident we see these #s. Never heard of a femur# caused by a TKR alone, can happen after a fall when the femure #s just above or even round the TKR, but this is abviously not the case!


Hope your doing fine! Sorry i can't help you out more

~H
Posted by kdhfrank (kdhfrank), 8 June 2004

i think i am the person heather was referring to regarding a similar situation following a closed mua. i sent you a private message....it should show you this at the top of the main forum page.

kim
Posted by hmaxwell (Heather M.), 8 June 2004

Yes, Kim, you were the one I was thinking of...sorry.  We do actually have someone with double patellar tendon ruptures as well, but she hasn't posted in a while.  Then there's poor Heather who had a PT partially rupture her quad tendon while working on ROM.

There are enough cautionary tales here that I would be reluctant to EVER let anyone--PT or OS--crank on my knee!

There's a great bumper sticker that my brother pointed out to me last time I visited.  It said "Sometimes I think my sole purpose in life is to serve as a cautionary tale to others."  Sigh.  I do feel that way sometimes....

Heather
Posted by bf7jy8t (bf7jy8t), 8 June 2004

Thank you all for your replies to my questions.  I really appreciate your support and input.  I feel very lucky that I am healing quite well and I believe my end results will be excellent.  Good luck to all of you too.

Gwen
Posted by Teresa_S (Teresa_S), 8 June 2004

Hi, anything I have ever read about manipulation under anesthesia warns of the fact that bones can be fractured during the procedure, and that sometimes the dr. isn't even aware that he did it. I know it has been a terrible experience, and nobody explained that to me as a possible complication, but when I read about it online, etc, it is always posted as a warning. I am sorry it turned out to be a problem for you. Hope your leg heals well, without further complications. I sometimes wonder if the physcians who write about possible complications, don't include every possible thing that could happen, to protect themselves. But then again, the surgical consent is only as good as the paper it is  written on. Teresa
Posted by bf7jy8t (bf7jy8t), 9 June 2004

Yes, my OS and PT both warned me it was a risk of the procedure - I just didn't think it would happen to me!
Posted by enuff81020 (enuff81020), 26 July 2004

Hi!

I had 2 different MUA's.  The first went well, but it didn't help my ROM because it turned out I had RSD that was not diagnosed at that time.  My knee kept getting worse.

So, they scheduled another procedure--another MUA,a scope to check on what was going on there and then an open procedure to do a complete or a partial revission.

The Mua was tricky because I had piled up so much scar tissue--so my ortho moved to an open procedure and surgically removed all of the scar tissue and replaced the plastic part of the replacement.  

I'm doing better, but the RSD is a wild card.  The other thing that you might be interested in is the fact that my PCP has had me on calcium supplements for about two years because of a deficiency.

The thing about this that bothers me the mnost is the fact that you haven't been given any real info explaining the situation.  You have a right to know anything the doc knows and a copy of your records.  That may be a place to learn what happened--and if you need additional treatments of care to get healthy.

Good luck, Sylvia

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