After going through the challenges of knee replacement surgery, there’s nothing more demoralising than becoming afflicted with knee stiffness and often patients can experience a similar lack of mobility to their pre-surgery state. Although it’s not a complication that Mr Jonathan Webb’s knee replacement patients commonly experience, it’s worth addressing.
There are two main options for the practitioner when it comes to knee stiffness after knee replacement surgery: the first is to accept that the patient still has a way to go before the new knee ‘beds in’, and to recommend a regime of exercise and manual therapy whilst being overseen by a trained physical therapist, to gradually ease the knee into its workload. As a matter of fact, most practitioners will try this route as a matter of course.
If that doesn’t work – or in cases where it’s clear that the replacement knee procedure hasn’t ‘knitted’ effectively – then further surgery is advised and there are a number of options to explore:
‘MUA’ stands for Manipulation Under Anaesthesia, and it does what it says on the tin: the patient is anesthetised, then the surgeon moves the joint through a full range of motion in an attempt to break through areas of fibrosis and scar tissue.
An arthroscopic exam and debridement
This involves examining the joint with an arthroscope (a camera fitted into the head of a needle) to see what’s preventing the knee joint from working, and then removing any dead, infected or damaged tissue therein, in order to give the living tissue the room it needs to do its business.
An open incision with revision
Simply put, the practitioner deduces that the new implant has been improperly positioned or has moved since it was fitted – or has malfunctioned – and goes in for a remove-and-replace procedure.
But which works best? A systematic review recently conducted by the Department of Orthopedics at New York’s Mount Sinai Hospital in New York City attempted to answer that question, by reviewing all of the articles on the three surgical techniques over a 42-year period. Although the bulk of the information over the years was sketchy at best, they managed to break down what they discovered by age, sex, time lapse between the replacement and adjustment procedure, and which technique was deployed.
The study concluded that the majority of procedures were conducted between two weeks and three months after the initial replacement surgery,
Results of each treatment approach were measured using change in knee motion and total motion. Any complications that affected the patients’ recovery or outcomes were also analysed.
The findings included:
- Manipulation under anaesthesia (MUA) and arthroscopy are more effective in removing adhesions and other tissue debris than open surgery
- MUA alone (without arthroscopy) appears to give the treated knee the most motion
- Using an open incision to gain access to the joint had the worst results overall
- The earlier the MUA, the better the results – but later MUA treatment is still effective
The moral of the story is that if you’ve had knee replacement treatment and you’re still struggling to get up the stairs, don’t assume that it’s something that will correct itself – get in touch with your practitioner as soon as possible so they can effectively eliminate any stiffness after knee replacement surgery.