ITB surgery after a total knee replacement

[ITB1942]

I am a 68 year old woman, obese but physically active (when pain doesn't limit my activities). I have had iliotibial band syndrome for about 4 years. I had arthroscopic surgery to repair meniscal tears / subluxation 2 years ago, in the hope that would help the ITB.  It did not, and I began to experience pain within the knee joint after a a few months due to bone-on-bone contact. I had a total knee replacement and recovered well from the surgery (March 2009). However, the ITB problem persists and flares up with rather short walks or bike rides. My orthopedic surgeon says that any surgical approach (such as Z-plasty) is contra-indicated after a TKR. Is that the general opinion?

[Abhijeet Ghosh]

Dear Friend,
The reason why your orthopaedician is not happy with any sort of surgery post TKR is due to the fact that any surgery can trigger a focus of infection, into the operated joint and hence can get infected.
Hence he must not be in favor of surgery. Even i would not suggest you to go for a surgery , for only releasing the I-T band. Try for the stretching physiotherapy and also can go for Manipulation for anesthesia, for stretching of the IT band.
What does your physiotherapist suggests?
Regards.

[ITB1942]

Thank you very much for your reply. Not what I wanted to hear, but it confirms that there is a consensus. I don't quite understand why the potential for infection couldn't be handled with a course of antibiotic treatment, though.

Yes, my physical therapist has assigned me some stretching exercises and tried a number of other things (ultrasound, taping, etc. etc.), to no avail. However, the idea of manipulation under anesthesia is new to me. I Googled the term, and found quite a few references to using it for frozen shoulder and other conditions, but not ITB syndrome. Do you have any suggestions for further reading? Is this something the orthopedic surgeon would do, or would it be another specialist?