Produced: April 2015
Author: Clinical Support
Ref: 252/01
Review: April 2017
Royal Orthopaedic Hospital NHS Foundation Trust Patient Information
Manipulation of the knee under
anaesthetic
Welcome to the Royal Orthopaedic
Hospital (ROH).
For further information please visit www.roh.nhs.uk
Manipulation of the Knee under Anaesthesia (MUA)
Why do I need an MUA?
Sometimes, the knee joint can become very stiff and sore. This can occasionally happen
after knee surgery, most commonly a Total Knee Replacement, where the movements have
been difficult to regain. It is thought to be due to scar like tissue forming in the joint capsule
causing restrictions. This can mean that you have difficulty with the movement in your knee
and can make your days to day activities difficult to perform.
What is an MUA?
A manipulation under anaesthetic is a non-invasive way of restoring range of movement at
the knee. Whilst you are under anaesthetic, the surgeons will ‘manipulate’ or move the knee
joint through flexion and extension in order to loosen it and reduce pain and stiffness.
What should I expect after my surgery?
Mobilisation
You will aim to be walking around a few hours after your surgery, the nursing staff can help
you to get out of bed. You don’t necessarily need any walking aids but can use them if you
did so before your MUA or if you find walking difficult after your surgery.
Pain Relief
A nerve block is sometimes used during surgery which means your limb may feel numb
immediately after your operation. It is normal to feel some pain as the block wears off and
you will be provided with some painkillers to help with this. It is important to take these as
prescribed to keep pain to a minimum.
Ice
Ice can be very helpful to reduce pain/swelling. Protect your dressings from getting wet with a
plastic bag. Wrap a bag of ice/frozen peas in a damp towel and apply for 10 -15 minutes.
This can be repeated every 3-4 hours. For knee surgery, elevating your leg on pillows can
also help.
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Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP Tel: 0121 685 4000
Manipulation of the knee under anaesthetic
Rehabilitation.
It is essential that you begin to move the knee as soon as possible to maintain the
amount of movement that the surgeons have achieved. The more that you move your
knee in each direction the more likely you are to achieve a good outcome and have less
pain overall.
You will see a physiotherapist on the ward before you go home who will teach you some
exercises that you must continue at home. You will also be referred to see a
physiotherapist as an out-patient at your local hospital after you have been discharged
home to continue your rehabilitation and to regularly check your movement.
Your Consultant will give you guidance on when you can return to work, activities and
driving. Your Physiotherapist will be able to give you guidance on returning to sporting
and leisure activities as your movement and muscle strength improves.
If you have any questions or need any advice about your exercises then please contact
the Physiotherapy Department between 8:00am —4:00pm Monday to Friday.
Royal Orthopaedic Hospital Physiotherapy Department: 0121 685 4120
Instruction for after your surgery:
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Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP Tel: 0121 685 4000
Manipulation of the knee under anaesthetic
Personal Exercise Program
MUA knee
Royal Orthopaedic Hospital NHS Foundation Trust
Royal Orthopaedic Hospital
Bristol Road South, Northfield, B31 2AP, Birmingham, United Kingdom
Lying on your back with legs straight.
Bend your ankle and push your knee down firmly
against the bed. Hold 5 secs. - relax.
Repeat 10 times.
Video
©PhysioTools Ltd
Lying on your back. Put a rolled up towel under
your operated knee.
Exercise your straight leg by pulling your foot and
toes up, tightening your thighmuscle and straightening the knee (keep knee on the towel). Hold approx. 5 secs. and slowly relax.
Repeat 10 times.
Video
©PhysioTools Ltd
N.B Ensure you take the towel out from under your
knee after completing the exercise.
Exercise your straight leg by pulling the toes up,
straightening the knee and lifting the leg 10-20 cm
off the bed. Hold approx 5 secs. - slowly relax.
Repeat 10 times.
Video
©PhysioTools Ltd
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Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP Tel: 0121 685 4000
Manipulation of the knee under anaesthetic
Lying on your back.
Bend and straighten your leg.
Repeat 10 times.
Video
©PhysioTools Ltd
Sit on a chair with a towel or something that will
slide under one foot.
Slide the foot under the chair as far as you can.
Move your knee forward keeping the sole of your
foot in contact with the floor.
Remove the object before you stand and start to
walk.
Video
©PhysioTools Ltd
Repeat 10 times.
Sitting on a chair, with the leg to be exercised supported on a chair as shown.
Let your leg straighten in this position.
Video
©PhysioTools Ltd
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Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP Tel: 0121 685 4000
Manipulation of the knee under anaesthetic
Sit on a chair.
Pull your toes up, tighten your thigh muscle and
straighten your knee. Hold approx. 5 secs. and
slowly relax your leg.
Repeat 10 times.
Video
©PhysioTools Ltd
Stand holding onto a solid surface.
Slowly bend your hips and knees until you cannot
see your toes. Stand up tightening your buttock
muscles.
Repeat 10 times.
Video
©PhysioTools Ltd
Stand.
Push up on your toes. Repeat 10 times. Try and
keep your weight evenly on both legs.
Video
©PhysioTools Ltd
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Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP Tel: 0121 685 4000
Manipulation of the knee under anaesthetic
Ice.therapy.
Place an ice pack on your knee for 15 minutes.
Repeat throughout the day approx 3-4 times, or as
required
Video
©PhysioTools Ltd
Walking up stairs.
Stand close to the stairs. Hold onto the handrail
with one hand and the crutch/crutches with the other hand.
Video
©PhysioTools Ltd
First take a step up with your healthy leg.
Then take a step up with your affected leg.
Then bring your crutch/stick up on the step.
Always go one step at a time.
©PhysioTools Ltd
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Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP Tel: 0121 685 4000
Manipulation of the knee under anaesthetic
Walking down stairs.
Stand close to the stairs. Hold onto the handrail
with one hand and the crutches/sticks with the other hand.
Video
©PhysioTools Ltd
First put your crutch/stick one step down.
Then take a step with your affected leg.
Then take a step down with your healthy leg, onto
the same step as your affected leg.
Always go one step at a time.
©PhysioTools Ltd
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Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP Tel: 0121 685 4000