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  1. PLEASE NOTE THAT ONE RECOVERY THREAD ONLY IS PREFERRED. PLEASE DON'T START ADDITIONAL THREADS ABOUT YOUR RECOVERY.

[MUA] painful inflamation 12 weeks post TKR

Discussion in 'Knee Replacement Recovery Area' started by stellar_knee_soon, Jan 16, 2014.

  1. stellar_knee_soon

    stellar_knee_soon New Member

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    Hello,
    This is my first post. I had a TKR on October 15th 2013 and surgically it went well (i.e nice looking xray).

    However, from the onset I have had continued extreme pain and inflammation around my knee. I was in Hospital for 4 weeks post op and had aggressive PT from the second week (during the first week my leg was too swollen to bend at all from my ankle to my thigh). I have been doing PT 3 times a week since discharge, this includes 45 mins in the gym and 45 mins in the pool. I frequently was unable to do any of my exercises at home after a day of PT as my leg was so swollen and excruciatingly sore despite strong pain medication.

    I also had excruciating calf cramps which have only been alleviated for a few weeks since being switched to Lyrica (not sure why they took so long to do this as I felt the cramps at night undid all my stretches in the day) I have 70-90 degrees flexion and 0-10 degrees extension depending on how much I have done at PT or been on my feet (it deteriorates the more I do). It seems the harder I try the worse it gets - yet the therapist just says I have to get over it.

    I've had severe rheumatoid arthritis for 30 years, so I am familiar with strong pain - yet my knee feel so inflamed that I don't want to force it any more as I can almost instantly feel it swell. My surgeon is not satisfied with my bend and I am scheduled for and MUA next Tuesday. He said that he wants me to do PT every day afterwards, but I am afraid of repeating the same mistakes, i.e if I am in such pain and my knee is so angry, should I push it as this failed the first time.

    At the same time, I feel a bit powerless to argue with the PT as they make you feel soft for not being able to get through the pain. I had a hip replaced 15 years ago and I've had natural childbirth, all of which I didn't complain about (or feel so much pain), so I feel like I'm not just being soft. I've also got a tendency to produce keloid scars, which I did with my hip so I accept that I may just be full of scar tissue.

    I also feel like I've damaged my medial ligament as it is now extremely painful to lift my knee in certain angles and go up stairs even in the pool - this only began after a vigorous PT session. My surgeon was uninterested and said that I need to get my muscles stronger.

    Although I willing to have the MUA in the hope some of the pain is due to scar tissue I am afraid that the outcome will be the same, and that I know I can't try any harder than I have. I wonder if the continued inflammation is going to cause the same issues and if anyone had any suggestions for mentally and physically getting through the MUA and recovery and not repeating the same mistakes?

    many thanks,
     
  2. Jaycey

    Jaycey Moderator

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    @stellar_knee_soon Welcome to BoneSmart! I think you will find we don't recommend the approach your surgeon and PT are taking. All that inflammation is making any progress on ROM impossible! Are you icing and elevating your leg? Can you fire your PT. Physio should never hurt and pushing you is only contributing to the problem. I am sure others will be along soon to give you advice. Meanwhile, here are a few links for you on the subject:
    First are the 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!

    Myth busting: no pain, no gain
    Swollen and stiff knee: what causes it?
    Progression of activity for TKRs
    Elevating your leg to control swelling and pain
    Using ice
    Work “Smarter” and not “Harder”
    Myth busting: The "window of opportunity"
    MUA (manipulation under anaesthetic) and adhesions
    It's never too late to get more ROM!
    It's Worth the Wait for ROM
     
  3. Campervan

    Campervan Sr Bonesmartie

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    Geez has that physio got you in boot camp? In my humble opinion you're doing way way too much. If you weren't having an MUA next week I'd say give your knee a vacation. Do nothing for at least a week other than ice, elevate and gentle stretches and see what happens. A hose pipe full of water can't bend. Your knee will still be swollen and you're not letting it recovery by the constant boot camp approach.

    Here's Josephine's, our wonderful Mother Hen, approach to her own recovery.
    http://bonesmart.org/forum/threads/knee-recovery-uk-style.11830/

    How are you coping with the heat wave? I'm across the ditch from you in Queenstown and its freezing. Can you send us some heat please. Ta muchly!
     
  4. NetballKnees

    NetballKnees Senior

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    Hi Stellar_Knee ... I had my TKR on 17 October - two days after you, so we are at about the same stage. I too have a lot of swelling too, but only in and around the knee, not all up and down the leg. I see my OS in a fortnight again and as my bend is only about 70-75, I feel he may mention the dreaded MUA. Believe me I am so frustrated with the lack of bend, that I will do almost anything if it works, BUT my knee is still swollen and my thinking is that a manipulation will just add to the stress the knee is under and if anything, the swelling may get worse and I still won't be able to bend. At the moment I do virtually no PT, just stretches and basic exercise at home. I have tried to ignore the knee and push it, have had kneecations, ice it, elevate it and it is just not bending.

    Sorry, I seem to have whinged all over your thread. I would really consider the MUA carefully as you would be putting a stressed knee under more stress, but I can understand why you would want to try something - anything - that will relieve things for you. Is it possible to delay the MUA even by a week? Then you could take Campervan's very good advice and give your knee a holiday, except for icing, elevating and gentle stretching.

    I wish you all the best in whatever you may decide to do. Please let us know how you are getting on.

    Take Care ... Ellen :flwrysmile:
     
  5. maryo52

    maryo52 Sr Bonesmartie

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    Your answer is in your own statement. It's amazing how we can chase our tails so long without realizing that's why we're going in circles!

    I think you need to bring your PT and home exercises to a complete halt and give your knee a much needed "kneecation." A week, two weeks. It needs to catch up on healing. After a two week kneecation, then re-assess. You may even find after such a rest your leg bends better (!!)

    OK, let's say you need MUA. Don't do it until you have allowed your body to heal and for the massive amounts of inflammation to settle down to near zero. That will take weeks, by the way. Very few of us escape this process with inflaming one or more areas, because these post operative tissues which got injured during surgery are very testy. So while your situation isn't exactly normal, it's a common problem.

    Please believe me: rest 2+ weeks and then see where you are. I promise you, you will lose nothing by doing so and may gain a lot in terms of pain relief, inflammation relief, less swelling, and perspective . . . and most likely it will involve defying your hired professionals. Remember, it's YOUR knee and, believe it or not, although they are "experts," you and not them know what's best for you.

    P.S. Scar tissue proliferates where there is inflammation.
     
    • Agree Agree x 3
  6. stellar_knee_soon

    stellar_knee_soon New Member

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    Hi Ellen - thanks for your lovely message it's nice to know that others share this (sort of, I'd prefer your knee was working properly) . I've been trying very hard to do what everyone says, i.e nothing but rest and ice (which is so difficult with a 10 year old daughter and 6 year son on summer holidays) but it has made a difference to the swelling and pain in the few days I have done this. However, even though my knee feels so much less angry and is not so swollen, I can still lie on my back raise my leg and it just bends to the 85 degree mark and stops - and it isn't painful just sticks out like a bent elbow - so I suspect it is genuine scar tissue.

    I'm going to take the advice of the forum and be much more rested after this. I just didn't realise how different it was from a hip and that doing more could be so bad for it - not that there was much choice with guests and Christmas shopping to contend with!!)

    Thanks everyone for your support and I will be sure to let you know how I go :)
     
  7. stellar_knee_soon

    stellar_knee_soon New Member

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    Thanks so much for your sage advice Jaycey - I wish i had abided to the mantra more strictly the first time! I'm hoping that because I can stay on my anti inflammatory meds for this that I won't have such an inflamed knee after the procedure. Last time I had to go 5 weeks without them because of the clotting risk :(

    They will also put me on the Continuous movement machine this time ... I hope that with no manipulation I would improve over time, but as I still need to do so much and haven't been able to work for 3 months already (and probably another 2 ..) I need to try the "quick fix" first. I've also realised that many of the exercises are useless becasue my ankles are fused from arthritis ... I checked my knee squatting ability on my good knee and it is exactly he same as my operated knee (despite being a good 120 in all other situations) ... my bend gets stuck at the bend of my ankles ... so this time I am going to try and be more assertive in expecting more tailored PT etc.

    I've been going to a rehab hospital where replacements are a dime a dozen and we are in a group - although the PT is tailored, it's the same exercise set to choose from, so this time I'm thinking of going to my usual physio. I just assumed I'd be in better hands with people who see TKN's all the time ...

    Anyhow, even though I seem to be ignoring everyone's good advice about giving it more time I feel like it is worth the chance of having reduced pain and also because he more I walk with this limp the more all my other joints hurt.

    Thanks ever so much for the response, it is so hard to know what is best, the surgeon is pulling me one way and everyone in the other but my body doesn't seem to be giving me a definitive answer !!!
     
  8. stellar_knee_soon

    stellar_knee_soon New Member

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    oops, sorry everyone, I'm not very experienced at this and seem to be replying in the wrong spot :)
     
  9. Campervan

    Campervan Sr Bonesmartie

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    Hi, I read above as to what happens when you raise your leg. I wonder if you have quad lag. Did you have a femoral nerve block post op? I have quad lag from femoral nerve damage from the block. Its now been proved by nerve conduction tests and EMG. Here's a link to a page of my thread where Orthodoc helps me with definitions etc. Then if you go to the last few pages you'll see a post from me after seeing a new physio. Fortunately for those of affected with this, the majority recover given time.

    http://bonesmart.org/forum/threads/...g-from-nerve-damage.12959/page-21#post-344230
     
  10. chereb

    chereb Member

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    Hi i am almost 12 weeks out and in a similar position. :-( Not gaining and pain more instead of less. I seemed to go okish until the 5-6 week mark and have not improved a bit since. Its very frustrating to be this far out and stuck in limbo. I have a 14yr old and a 9 yr old and understand where you want to be I am seeing my surgeon for the first time tomorrow since i had my op and hope to find out what i need to do. Hang in there and hopefully we will improve :)
     
    • Agree Agree x 1
  11. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    That's the single biggest block to ROM ever.
    Refuse to have it done yet. It's more than likely that you are right.

    It's a free world and you are supposed to consent to such procedures freely and without pressure. It won't hurt a bit if it happens that you do need it and don't get it done till another couple of months out. But my bet is that you don't need it at all and that your only problem is swelling and pain! But if he does it and comes to you after gleefully reporting how he got it to 145 or something stupid, it will be because there were no adhesions just swelling. You will know if your knee is relatively painfree after.

    Read the article about the swollen knee and you will see what I mean.

    This is the same issue - consent. YOU have the power to choose what you will or won't do. The PT works for you and that means you have the power. Don't ever allow yourself to be bullied into doing things you don't feel comfortable with. You know your body better than they do.
    Keloid scars have nothing to do with adhesions.


    So now I have some questions to ask you:

    1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery! [​IMG])

    2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

    3. how often are you icing your hip and for how long?

    4. are you elevating your leg, how often and for how long?

    5. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

    6. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! reps, sets and session and all that)
     
  12. stellar_knee_soon

    stellar_knee_soon New Member

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    I really feel that the swelling has decreased to almost nothing now that I am on bed rest - yet the leg seems fixed. It's also hard to make a decision because my inability to get back to work or participate in household chores significantly affects everyone else. My husband has been amazing, but he is extremely busy at work and I don't enjoy seeing how he is getting worn out doing everything and then needing to be available to me to take me to physio during the day etc.
    My pain levels are now quite good - since starting lyrica (one month ago) 75mg at night and in the morning my muscle cramping and serious discomfort that affected sleep have gone. My resting pain would now be 1 and my pain after walking would be a 3.
    I am on 75 mg lyrica morning and night, 2 panadol osteo approx 3 x daily, mobic 15mg. Since cutting down my activities I haven't needed endone for breakthrough pain.
    I'm raising my knee at the moment in between activities and trying to ice it at least 4 times a day.
    probably for most of the day at the moment.
    I'm doing things like hanging washing on racks inside, folding clothes, making lunch etc - I've stopped doing any shopping and cleaning since I posted a few days ago and am feeling less pain now.
    Since I agreed to the MUA I've not been back to physio and am only doing calf stretches and the bends that you do in bed (I decided to try and really rest it), up until last week I was doing 3 times a week - IN THE GYM: 10 mins on the bike, up and down 3 stairs 10 x, warm up for 10 mins of squats etc. 10 squats, sitting and standing x 10, quoits x 5 mins, lying on stomach to straighten the knee, sitting and using the good leg to bend the other back x 10 - IN THE POOL: repeat all and add 10 x lunges as well as 10 x pushing a foam float up and down.
     
  13. stellar_knee_soon

    stellar_knee_soon New Member

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    Thanks for the tip -I did have a nerve block and my pain has decreased since being on the lyrica, so I wonder if there is something pinched in there? My straightening improves if I spend time massaging it down, but I can't mentally make it relax on it's own from about 10 degrees (however this was perfect post op and declined from about week 6)- and this varies from 0 degrees to about 15. Despite the good definition I'm stll a little confused if this is my issue - here is a picture and maybe you can let me know if what I'm describing is possibly quad leg?

    photo-4.jpg
     
  14. stellar_knee_soon

    stellar_knee_soon New Member

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    chereb, Good luck with your visit tomorrow - it is tricky when people depend upon you to rest etc. I think I've been deteriorating since week 6 ! Hopefully I can post an update tomorrow as the MUA doesn't take long - depends on my pain levels!!! take care
     
  15. NetballKnees

    NetballKnees Senior

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    Hi @stellar_knee_soon - All the best for the MUA tomorrow. Please let us know how it goes. Even though everyone here is against it at this stage, I totally understand you wanting to do something to help with the bend. Will you go home same day or say overnight?

    The photo you put up - is that all the straightening you can do with your leg? I have been extremely lucky in the leg lifting department as I could lift virtually straight up from about 3rd day after surgery and straighten it. I think it was because my quads were so strong from all the bike classes and bike riding I did in the gym - how I miss them. :boohoo:It's bending that I have trouble with.

    I realised you were young, but didn't know you had two such young children. I admire so much the TKR-ers who have a young family to look after. It must make things just that much more difficult. I only had to be responsible for myself. So :yay:for coping with that.

    Again, all the very best for tomorrow. I hope it goes well and provides some relief and improvement for you.

    Take Care ... Ellen :flwrysmile:
     
  16. stellar_knee_soon

    stellar_knee_soon New Member

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    Thanks Ellen - the photo is of my bending :) When I hold my leg up straight and then let it hang down so gravity will help the bend it just gets stuck there .My straightening is pretty good and my leg lifting has always been good (flexible hamstrings is one of the few things my body excels at!) I definitely have very weak quads and gluts as I've not been able to squat for probably 15 years or more - and haven't been able to cycle for the same. I think this is why I was so excited about cycling in rehab even though it was only the recumbent bike :)

    The plan so far is that I go in at 11 am tomorrow, have it done at 1pm and then go straight onto the CPM machine for 24 hours. The surgeon also wants me to go to physio every day starting the next day ... I'm feeling so conflicted now, between the wise words of those on this site and what I have organised for tomorrow, but I feel like I can't be worse off for trying ( I hope).

    In some ways it's nice to have people to be around you when you aren't well and in others it must be hard for you not having company - and at least someone is cooking for me - so sorry if I whined so much about the kids, it's so hard having them see me in pain as they have so much empathy it can become a little circle of sadness!

    Let me know how you go too :)
     
  17. chereb

    chereb Member

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    Good luck today with the MUA! Your picture of your bend is exactly like mines. Let us know how you get on.
     
  18. class dunce

    class dunce Junior Member

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    Hi there Adelaide girl! :goodpost:Good luck with the MUA. The whole thing is a bit of a :spin:but at the end of the day you will get there. You have made your plan and I hope it works :dancy: If not then you are streets ahead with what you have learned and you will know to rest up properly this time and recover in a more gentle way. Not long now and one big question will be put to bed one way or the other, giving you a much clearer view of the finishing line. Let's hope the line is just around the corner! If not, hi ho, hi ho, it's ice and pool we go! Glad you found this forum. Let's know how you go. Fingers crossed for you. From the other Adelaide girl! :shocked:
     
  19. claire61

    claire61 Junior Member

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    Good luck with the MUA. Let us all know how it goes. I am 8 weeks post op and struggling with the bending, only at 90, at best. Will you stay overnight in hospital?
     
  20. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    That's not a quad leg and I take back all I said about the MUA - you need one!

    Sorry :sad:
     

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