MUA Knee Replacement & Manipulation<

[scruffy]

On Oct. 30, 2015 I had a total knee replacement. After my Dr. Refused to send me to rehab and did not send me him with a CPM machine. I had two weeks in home PT and then was sent to outpatient PT. after being in outpatient PT for 12 weeks with terrible swelling and stiffness, it was determined that I had a lot of scar tissue and needed a Manipulation. This past Tuesday just shy of 3 months post surgery I had my Manipulation done. I went back to PT the very next day and find my knee swelling with each visit more & more with all the exercise & bending. My knee is so swollen I cannot walk or bend it. Is this normal after a Manipulation? I thought this was supposed free up my knee and give me better range of motion, not have a knee the size of a cantaloupe? My thigh is killing me when I try to sit. I refuse to take narcotic drugs. I only take Naproxin 500 mg 2x a day. I'm really starting to get concerned that this knee is never going to be ok? Any suggestions or ideas regarding my situation? I am a 48 yr old female. Thank you.

 

[Pumpkin]

Scruffy,
Welcome to Bonesmart, glad you decided to join us! .
Sorry to hear you are having so much swelling and pain after your TKR and MUA, it is unusual to develop scar tissue this early. Usually the swelling and pain you have after TKR are the result of doing too much activity, exercise, poor pain control, and aggressive bending of your knee. It sounds like you experienced of of this in your rehab.

Suggest you slow down and give your poor knee a break, it had major surgery and needs time to heal. As the swelling goes down your ROM will be there, as it has been all along. With all the pushing and shoving in PT, and over exercise it is swollen and stiff in response. Listen to your knee, it needs Rest, Ice, Elevation, and Medication on schedule as prescribed. Tylenol is a better pain reliever, you can take it according to the instructions on the bottle.

Give your knee a chance to heal, then you can increase your activity and exercise.

Here are some articles about ROM:
ROM: it's worth the wait for ROM
ROM: it's never too late to get more ROM!
ROM (range of motion) information
Myth busting: the "window of opportunity" in TKR
Myth busting: the "window of opportunity" JBJS
And about MUA
MUA (Manipulation under Anaesthetic) and Adhesions
MUA for Stiffness Following TKR
MUA: the ineffectiveness of early MUA (JBJS)

Please add your surgery date to your signature, hover over your username top right, click on signature and add your information there, Thanks!

Here are the recovery articles, they are short and will not take long to read:

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

 

[Celle]

As Pumpkln said, your poor knee has had enough trauma for now. Give it a break and rest it for a couple of weeks. you don't need to do lots of exercises after a MUA. Just a little bending and stretching is all it needs. It was wounded again by the MUA, so give it some time to recover.

Most likely, the main reason why your knee doesn't bend is the swelling. All the extra fluid keeps it stiff, just like a hosepipe filled with water. Get rid of the swelling and your knee will be able to bend.

So, concentrate on reducing the swelling, with lots of rest, elevate, ice and take your pain meds by the clock and only a little,very gentle exercise.

 

[scruffy]

I appreciate both your advice and Pumpkins advice. I don't understand why the Dr. Said get right back to PT tomorrow after the MUA? This knee is so swollen and it got worse after the two days of PT. Now it's the weekend and it's like a cantaloupe and I can't walk or bend it. I've been icing it and elevating it. I demanded a CPM machine this time at my home for after the MUA and I'm afraid to use it now because the knee is so swollen? I'm not sure it's even beneficial. I feel so torn at this point I'm afraid to do the wrong thing and not do what's right for me and my knee. My thigh is killing me with pain. My knee doesn't hurt its just swollen, but my thigh is killing me I guess the muscle after the MUA? I'm so happy I found this group. Thank you, thank you.

 

[newlybionic]

I used ice on my thigh to help with pain and cramping. The PT packed my entire leg in ice and I continued to do it at home. I iced almost constantly. It did help with the swelling of my knee and also my thigh pain.

 

[Celle]

I don't understand why the Dr. Said get right back to PT tomorrow after the MUA? This knee is so swollen and it got worse after the two days of PT. Now it's the weekend and it's like a cantaloupe and I can't walk or bend it.

Your doctor advised the exercise because he was taught that it's necessary. However, the more up-to-date approach says that less exercise and gentler treatment are more effective.

 

[scruffy]

I think I'm going to give it a break and let it rest. I will keep icing, elivating it and take Tylenol. Thank you.

 

[Jaycey]

Sounds like a plan @scruffy . But Tylenol may not manage your pain. I suggest you see your family doctor for something to help ease the inflammation.

 

[Roy Gardiner]

I think I'm going to give it a break and let it rest.

100% correct. Exercise will not help your (doubly) traumatised knee. As everyone has set, rest, ice, elevate. Let it heal. You can do some gentle stretching if you really want to, but no more.

I refuse to take narcotic drugs.

Why not? They are there to control pain. You won't turn into Jimi Hendrix, really.

 

[Josephine]

I went back to PT the very next day and find my knee swelling with each visit more & more with all the exercise & bending. My knee is so swollen I cannot walk or bend it. Is this normal after a Manipulation?

It's normal when the knee is being abused like that. Too much of anything will cause excessive swelling. I suggest (as others have done) that you quit PT altogether, both at PT and at home. It's not necessary.

I refuse to take narcotic drugs. I only take Naproxin 500 mg 2x a day.

Well you're going to have to change your opinion. Read the articles you were left earlier. If your reason for not taking narcotics is for fear of becoming addicted, there is a very article about that amongst them. Read it and be educated! Besides which, if your pain isn't properly controlled, then you are bound to get excessive swelling plus other manifestations of pain such as soreness, burning, stabbing, throbbing, aching and stiffness. Good pain management is an essential part of TKR recovery and cannot be avoided.

 

[kneeper]

You can use mild heat on your sore muscles, just not on the knee itself.

 

[sleepilu]

Hey @scruffy! I'm an acupuncturist, I spend my life dedicated to providing drug free treatments using an ancient form of medicine in a modern world.
I managed to hold back the progression of my arthritis in my knees with acupuncture for 7 years. But the time came that I had to look to westernised solutions.... Surgery and narcotics!! I would not have got through the last few weeks without serious pain meds. But now I'm down to just a couple of cocodomol at night. Give your body what you can to help it mend, you won't get addicted because as your body heals and your pain reduces you will naturally reduce the meds alongside.


Sent from my iPhone using BoneSmart Forum

 

[scruffy]

Thank you for all the input. I'm not afraid of getting addicted to the pain killers, I took one Percocet and I began sweating like crazy, I got nauseous & did not feel well. This is something I was afraid of. I have seen what these drugs can do as far as making ppl sick. I'm actually not in any pain I haven't been. My biggest problem is the swelling I can't get it to go down no matter what I do. I have taken Aleve, Naoroxen 500 mg. icing, elevation etc. the Dr. has no answers. He told me after the manipulation I would have better ROM and minimal swelling. I do not have any better Range of motion and a lot of swelling. ROM can't happen because of the swelling. It is very frustrating. I have done everything I am supposed to and I'm going nowhere fast. My PT is concerned if I don't go my leg will lock up on me? I get so many different things my head is spinning and I'm actually scared that I'm going to do the wrong thing or never get better. I feel like it's mentally breaking me down and I am a very strong person. I've had many surgeries over the years including heart, this by far has been the biggest nightmare.

 

[Pumpkin]

@KarriB had her knee in a straight knee brace, she has great ROM.
Your leg needs to heal, pushing and shoving for ROM will only irritate your soft tissues and set back your recovery as you have found.
You are receiving conflicting advice, no wonder your head is spinning. Listen to your knee, what has happened when it has been forcefully bent, it swells, is more painful (swelling is pain), and limits your ROM.
Suggest you look for a lymphedema expert in your area, they have the training to help with your swelling. @skigirl had good results with a lymphedema expert during her recovery.
You have already given yourself the advice that you need.

I think I'm going to give it a break and let it rest. I will keep icing, elivating it and take Tylenol. Thank you.

You can also try this, it helped my swelling go down. On your back, Breathe in your mouth, out your nose slowly 5x, do ankle pumps 5x, do glut sets 5x (squeeze your rear), do quad sets 5x (push your knee gently into the bed), repeat several times a day. Rest, Ice, Elevate, and Medicate on schedule as prescribed afterwards.

 

[referee54]

My PT is concerned if I don't go my leg will lock up on me?

I would say that these fears are unfounded. There is no "window of opportunity." @KarriB had issues and she is doing phenomenal, and, if you look through the threads, you will see that others, too, have had issues and have come through with great ROM.

Your leg needs to heal, pushing and shoving for ROM will only irritate your soft tissues and set back your recovery as you have found.

Let it rest---let your leg relax and take a vacation from all of the ordeals that it---and yourself---have been through. Take it easily and take it gently---and ice and elevate and rest.

 

[SwimMom14]

Hi Scruffy, I think you and me are a lot alike. I am 47 and had my ltkr on September 9th. I have had two manipulations. The 1st one wasn't too bad but the 2nd one has been awful. I have had knee problems since I was 13. I have lost count of how many operations I have had on my knees, 15 or more on the left, and 10 or more on the right. I was always told I was way too young for knee replacement. Last June my right knee was really giving me trouble so I asked around for a good orthopedic surgeon. I did a lot of research and the doctor I chose has very high ratings and came highly recommended. I saw him in July and after reviewing my MRI he said my left knee looked worse and it should be replaced 1st, even if my right was giving me more problems at the moment. I scheduled the surgery for August 19th. The closer I got to the date the more nervous I became and thought I was making a huge mistake. The reason I wanted to replace my knees is because, like you, I have a 22 year old son and a 14 year old daughter. I want to be able to do things with my daughter. When I went in for my pre-surgery check up my blood pressure was sky high. They told me to go have it checked by my regular family doctor. He put me on blood pressure medication. A week before surgery I got a call saying I had the staph infection bacteria in my body, so they put me on antibiotics for a week. Surgery day, I get at the hospital at 6:00 am, they get me all ready, give me the drugs, etc. The doctor comes in and says they had to cancel all surgeries for the day because the back up generator went out and they can't get it fixed until Thursday. You would think after 3 strikes I would have realized something was trying to tell me something. We rescheduled the surgery for September 9th. I had the left total knee replacement and the doctor also took out some hardware in my right knee and fixed some ligaments in it. When I woke up the pain was alright but that night when they had me try to get up and walk I passed out from just trying to move my left leg. It has been I very long road and recovery for me. My doctor is extremely dissatisfied with my rom progress. After the 2nd manipulation I am still only at 115 degrees, which a lot of people say is great. I am a little over 5 months out. When I saw my doctor after the 2nd manipulation, he told me it was a waist of time because he got me to 135. He basically told me I wasn't working hard enough at therapy and I just had to push harder. I left in tears and don't want to go back. I have an appointment with him next Thursday and don't want to go. Right now I feel like this was just a huge mistake. I am at the lowest I have ever been in my life and I am a very strong person, having gone through quite a bit, including 4 miscarriages. I have got to say I am glad I found this forum because it has helped me feel not so alone and like maybe I can get through this. Hang in there and like everyone has said give it a break. That is what I am doing. I don't care what the doctor says anymore. I might not be as far along as he wants but you know what? It isn't his knee, it's mine.

 

[scruffy]

SwimMom14- Well I will say you certainly have been through a lot and from a young age. Yes we are a lot alike. I didn't even know you could need or get more than 1 manipulation on the same knee? Funny both of my knees were the same as you. My right hurts more but he told me the left was worse so that one had to go first.

I listened to the Dr. what did I know. To make matters worse after my LTKR he said to put gel in the right that did nothing but cause more pain and now I feel the bones snapping. He never even asks me how it's doing or feels? This is a joke. I went to him yesterday 1 week after the manipulation because that's what he told my husband to tell me to do after they spoke after the manipulation. The Dr. walks into the room and says to me what are you doing here? I was like what you told my husband to tell me 1 week, no I didn't he says. You come 4-6 weeks after.

Anyway, I questioned him about all the swelling it's like they don't care, they don't have answers and treat you like you're crazy. I left there in tears. Every time I go it's nothing but empty promises and inconsistencies. I bought a bike for home I do stretching etc. Right now a week after manipulation my knee is tight, swollen, the back of my knee is swollen and it's uncomfortable I can't walk or sleep. I feel like I'm losing it. My right leg will fall off before I ever do this again. NO WAY!!!! It's been hell.

 

[SwimMom14]

Scruffy, I am right here with you. No way will I ever get my right replaced. I am hanging on by a thread, if that. My husband tries to help out but he actually is making me feel worse. I feel like every time or anything I say lately is wrong. No one listens to me, especially the doctor. Why is it that doctors treat you like you are not even human, especially male doctors? They all think you are crazy or just making things up.

After my 1st manipulation the doctor prescribed Percocet which I have had in the past. I am allergic to Lortab. This time, however, I got a rash and itched like crazy. My face was so red I looked like a beet. Called the doctor and the nurse said it was fine to continue taking it, the doctor prescribed it for a reason. Again after the 2nd manipulation he prescribed Percocet. I told him I had an allergic reaction the last time. No you didn't, you have had it in the past and where fine with it. Sorry doctor, but your body can change. I am just so tired of people not listening to me. My husband doesn't yell at me when I try to talk to him, it's the way he responds that makes me feel like why am I even talking to you.

Today I asked my husband to email a company that my daughter ordered something from and hasn't received it yet. I emailed them already and they said it would ship this past Monday. I tried to explain that to my husband and he just kept saying alright, alright, not even listening to me. Well, now I am giving him the silent treatment. If he can't figure it out too bad! If every time I talk, no one is going to listen, why talk at all. I am trying not to lose it all but I am struggling today. On top of it all I have come down with a bad cold and am running a fever but my daughter has a swim meet today and tomorrow that I have to drive her to. Can we just cry and scream????

 

[Jamie]

Scruffy, I'm so sorry that you're having all these problems. I know it's difficult when your medical team tells you things that you feel in your gut are not right for you. This is one time that you really need to follow your body. You know it better than anyone else. There is no one-size-fits-all recovery. So it's wrong of your doctor to tell you how your recovery may go. He doesn't know how the details of it will go!

Please take the advice of all who have told you to let your knee rest. This means take a couple of weeks off from therapy and activity. Only gentle bends and stretches are needed anyway for your knee to heal and swelling to reduce. Use lots of ice and elevation as you're resting. Just be sure to put a kitchen towel between the ice source and your skin to prevent damage. Taking this time off will not hamper your ability to get ROM. Many BoneSmarties (me included!) gained ROM for a year or more after surgery. But that cannot happen when your knee is inflamed like it is now.

As for pain management, Percocet is a fairly strong narcotic. There are medications to prevent the nausea you felt. Ask your doctor about that. You may have more luck with your GP than your surgeon. You can also try lesser pain medications like Hydrocodone or Tramadol. Bottom line though is that you need to get any pain under control and be comfortable or the swelling will continue. It's a natural reaction to your body's sensing the pain. Realize that pain can manifest in many ways too.....not only stabbing pain but aching, stiffness, restlessness or just general discomfort. All need to be treated during these early months of recovery.

 

[referee54]

@scruffy ---how much and how often are you icing and elevating? This is very, very vitally important in reducing swelling, inflammation, and pain.