Manipulation Under Anesthesia (MUA) after Total Knee - Treatment for Stiffness 

I always learn the most from this guy. He always clearly and concisely explains what I need to hear.

In the uk.Had my knee replacement, knee was very swollen from the start. Then i was forgotten on the waiting list for physio for the lst 7 weeks. I did however do the exercises i was given from the hospital. I am now at 90 degrees At 9 weeks. 3 courses of physio. The pain is still there around and behind knee, but will keep on doing exercises. What i didn't expect was the depression i felt if you have friends & family do involved them in your recovery. Good luck everyone!

There is no better information than than what you provide. Thank You so much

Had my first MUA since my accident on June 4, 2023, and it is now July 26, 2024. I can't tell any difference if anything it made my bend worse.

Excellent video

Thanks a lot Dr. Rosen for this video, that explain clearly about stiffness matter I am experiencing now. I feel much relief that I am on the right track now, 5 weeks after TKR and 115 flexion.

I'm on my 12th week now and I'm at 108% bend.

Excellent explanation I wish I had moved my right knee more after surgery.

Thanks Dr. Adam Rosen for this video. I had my TKR on my right knee last April 17, 2023 but still very stiff even though I have physiotherapy 3 times a week. So my surgeon told me to go for a MUA soon to have more flexion on my right knee. Hopefully, I'll get the best result that I wanted after my MUA. Thanks again on your video. It gave me enough information about MUA.

Good information..... now I'm scared that I'm going to need this, but good information.

This was great, so informative. Thank you. I have not reached 100 yet ( not sure if I was there before the surgery) I had a bowed leg for years. Anyway, I have one more week to decide if I want the procedure done. Just so nervous. My surgeon is not pushing it on me either.

I learn a lot from your video , I am a technical guy and I understand perfectly your explanation , not sure why my doctor wasn’t more informative about all this , knowing how scary all this is . I did both knee on the range of two months, is a lot to learn and do for you to get your quality of life that you expect . But the more we know the better we can regain control , so thank you again for your time 👏🙏sincerely Nikola Sekulic

Good info I'm 6 mths out stiff , was stiff and in pain since day 1, back in PT doc says next step mua , I don't like the risk this far out , doc probably will drop me from patient list but I feel I have to make a informed decision here ..., I'll keep PT going if I can and , say no to mua , don't want a rupture or fracture , ... O well...I can walk ...

Many thanks for your explanation of this procedure Dr. Much appreciated.

I was doing better than before the knee replacement. At 97 degs I was cutting the grass, walk a mile a day, stairs etc. The big thing for me was getting in and out of a car without the occasional small teardrop. In short, I was functioning. But my doctor wanted 120 degs. The three-day IV pain blocker did very little…PT is done the day of the procedure and was PAINFUL. The day of the procedure knee was forced to 113. My recommendation if you need MUA, have it done a month into PT and not three months as I did

Thanks very much for your helpful information. I had my TKR done three months ago and have been working hard but have been stuck to about 5 degree extension. Can I still reach full extension with continued PT or will I need to undergo another procedure?

HI Dr, is this procedure recommended for gaining extension as well?

Hi sir my grandfather had tkr he is lagging full extention it's been 5 month's for surgery and how can he get full extention pre operations he did not had 0 ° but now how can we get that's. And about flexion is around 110° (bend) kindly guide as due to financial issue we are unable to visit. Doc and we had done surgery in gov hospital

Thank you DR. Rosen, that was a perfect description of a MUA! I have heard the term but did not know what it was!! My right knee was a TKR 4 weeks ago and I am working hard to regain the range of motion, up to almost 120 degrees now but I am wondering how much I can force it? On a pain scale of 1 to 10 I push it to around 7 or 8 on that pain scale and dont want to go more in fear of damaging something. According to the MUA they are probably manipulating that leg more then a human could possibly stand the pain so I should be safe forcing it as much as I can endure? Thanks again for your video!!!! :)

I had patella inferior pole fracture 11 weeks back and my lower pole some part came outside tbw but wiring is intact. I m planning to get MUA this week and i m afraid of quad or patella tendon rupture. My flexion is currently only 70°. Please advise

Is this procedure appropriate with stiffness in the other direction, that is, unable to fully straighten the leg?

Than you for this video. I’m just over 2 weeks post TKA and hit a milestone of 100 degrees flexion. Oh so stiff, but making progress. Does this scar tissue ever go away? Is there a way to loosen it up? Message?

What are the risks of open lysis of adhesion ??

How long does it take for numbness to go away in a knee after a knee manipulation injection

Very helpful

Person having knee ffd 30 degree with further flexion up to 120 degree after tkr.What is the remedy?

What about crps in the foot/ankle on the affected leg. My 90 yr old mom just had knee replacement surgery and can’t put weight on her foot. It’s numb, stiff, little range of motion, swollen. Is that temporary and what can be done to get it to heal.

I had full range before partial knee replacement. Done what I was told. As a Military Veteran i know how to stretch and exercise. Second operation on same knee now can't bend worth a crap..

Thanks for this video, I am getting total knee replacement soon,

I had my knee replaced one month 6 days ago. I came home and PT came here twice a week and really did nothing except help me stretch. No up and walking or nothing. Finally I went back to hospital for 3 days and sent to inpatient therapy for 8 days which was a waist of time. I’m this far out from surgery and only at 40 degrees. Doctor did say because of past surgery from sports I have multiple ligament reconstruction and excessive amount of scar tissue he saw during replacement so it would make it harder for me. I’m struggling at age 48 and live alone. Considering having this done.

I broke my femur 1yr ago and my knee can’t bend at all but am with an external fixation can this procedure been done with it on??

I'm four weeks and a half weeks out I'm 92 degrees. Been a super struggle. I'm getting very worried . Any thoughts . I am working with a physical Therapist

Should I be worried if 100 degrees of flexing at 6 weeks?

Dr Rosen, why do I need 110 or 120 flexion after surgery? I have 90 now pre TKR, and have had 90 for years, and I do fine. Why would I need more than that and need to undergo that risky MUA?

I'm a 20 Year old male. I had a femur fracture 1 year ago. My knee mobillity is 90 degree. What should i do now. Is manipulation under anaesthesia is possible in my condition?

Sir Is this procedure safe after 4 months I am not able to bend my knee beyond 95 degree after femoral shaft fracture and patella fracture please suggest Sir 🙏

Thanks for these videos,some great advice. I'm 8 weeks post full knee replacement and have a 90 degree range of bend but really struggling to make any gains.Pre op i wouldn't have been getting that much more and the main issue is tremendous pain in the thigh,quite a bit in the calf and not actually in the knee.Is there anything you could recommend as it's a brick wall at the moment no matter how much i do the exercises i'm given? Presuming it's just with having so many years of limited range and the muscles are struggling to adjust and also the leg was re-aligned after having a fair dog leg in it.

Good information wish I would have known all of this before my knee replacement

I have stiffness from meniscus tear but I didn’t get surgery I’m just doing therapy. I can’t bend it past a certain point because it hurts. Would I possibly need MUA? I’m worried, it sounds so scary it would hurt so much

I fell and tore my Quads October 2 and had surgery November 2 then got blood clots in my lungs. I have been going to PT. They move my leg till I scream with pain. I only keep the brace on for going outside in bad weather or going on stairs. I can't move my leg more than 60 and they pushed it to 70 and I screamed it hurt so bad. The PT. were talking about manipulation. It is now late January I am worried and Can't stand the pain in PT.

It's recommended for Heamophilic patient

I never knew any of this before. As for me from watching this video, if I had to do something to correct my stiffness, it would be the “open” procedure where they carve out the scar tissue. The other option I think opens you up to too many risks. That tearing of the connective tissue doesn’t sound worth it.

Mums currently 13months post TKR. Suffering from lots of swelling too, consultant offered her MUA but its not guaranteed to help. Plus feel like it could just swell back up again and back to square one. Only just going back to work. She wants to go ahead, but im worried for her.

The terminology, at least for myself, s/p TKR over 3 years, great success with therapy however, now my "stiff" is frozen. I am 57 years old, I cannot put on my pant leg normally, much less ride bike. Following up with surgeon, he said it was fine, PT improved during appt and immediately lost it as soon as I left. Scar tissue or too large...I am not sure. Researching revision specialist for hopefully...answers

Thanks Doc, 7 weeks post-op tkr . At 90 degrees without anymore progress. Scheduled for MUA in 2 weeks. I understand it varies with surgeons. But is there a universal acceptance rate for fracture or tendon rupture? Thanks again.

63 YO male, bi-lateral TKR 8 weeks ago. My flexion is about 125 left and 120 right but my extension is +8 left and +4 right and is not progressing. Swelling, pain, weakness in quads and lack of good sleep remains. I am very concerned and a bit depressed. Does MUA work for extension also? I appreciate your videos, thank you!

Does anyone ever get back to their normal?

Hello fellow knee replacement Team it's been a while now I can move my knee Knee forwards and backwards and I can bend better,unfortunately I cannot put any weight on it as it gets extremely painful I've seen my consultant and he seems too think everything is okay🙄 not for me !! in pain daily around the sides of my knee and at the front still doing excise. Different pain as I was before but just as painful in a different way.I guess thats life. I hope everyone is better ❤❤❤ oh ps... The depression I felt, I have Got help with so on that part not doing so bad Good luck everyone🐾🙋🏽‍♀️🙋‍♂️🇬🇧🇱🇨🦵🏾

Thank you for your explanation in the video re MUA. I am a Polio sufferer, had TKR in right knee with a reputable consultant surgeon at the King Edward VII hospital in London back in September 2019, following physiotherapy treatment for two months I couldn't the get the desired flexion and the surgeon recommended MUA however still followed by more physiotherapy that range of motion could not be achieved. My flexion is more than it was before TKR. Should I go back for another MUA or have another surgery to remove the scar tissue? Thank you.

I am 4 months out , was in the 1% to have complications, with saddle block, my bladder went to sleep, then they said my prostrate had problems, then a UTI, so did some exercisers for weeks 2,3,4,5, but none in week one( I was in the hospital). PT got me range of motion from 0 to 102 degrees, Great PT!!!! We hit a brick wall they said scar tissue. My question is, if you can manipulate me to to 120-125, can I just grin and bare it and get it myself? It seems to me like when I push it to hard, I have problems with my IT Band and set myself back 2 weeks. any ideas? thank you!!!!😊

i’m 19 (female), fractured and displaced my tibial plateau and didn’t have surgery. after healing, they told me i should’ve had surgery from the beginning and now i need this MUA. my extension is 35° and flexion is 90°. i’ve been in physical therapy for 2 weeks and i have barely made any progress and i do the exercises 2 times a day. i’ve lost hope in ever being able to walk and i really hope this MUA helps me. any tips?

Hello Doctor, I experienced an accident six months ago resulting in fractures to my patella and femur. Currently, my femur is still in the healing process, and my knee can only bend to about 95 degrees. My Surgeon suggests undergoing Manipulation Under Anesthesia (MUA). Any recommendations or advice?

DR ROSEN, My case is unusual: I had a TKR Oct 25, plus a synovectomy. I am now 12 weeks out. I am only at 105-108 (one time I had 110) with max pushing, have had a lot of stiffness, swelling and pain, likely the synovectomy the culprit- it is also a very invasive procedure,,,and I had one 34 years ago too. I was 110-115 before surgery. I have had the condition called Synovial Chondromatosis for 34 yrs: I had a synovectomy then, and also an MUA 6 weeks post when I was stuck at 90 degrees. It sort of helped, but I was also 30 years old..now at age 64, I am fit, but not sure my scar tissue building tendency will keep me at an improved angle if I choose MUA again, scar tissue came back before, so why would it help now? The burning Question, Is it worth the risk of time down again, and possible damage to tendons? My brain screams NO! But...traditional PT did not help much, I could not progress, and I ordered the X10 machine from research on my own, had it delivered, and been on it 4 weeks- gradual improvement. It is a gradual flexion/extension machine to assist in recovery. The new antii-inflam helped 2 weeks ago plus a 5 hour long trial of a nerve ablation to help numb the pain, so I could bend. I forced to 105 degrees, and have been there for 2 weeks. So here I am again, 34 years after a synovectomy, also recovering from the TKR, the condition contributed to degenerative arthritis. My knee "was a mess" surgeon said after. I continued being a moderate athlete all these years (hike, mountain bike, kayak, yoga, other activities) with knee flexion limitations (110-115), but I did it all anyways. So now, at 12 weeks, I want to AVOID the RISKS of MUA...and I am at a cross roads. Easy for a surgeon to say "let's give it a try" because he doesn't have to live in my body with the results that may be damaging! Or take more time off work I do not have, so Disability, I am going to retire in a year, and planned on continuing my active lifestyle, but you cannot pedal a bike with only 105 degrees! I need 110-115...I NEED to get back to my passion- mountain biking! My surgeon said to not give up, I MAY be able to keep improving slowly..but that "window" of 12 weeks has now passed. I am scheduled for a knee Ablation, but not for 4 weeks (the first available appt, and they will not fit me in, insane, since I am on a timeline of effectiveness here, and, already used all my sick days (8 weeks) from work. The Ablation is a last ditch effort my Surgeon thought of the day before I went back to work- ugh! Even though I asked, he said it is not a typical procedure, but i am not a typical patient! He should have thought of this 6 weeks ago! The idea is to NUMB the sensory nerves to the knee so I can do more forceful flexion exercises, and keep taking Mobic anti-inflammtory to keep the swelling down (common with synovectomy). So I worry 4 more weeks out of the doable timeframe of getting that scar tissue to break/bend puts me in another risk category. After all this, so much pain and suffering...to be left to "wait" for an opening is really not OK. I tried, the Dr said he cannot get me in earlier. Stuck. just living on hope and possibility..but my future ability to ride a bike and have functional flexibility is looking elusive.

Thanks so much Dr for this video.I had to have this done a few months after my first knee replacement as it was toostiff.10 weeks ago I got the second knee done and same problem so I'm scheduled to have it bent this month. I know what to expect now and I must admit I gained really well in flexion and bending after thie procedure.But thank you for explaining it in this video.

I just keep saying i didn't get what was needed in the beginning. Wasn't my fault. I did take myself to bathroom n walk the hall but u actually almost had to pitch a fit to get therapy n im serious here. I left there. So i know i we t to long wo what i needed.

I’m scheduled to have MUA done next week and I’m hoping it’s not painful due to me having total knee replacement about 8 weeks ago.

8 weeks and only 70 degrees, my MUA is coming in two days, I hope it goes well

Talk w my surgeon. My surgeon is so concrete in her beliefs. No personality n very robotic!

Brilliant video i will be having my Mua tomorrow not looking forward to it 😢

This literally has me so scared my MUA is Tuesday omg 😢

My sister was told to do it after only 2 weeks of pt. This is ridiculous. This was never done before, but greed prevails. They always find new ways to make more money, regardless of how they affect someone's quality of life. Being just under anesthesia for the surgery and going under so soon is literally life threatening, but do they care? Many people have a very bad reaction and die. Who do you blame? They cover their butts in the form you sign, you give them the permission to do this to you and they do NOT take responsibility when something terrible happens. With Physical Therapy you can do well, stick with it. Do NOT let them bully you into it. The risks outweigh the benefits.

Why is the patient not fully sedated and also have a thigh nerve block? Clearly the patient is in pain during this procedure.

I am in 50 degrees 😂😂😂this what he said going to do , pray please 😢😢😢😢

Need to talk louder