Manipulation under Anesthesia

Manipulation under Anesthesia

Manipulation under anaesthesia (MUA) is a noninvasive technique used to provide relief from recurrent hip and knee pain through stretching and manipulation techniques. It is performed under sedation. This makes the procedure painless and helps your doctor apply appropriate force. You will lie on your back or side for the procedure. Your doctor will adjust the alignment of your bone and joints, causing your muscles to be stretched.

MUA helps to dislodge internal scar tissue or adhesions that may develop due to injury or after knee or hip surgery. It helps restore normal range of motion and improves flexibility. 

Indications for Manipulation under Anesthesia

Manipulation under anaesthesia may be recommended for people with the following conditions:

  • Chronic hip or knee pain
  • Acute muscle spasms
  • Chronic sprain/strain
  • Presence of fibrous adhesions
  • Stiffness in the knee or hip joint 
  • Loss of motion or joint stiffness after a total or partial joint replacement

Contraindications for Manipulation under Anesthesia

Manipulation under anaesthesia is not recommended for people with the following conditions:

  • Inflammatory arthritis
  • Bone infection or osteomyelitis
  • Bone fracture
  • Acute inflammatory gout
  • Cancer
  • Severe osteoporosis
  • Obesity

How to Prepare for Manipulation under Anesthesia?

Your doctor will review your medical history, symptoms, and ask about any prior treatments for hip or knee pain. 

Then your doctor may perform certain tests to determine your suitability for MUA. These tests include:

  • Imaging tests such as X-ray, MRI and CT scans
  • Musculoskeletal sonogram: A test using sound waves to generate images of joints, muscles, tendons, and ligaments in your body

Procedure: How is Manipulation under Anesthesia Performed?

Manipulation can be performed under general anaesthesia (unconscious), or twilight anaesthesia where you may be sedated but remain conscious. The choice of anaesthesia depends on the severity of your symptoms. 

After the anaesthesia is administered, your doctor will employ specific techniques to stretch, adjust, and mobilize the affected areas of the hip or knee joint. The adjustments help to dislodge scar tissue or fibrous adhesions in one or more areas of the hip and knee joint.

Manipulation under anaesthesia takes around 15 to 30 minutes. After the effect of anaesthesia wears off, you will be monitored for a time. You may be discharged the same day. Some people are required to stay overnight, depending on their condition.

You may be advised to keep your leg elevated to minimize knee swelling.

Care after Manipulation

After manipulation, many people experience instant pain relief and a better range of motion. Common unwanted after-effects include temporary muscle soreness which may require pain relief medication.

Your doctor will recommend physical therapy and warm-up activities for home. You may also be recommended the application of ice packs to minimize pain.

How many Sessions are Required for Manipulation under Anesthesia?

Some people require multiple sessions of manipulation under anaesthesia. You may be required to visit your doctor soon after your first session, usually within 2 to 4 days. Small improvements after each session will promote pain relief.

What are the Advantages of Manipulation Under Anesthesia?

Manipulation under anaesthesia offers the following benefits:

  • Suitable for people who don’t get relief from chiropractic manipulation, exercise, and physical therapy
  • Safe procedure
  • Helps relieve hip and knee pain
  • Improves range of motion and joint movements
  • Economical

Manipulation under anaesthesia is effective in providing relief from knee or hip stiffness after total arthroplasty surgery.

  • British Orthopaedic Association
  • British Orthopaedic Sports Trauma and Arthroscopy Association
  • British Association of Sport and Exercise Medicine
  • British Elbow & Shoulder Society
  • The Royal College of Surgeons of Edinburgh