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Author Topic: Manipulation Under Anesthesia Advice-New Member  (Read 2042 times)

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Offline annie5970

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Manipulation Under Anesthesia Advice-New Member
« on: June 29, 2010, 08:15:09 PM »
Hello,

I am new to the board, but have been lurking off and on for a couple of years, when my knee nightmares began, and have found a lot of very good information here.

Let me give you a bit of background about my knee issues: Back in October 2008, I began to have left knee pain, particularly after sitting for a while. At first I did not pay too much attention to it, but over a few weeks, the pain steadily increased, and I became a bit concerned. After x-rays and an MRI, I was found to have a torn medial meniscus (not sure when or how I tore it). I was referred to an Ortho in January 2009, and he did a scope and removed the torn piece of meniscus, and removed a bit of synovitis (pretty straight forward stuff, so I thought). I was in PT after the surgery, but I kept getting swelling and pain during exercise. The PT was located within the same building as the ortho, and they began to think something was wrong (after a few weeks of therapy, and the symptoms kept worsening). They set me up to see the surgeon again, and he said I was likely just "getting old" (I was 39 years old at the time). I heard very little of what he said after that, since I could only envision strangling him for a comment like that. He basically told me he fixed the problem, and he was done with me. He sent me to a rheumatologist (which took another 3 months to get in), and she ran a battery of tests (all were negative). An additional MRI showed a lot of swelling, but nothing conclusive. By this time, I had some arthritis, and this was a change from the earlier MRI. In the meantime, the knee was getting steadily worse, and she said I needed to see the surgeon again. I told the rheumatologist I would not see the same surgeon again, so she recommended another ortho who runs a knee institute about 45 minutes away. I went to see him, and he had me set for another scope very quickly. The surgery revealed a very severe case of synovitis, and a plica, both were removed.

After the second surgery, things went from bad to worse. I had blood and fluid removed from my knee 11 times in 5 months, and the pain and swelling had reached a severe level. The fluid was sent for analysis each time it was removed, and nothing of concern was showing up (no infection, no gout,  RA, etc). My surgeon suspected a was carred down, and I needed a lateral release. I had the surgery on April 9th, and he did the LR, plus I had extensive scarring removed. The scarring was everywhere (medial and lateral gutters, retropatellar fat pad down to the anterior tibia, extensive scarring of lateral retinaculum). As soon as I woke from this surgery, something did not seem right. The pain was extreme, and I was a little shocked at how bad I felt. Over the next few days, I bruised all the way to my hip, and the swelling and pain were terrible. The pain progressed to a point where I could not longer put my foot down, walk, or stand. I was seen at the surgeonís office, and immediately admitted to the hospital for emergency surgery for an enormous hematoma in the joint. It took the surgeon over 2 hours to shave the hematoma from the joint. A drain was placed in my knee, and I was kept at the hospital for a few days for pain control. My knee was immobilized for about 3 weeks, and when I was finally cleared to begin PT, I was shocked at my loss of ROM.  I had never lost ROM before, and my quad was severely atrophied. Since removing the hematoma, I have had fluid removed from my knee three more times, and the pain and swelling continue. The swelling has been so bad, my lower leg, ankle and foot have been swelling. I have done extensive PT, but the ROM is just not coming back. I am the subject of awe and confusion in PT, since they can almost watch my knee swell with any movement, and surface of my knee becomes hot to the touch (I do not have an infection or a blood clot).

My surgeon now wants to try a manipulation under anesthesia, since it appears the scarring has indeed returned. I am a bit scared and doubtful that it will work to correct the problems I am experiencing. I understand that after he does the MUA, I will likely experience a period of increased pain and swelling? I am at my wits end with this knee, and I seem to be the poster child for Murphyís Law at this point. Please if anyone can give me a patientís perspective of what to expect from this procedure, please share with me. I am scheduled for the MUA on July 12th, which is getting close to 3 months post-op from the April surgeries. I was told I am close to the being out of the small window of time to perform the manipulation, and wonder what to do if it does not work.

I literally cannot do anything right now, since everything I attempt causes a massive swelling response and the pain is extreme. I have a large, hard band of something (scar tissue I assume) running from the top lateral area of my knee to my kneecap, and a thickened area above my kneecap in the shape of a half moon. In addition, two of the incision areas are pulled in, hard, and extremely painful. I have a scar on my thigh, just above my knee,  that has been there since I was a child. The scar used to be dead center, but is now off to the lateral side (very strange).

I have read countless studies, and information on arthrofibrosis, but have not found anything written telling patients what to expect during or after the procedure (except for the extensive PT part).
Jan 09-Surgery for torn mensicus/synovitis
Nov 09-Scope-Extensive Synovitis/Plica Removal
Apr 10-LR-Scar Tissue Removal
Apr 10-Hematoma Evacuated
July 10-MUA
Oct 10-Scope/Synovitis/Extensive Scar Tissue/Chondromalacia/Maltracking
Nov 10-TTO/Scar Tissue Removal
Knee Aspirated 20 Times
July 11-LK TKR

Offline crankerchick

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Re: Manipulation Under Anesthesia Advice-New Member
« Reply #1 on: June 29, 2010, 08:21:46 PM »
I'm not of too much help on this one, but for what it's worth, I think you need to see an OS that specializes in arthrofibrosis at this point. The post-op care is just as important, if not more important, then the MUA itself.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline annie5970

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Re: Manipulation Under Anesthesia Advice-New Member
« Reply #2 on: June 29, 2010, 10:39:59 PM »
Hello,

Thank you so much for your reply. Yes, I am already set up for extensive PT following the MUA. In fact, I have to go to PT the same day as the MUA, and everyday thereafter. I follow-up with the surgeon the following week, to determine if the MUA was helpful in treating the condition. Although, I was told that I may experience an increase in pain and swelling for a while after the MUA, so I will expect that could happen.
Jan 09-Surgery for torn mensicus/synovitis
Nov 09-Scope-Extensive Synovitis/Plica Removal
Apr 10-LR-Scar Tissue Removal
Apr 10-Hematoma Evacuated
July 10-MUA
Oct 10-Scope/Synovitis/Extensive Scar Tissue/Chondromalacia/Maltracking
Nov 10-TTO/Scar Tissue Removal
Knee Aspirated 20 Times
July 11-LK TKR

Offline Lottiefox

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Re: Manipulation Under Anesthesia Advice-New Member
« Reply #3 on: June 29, 2010, 11:05:13 PM »
Hello annie,

What a nightmare you have had over the past two years. Like Cranker I am no expert on AF or MUA but I know that the post surgical regime is crucial to a good outcome. Have you read the Arthrofibrosis notes on here in the Information Hub? There is a LOT of information on them and other members have literally printed some of it off and taken it to PT. There have been successful battles with AF by members on here - I am struggling to remember names but if you hunt down in the AF section there may be practical advice from them on what to expect. There have also been people who have undergone MUA after total knee replacement and had good outcomes (slightly different I know) and their advice may also be transferable. Cloudy has a TKR diary and she had MUA is the one name that comes to mind. You could always post your story down in the AF section as not everyone on there checks out the general area and they are a really helpful bunch. From reading other members' experiences it seems that slow and steady is the route forwards - early PT but not PT to the point of screaming pain, that simply creates more inflammation and hence more scarring..etc etc....

 Where in the world are you based? You probably do need an OS that understands AF as Cranker mentions - and I am not trying to get you to delay the surgery but I would be asking myself if I totally trusted this surgeon was going to his best for me and had the requisite experience. AF is like other problems in the knee - it needs expertise. I have patella issues - my first OS (a good general knee surgeon) recommended cartilage repair for various defects - without even exploring any alignment issues, patella tracking, biomechanics etc. I'd have gone through extensive open surgery and worn all my new stuff out in 3 months...

I really feel for what you're going through and hope the 12th brings some relief for you. Please keep us posted.

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline annie5970

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Re: Manipulation Under Anesthesia Advice-New Member
« Reply #4 on: June 30, 2010, 03:23:08 PM »
Hi Lottie,

Thank you so much for your reply. I will post my story and questions in the AF area as well. I am here in Michigan, around the Rochester Hills area. I actually did print off a lot of information from Dr. Noyes to take to both my PT and surgeon. It is funny, my PT just could not understand what in the world was happening with my knee, and after extensive research, I found information on AF, and took it in to get her impression. She agreed that I hit the nail on the head; my symptoms are textbook for AF. At my follow-up last week with the surgeon, he diagnosed AF immediately. When I read through Dr. Noyes' information, it was clear to me that my surgeon was looking for signs of AF a month before he suggeted the MUA. He even changed my PT protocol for a month, thinking we could make some headway with my ROM, but it just did not happen. My knee is so touchy, and since bleeding in the joint so bad after the last surgery, I think he was hoping he would not have to do anything to further irritate it, but it is necessary to try the MUA now. I am afraid it will not work, and I will end up back in surgery again. I hate the waiting around for something to improve, when I really just want the situation corrected.
Jan 09-Surgery for torn mensicus/synovitis
Nov 09-Scope-Extensive Synovitis/Plica Removal
Apr 10-LR-Scar Tissue Removal
Apr 10-Hematoma Evacuated
July 10-MUA
Oct 10-Scope/Synovitis/Extensive Scar Tissue/Chondromalacia/Maltracking
Nov 10-TTO/Scar Tissue Removal
Knee Aspirated 20 Times
July 11-LK TKR















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