MUA 1 Week post op

[CATSMUM]

My knee also felt unsteady after it was done, never occurred to me that Roy's explanation abov was the reason. You'll soon get used to it and enjoy the way it moves easily.

 

[KameronSteele]

How long post op before MUA is considered?

 

[dtmbf]

I think you are far from thinking about a MUA at this time. You are indeed swollen - much like I was for my 1st knee - and believe me - the knee won't bend till the swelling goes down! I felt like my skin was going to tear apart with little or no provocation - a horrible feeling as you know. Ice & elevation are your best friends right now. I sat encased in ice for hours at a time, as long as your skin is protected you can ice for prolonged periods of time, not just the 20-30 minutes everyone tells you. And I couldn't elevate much either early on - but any little bit helps. And personally, I was awful at heel slides, couldn't do them to save my soul. Sitting in a chair & bending the knee back was my concept of a heel slide. And I hesitate to say this, but you may be under medicating or Tramadol isn't the right drug. Stiffness & tightness is a form of pain that needs to be managed - learned that the hard way. This is a much tougher recovery than most of us ever expected, and I think you are on the right road - don't despair!

 

[CATSMUM]

I agree with dtmbf, you are along way from having a MUA. I still have swelling and my ROM didn't improve for some weeks, so stop stressing yourself. I ice quite a few times a day for at least 45 minutes a time (I use a cryo cuff). You'll get there in the end so stop worrying.

 

[Roy Gardiner]

How long post op before MUA is considered?

Not for ages yet, please don't worry and continue with gentle mobility exercises.

 

[KameronSteele]

dtmbf, catsmum and Roy..thank you all. I needed to hear that. And catsmum. I just got my cryocuff about an hour ago..I didn't realize it was a gravity thing that you have to raise and lower the cooler. did it still help you? it just seems like you have to "change" the cuff water every few minutes for it to stay cold. how did you have the best results using it?

 

[chris042]

Only a week out and you sound like you are doing well.
I know how you feel, wanting to "fix it" right away. I really have to watch my tendency to over do. Don't let that happen to you. Keep reading these threads and take heart.
I used the CPM for the first 3 weeks and was sad when the insurance would no longer cover it. I thought it helped a lot, and the best is, you control the settings so it does not cause pain. It keeps the joint moving in a gentle and relaxed way.
I am glad to hear you have a surgeon who is wise enough to not start you on PT immediately. I was not so lucky and my 3 weeks of home health PT were hell. I am glad I can't afford out-patient--LOL
Good luck on your continued recovery.

Chris

 

[KameronSteele]

Hello again everyone. Ok so now I'm 4 weeks out and would like to know if my progression seems typical. I graduated / forced myself off the walker and on to 2 crutches (swear I don't know how some are walking unaided 2 weeks post op). My main concern and the reason for this post was my limited ROM. My knee is still tight as a drum, hard as a rock , warm to touch and will-not-bend. Period. End.of.story. I've read on here, don't force it, it will come when it's ready and that the soft tissue swelling is from the trauma which makes sense to me. Then I read some ppl are at 100+ 2-3 weeks post op! How?! Should I be forcing this to bend more Or just wait it out? Will ROM come in time? I do heel slides, straight leg raises, prone leg hangs, ice 3-5x day and elevate of course. What else should I be doing? What else can I do? This knee is so bloody tight and unstable hence the crutches. @Josephine asked me questions a few replies up but she has yet to comment on my answers. Can someone please tag her/IM her, etc (sorry, don't know the proper lingo) and ask her to reply when she has a free moment. All comments are certainly welcomed. Thanks in advance.

 

[Josephine]

@Josephine asked me questions a few replies up but she has yet to comment on my answers.

Oh my gosh! That was 2½ weeks ago! I am covered with embarrassment! Usually when I leave those questions, I put the thread on my watch list so I know as soon as somebody's posted in it. Only it seem I totally forgot to do that. Unfortunately, it's now almost 2am and I have really got to get to bed! I will see to these tomorrow for you. Can you check them and see if your answers need to be updated? Thanks everso. And again, my sincere apologies.

 

[KarriB]

@KameronSteele i didn't have a cyro cuff, but we put frozen ice packs or water bottles in my ice machine. It lasted longer than the ice and we didn't go through as much use.

 

[tigz]

How long post op before MUA is considered?

My ROM was less than 90 at my four week follow-up with the OS, and he wanted to then see me at eight weeks. At eight weeks it was still less than 90, and I scheduled an MUA which has made a world of difference for me for 1.5 weeks later.

You're still really early in this recovery. Take it easy and don't worry about this for now.

 

[KameronSteele]

1) my pain levels: not really pain except the dreaded 2am aching that I have to massage out for ab 30 min. Everything else is just EXTREME stiffness/tightness..it feels like it's going to burst when I attempt to walk or begin a heel slide. The swelling and stiffness are very bothersome. Did I mention EXTREME TIGHTNESS AND STIFFNESS?
2) pain rx: upon discharge from hospital Percocet 10/325, Mobic (don't recall mg and I'm lying in bed I stopped percocet bc I HATE the way it makes me feel and makes my skin gross and scaly. I felt I didn't need narcotic pain control anyway. Instead Doc rx'd tramadol 50mg q 6 hrs. As soon as I started tramadolI stopped mobic. Pharmacist said don't take both. So currently only pain med is tramadol 3x day and ASA 2x day but that's not for pain.
3) ice: about 4-5x day ~ 30 min each time. I do the Cpm for 2 hrs day and ice while doing it. Ice machine will be here Tuesday.
4) elevation: knee is always up unless I'm going to bathroom or kitchen. Otherwise I sit on a bed all day and work on my website and my leg is straight out in front of me usually with a pillow under it. Not sure if that's considered "elevation" but it's not dependent.
5) ROM: I haven't been back to doc yet to get measured, first visit is this Wednesday. But according to CPM Today 5 ext/56 flex. 2 days ago it was -4/65... Not sure why the big difference but I always have to start at 10/45 and work my way back to previous levels. It's so tight and stiff I can't even imagine 110/120 degrees..I wonder if it will ever come. It feels like it is literally going to pop!
6) activity level- I sit all day bc I thought I was on my feet too much earlier this week.My knee definitely tells me when I need to sit. When I am up and about after 5 minutes I'm ready to sit again and elevate..that stiff and tight thing again.
7) doc said no pt at all yet. Only ROM stuff. And really that isn't anything other than attempting heel slides and using the CPM.

I read your recovery thread Josephine and am absolutely amazed at how on day 9 you were on one crutch!? I can't even weight bear using my walker. It feels so completely unsteady and like it wants to flop back and forth quickly if I try to weight bear. I move so slow and am no where close to being off this walker. I have zero strength or control over it.

Can you offer any advice or even rom exercises I can do at this point to make me feel like I am progressing? Should I be doing leg lifts or quad sets?

Thank you in advance.

KS

Josephine, here are updates to the first time I posted the answers onJULY 27:
1) pain levels: subsided somewhat. Still occasional surprise stabbing pains and sometimes achy but overall better. today (August 13)extreme tightness and stiffness. Swelling seems to have gone down but this thing ain't bending! I struggle to get 90 and each day have to start over at 30-ish and work up.
2) Pain meds: still tramadol at 7am,11 pm and I also take 2 Tylenol arthritis with my 11 pm tramadol.
3) Ice: several times each day, no more CPM (torture machine)
4) Elevation- when icing
5) ROM- still officially not measured but when I sit on edge of bed I pull and tug for 10 min or so until I'm at 90. It feels like it's gonna pop, explode, rip, etc
6) Activity level- I do this and that..walk outside 1-2 day, maybe fix lunch but then go back and sit, ice and elevate. I wouldn't even call what I do an activity level.
7) Exercises- heel slides are easier than when I last posted but I still pull and struggle to get anything past 30., straight leg raises, prone hangs, glute sets. All about 10 each 2x day.

 

[Josephine]

Then I read some ppl are at 100+ 2-3 weeks post op! How?! Should I be forcing this to bend more Or just wait it out? Will ROM come in time?

If they did, they probably didn't have a TKR! But all joking aside, the very worst thing you can do is to force it. That just causes more swelling and stiffness and it's that which is blocking your ROM. You're not even 4 weeks out yet so a flexion of 90 is about right.

How long post op before MUA is considered?

Any time from 8 weeks to a year!

 

[Josephine]

1) my pain levels: not really pain except the dreaded 2am aching that I have to massage out for about 30 min. Everything else is just EXTREME stiffness/tightness..it feels like it's going to burst when I attempt to walk or begin a heel slide. The swelling and stiffness are very bothersome. Did I mention EXTREME TIGHTNESS AND STIFFNESS?

You were less than two weeks out here and displaying a TKR's worst enemy - impatience!

1) pain levels: subsided somewhat. Still occasional surprise stabbing pains and sometimes achy but overall better. Today extreme tightness and stiffness. Swelling seems to have gone down but this thing ain't bending! I struggle to get 90 and each day have to start over at 30-ish and work up.

You are trying too hard! Did you so quickly forget my example - rest, rest and more rest. No pushing, pulling or anything similar. It will come on its own in due course. Even now you are only 4 weeks out and 90 isn't that bad for 4 weeks!

2) pain rx: upon discharge from hospital Percocet 10/325, Mobic. I stopped Percocet bc I HATE the way it makes me feel and makes my skin gross and scaly. I felt I didn't need narcotic pain control anyway. Instead Doc rx'd Tramadol 50mg 6 hrly. As soon as I started Tramadol I stopped Mobic. Pharmacist said don't take both. So currently only pain med is Tramadol 3x day.

2) Pain meds: still Tramadol at 7am,11 pm and I also take 2 Tylenol arthritis with my 11 pm Tramadol.

Well you're certainly under-medicated, my dear.
You'd be better off taking 100mg Tramadol with 1,000mgs Tylenol every 6 hours. You may only need to take this for about 3-4 weeks but you need it now to manage the pain you have. There is a vicious circle in this: more pain = more swelling = more pain. You might also want to bear in mind that stiffness is a form of pain as are soreness, burning, stabbing, throbbing, aching and, believe it or not - swelling. These all need to be treated as the one thing - pain - and medicated adequately.

Here is another article you might find helpful Swollen and stiff knee: what causes it?

3) ice: about 4-5x day 30min each time. I do the CPM for 2 hrs day and ice while doing it. Ice machine will be here Tuesday.
4) elevation: knee is always up unless I'm going to bathroom or kitchen. Otherwise I sit on a bed all day and work on my website and my leg is straight out in front of me usually with a pillow under it. Not sure if that's considered "elevation" but it's not dependent.

3) Ice: several times each day, no more CPM (torture machine)
4) Elevation- when icing

Well you're getting there - but having you leg straight out it not elevating. Have a look here Pain and swelling control: elevation is the key where there are excellent photos showing what it good and what is bad elevation. You also accomplish little or nothing in 30 minutes. Ice for at least 60mins and more than 4 times a day for full benefit.

5) ROM: I haven't been back to doc yet to get measured, first visit is this Wednesday. But according to CPM Today 5 ext/56 flex. 2 days ago it was -4/65... Not sure why the big difference but I always have to start at 10/45 and work my way back to previous levels.

5) ROM- still officially not measured but when I sit on edge of bed I pull and tug for 10 min or so until I'm at 90. It feels like it's gonna pop, explode, rip, etc

As I said before, you are only 4 weeks out and 90 isn't that bad for 4 weeks! Plus you are trying to beat your poor knee into submission which is not the day to do it. All you are doing is creating MORE swelling, MORE stiffness (which is a product of the swelling) and MORE pain. Stop the torture. Let your leg rest and heal which will allow the swelling to go down. Only since you've been so aggressive with your knee, it might now take longer for things to settle down - which will require even more ......... patience!

6) activity level- I sit all day bc I thought I was on my feet too much earlier this week. My knee definitely tells me when I need to sit. When I am up and about after 5 minutes I'm ready to sit again and elevate.. that stiff and tight thing again.

6) Activity level- I do this and that..walk outside 1-2 day, maybe fix lunch but then go back and sit, ice and elevate. I wouldn't even call what I do an activity level.

7) doc said no pt at all yet. Only ROM stuff. And really that isn't anything other than attempting heel slides and using the CPM.

I love your doctor!

7) Exercises- heel slides are easier than when I last posted but I still pull and struggle to get anything past 30., .

Heel slides need to be done properly - read this Heel slides and how to do them. Do not EVER cause yourself pain doing heel slides. Never more than mild discomfort.

My comments in bold
straight leg raises x10 2x day - a tip - once you can do SLRs you can do them, no need to keep doing them
glute sets x10 2x day - how are you accomplishing these? just laying on your back or doing glute bridges?
prone hangs x10 2x day - how are you accomplishing these? There are several methods, see here Extension exercises. I suggest you do 2 or three every 3-4 hours only and if this is causing you pain in the back of your knee, then only do it until the pain starts and then STOP! Any time you spend doing prone hangs in pain is counter-productive and will regress any progress you made.

Mostly what I am saying here is that you are trying to hurry your recovery which is a sure way to make it stall. Please be assured there is nothing wrong with your knee except
1. under-medicating your pain
2. pushing on your knee
3. being in too much of a hurry to get this over and done with

I've had an awful lot of members just like you who appear to be under the impression they should be all healed up and ready to go in a few weeks. This isn't true. I see you were left our recovery articles in post #19 - did you ever read them? In particular did you read these
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

This is where the kernel of our philosophy resides though I think the 'smarter not harder' article is probably the key one. It's been said before but this recovery isn't a sprint, it's a marathon and you need to pace yourself.

Any questions?

 

[kneeper]

I would have loved to be at 90 in 4 weeks. I sort of stalled for a few weeks and then started gaining as the swelling went down around week 6. Not very taxing exercises and lots of and elevation seemed to do the trick for me.
Hang in there!

 

[KameronSteele]

Question..oh my yes.ok so, no pushing, pulling etc. so....let's take today for instance ...I can't get past what looks like 35-40. It's just so bloody tight and was all nite. It kept me awake most of the nite it was so stiff and tight. On days like today what should I do? Nothing? Does tramadol help with flexion by decreasing actual stiffness? I will certainly increase icing to 1 hour and proper elevation instead of straight.you said stop the torture as I'm creating more stiffness, pain, swelling etc. stop everything as in all exercises and only ice and elevate? And for how long do I do nothing? Again, what should I be doing ? Glute sets are lying flat and sqeezing..no bridges. Prone hangs done both ways...lying face done on bed with knee hanging off..TORTURE, and sitting in chair w heel propped and thigh weighted..also torture. Now I just do prone hamstring curls. I'm much stronger after two days of these. I did read all of the articles when I first joined but will read again tonite. I'll try tramadol 100mg tonite with Tylenol 650x2. Thank you so very much for your time!

 

[KameronSteele]

@kneeper

I would have loved to be at 90 in 4 weeks. I sort of stalled for a few weeks and then started gaining as the swelling went down around week 6. Not very taxing exercises and lots of and elevation seemed to do the trick for me.
Hang in there!

So did you just do nothing for a couple of weeks? Was it visibly swollen? I don't think mine is grossly swollen but hard as a rock and stiff. How many weeks would you say before you were getting 90 consistently without pain and it feeling like it's going to split open?

 

[KarriB]

You should ice, elevate, if you have to do something try easy heel slides until the swelling goes down. You can't get ROM while your knee is swollen. This long recovery is a marathon, not a sprint. You are just a month out and still have a long way to go. Try icing through the night to help ease the pain as well as setting an alarm to take pain meds on schedule through the night instead of waiting till you wake up in pain. Patience is a key ingredient in this journey.

 

[KameronSteele]

@KarriB, 11pm and 7am isn't good for my tramadol sched? And I don't have to do anything.. I actually don't like exercising bc I get frustrated so not doing anything works for me!lol. I've slept w peas thru the hite I'll start doing that again. Thank you for replying!

 

[KameronSteele]

@KameronSteele i didn't have a cyro cuff, but we put frozen ice packs or water bottles in my ice machine. It lasted longer than the ice and we didn't go through as much use.

Just started this today..putting 2 frozen ice bottles in my cryocuff cooler! Awesome idea!