MUA 1 year this month on TKR

[volLady]

My first post op appt is next Thurs. I'm prepared that he will give me some push back on ROM. I've only been to PT twice. I know I'm at 90 + on flex. I don't really care what doc says LOL. I know ROM continues long past the initial recovery. And I will tell him not to bend or push my knee. Or else. LOL

Your appt is going to be great! Please let us know how it goes!

I see the OS day after tomorrow and I will let you know what he says. He is very understanding surgeon and a great one too. I trust him completely.....

 

[volLady]

well went to see my OS today for 6 wks check up. He said the knee looked good but he was hoping I would be further a long in my ROM. I told him it was 97 this week at PT but he wants it to be 100 or 105 at least. He wants to do MUA in another month if I don't get 100 or over in the next 4 weeks. Said I could do it at home and stop PT. Isn't worried about anything else except ROM. I am so depressed and sick to my stomach knowing what will happen if I can't go any farther with ROM. Put to asleep again and start over in PT.... What does everyone think about this? lonely and hurt tonight

 

[Jockette]

went to PT today and my ext., is 0 and flex went from 80 to back to 97.

I told him it was 97 this week at PT but he wants it to be 100 or 105 at least.

He can want that number all he wants, but that’s all it is, a desire. Your ROM is improving just fine. He is not giving your knee the privilege of sorting itself out on its own terms. No one has to be any number by any date.

Just because he wants to possibly do an MUA does not mean you have to agree. And he can’t do it unless you sign a consent form and walk into the room to have it done. The final choice is all yours. You can say no.
Saying no to therapy - am I allowed to?

I am so depressed and sick to my stomach knowing what will happen if I can't go any farther with ROM.

Please, please don’t let him cause you so much upset and stress. Your ROM is fine! It will get better! You are still so early in recovery. Where you are now is not where you will end up.

I‘ve posted the following a lot in the past few days, but it’s so true:

This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."

It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)
So, if a OS or PT bullies you into thinking your ROM will not improve over time they are wrong. By the way, I haven't been back to see the OS since that horrible appointment at 6 weeks, but I sure am going back when I reach 120 just to say, "Ha! You were wrong, BoneSmart was right!" “

And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. “

 

[sistersinhim]

I think he's being unreasonable. Most doctors won't do a MUA once you reach 90 degrees. You have surpassed that. Don't overwork your knee trying to get to 100. Doing just your daily activities will be all you need to get there plus more. Gentle movements is much better to rehab a joint replacement than forced bending or repetitive exercises.

Your doctor can say he's doing a MUA, but you don't have to agree to it. It's your knee and your decision. In my opinion, it'd be a big mistake to to let him do that. You don't need it. You just need time to heal and get the swelling down.

 

[JBL]

My right knee is very unstable and it will buckle under me sometimes

I had a Left TKR on Jan 10t I was able to walk around house w/o cane until 2 days ago. Now, like you, my right knee is unstable! It's scary! Is this happening because we are putting too much stress on our "good leg"?

 

[JusticeRider]

I am so depressed and sick to my stomach knowing what will happen if I can't go any farther with ROM. Put to asleep again and start over in PT

I’m so sorry you went through this. I felt exactly the same way after my 6 week appointment. You could be describing my experience with my PA exactly. But at 8 weeks I refused the MUA and at 6 months, I’m so glad I did!

 

[InkedMarie]

@volLady I’m sorry you’re feeling like this. I’m sorry your surgeon is making you feel bad. An MUA is *your* choice….you can say yes or no. I would not do it but that is me. We’re all here for you to answer questions or be a (virtual) shoulder to cry on.

Marie

 

[volLady]

Are you using a quad cane? Make sure it is the right height for you. And that you’re using it in the opposite hand of your surgical knee.

I use a quad cane and it has really helped me but at times I use my walker. I do this because my other knee is very unstable and I am afraid I might fall. My OS said for me to use it has long I felt like the other knee wasn't stable. I will have to have surgery on it later this fall. OA in both knees, almost 7 wks out and I am scheduled for a MUA due to my ROM not going beyond. Scar tissue has formed and I am tired of the stiffness and not bending it well.

 

[Jockette]

almost 7 wks out and I am scheduled for a MUA due to my ROM not going beyond. Scar tissue has formed and I am tired of the stiffness and not bending it well.

I’m sorry to read that you are scheduled for an MUA so early in your recovery. The most likely reason you can’t “bend well” is due to being so early in recovery and therefore far from fully healed, and also because of swelling.

Just be aware that an MUA is not an automatic fix for this. I’m sorry that you are tired of the stiffness, we all were, but Stiffness/Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue has been disturbed and is healing...and full healing takes a full year or more.

The MUA is going to cause more swelling, so be prepared for that. You may see an immediate increase in ROM, but if it doesn’t last, then you didn’t have any “scar tissue” (otherwise known as adhesions) you just have swelling, which is very common at 7 weeks.

If it was me, I’d give myself several more months to heal before having an MUA.

 

[Jockette]

And, by the way, I copied your post above, to your thread, so that we have a record of the scheduled MUA in your thread, and so that I could address it without taking the other thread off topic.

 

[Jamie]

Your surgeon says he wants you at 100 in another month and you are measuring at 97 now. I have to tell you that 3 degrees can be just a measuring error. Please don't let numbers stress you out! You are so early in this recovery. I hope you don't feel like you should be able to go back to normal activity at this stage. From your posts, it sounds like you may be overdoing things on a pretty routine basis. Your knee still needs a good amount of rest and elevation in addition to any therapy or normal activities. Sitting for hours will make most new knees swell and get stiff. It's why we suggest that people not go back to work for at least 10-12 weeks if that's at all possible.

Take a hard look at what you do on an average day. Try to find ways to slow down and allow your knee to heal. The ROM is there....it's the swelling that's holding you back. You can opt not to have a recommended MUA and tell your surgeon you prefer to deal with your range of motion on your own. It's not like your knee is going to "freeze" at the ROM you have now. Knee replacements just don't work that way, even though you may hear from medical professionals there is a "window of opportunity" for you to regain ROM. You cannot "work" to get swelling down. It takes rest, ice, elevation, time, and pain meds if you're hurting. If you're not taking something when you have pain, you should.....usually Extra Strength Tylenol will do the trick, especially if you take it on a schedule of 2 tablets every 6 hours. Since there is a maximum of acetaminophen you can take in any 24 hour period, be sure and count other medications you may take - especially cold and sinus medicine.

 

[EalingGran]

Can you just really rest and ice and then get someone to take picture and a video of your knee flexion at it's very best. Maybe first thing in the morning on the bed after an ice session. Then send it to your surgeon or bring it to the appointment for proof.

 

[beachy]

You are 1 week before me. I'm still having swelling and stiffness if I don't ice most of the day some days. And I have to elevate toes over nose. If ROM was measured on my very swollen days I doubt it would be good.
Please take swelling into account before you agree to MUA.

 

[CricketHip]

@volLady I am reading your thread about your ROM and swelling. Would you want to try some very easy techniques to help your body move the swelling?
The techniques are called Manual Lymphatic Drainage-MLD- it's very gentle and some of the basic moves are easily done by you.
Anyone going through surgery suffers with edema and inflammation and some of us react a bit more strongly in that area..
Our lymph nodes are what help absorb/ move the edema, sometimes we need to help wake them up to get them to work better.
I am trained/certified in MLD and was so thankful I knew how to help myself after my 2 THR's , especially with my right hip, I had quite a bit of swelling and it was so stubborn.

I will leave the article here for you to read and I hope you give this a try.

****
Take deep breaths.. deep, as in breathing in to a count of 3 or 4, whatever is best for you. hold it for another count of 3-4, then blow out completely, still using the count that's comfortable for you. A series of at least 6 of these could help get your excess swelling to move. To ensure you are taking proper deep breaths, place your hand on your naval and watch while taking in your breath, if doing this properly you should see your hand move up.

Then, as you slowly breath out, to the same count of either 3, 4 or 5 gently press down and slightly upwards with the palm of your hand.
Do this whenever you feel up to it during the day or night. The more supine that you can get in the recliner or bed, the more effective this can be.. you have lymph nodes located in your groin and sitting up too much can cause a restriction of the lymph flow.

You can, after the breathing, place your hands lightly on your upper thigh, right where the crease is in your groin and lightly stroke upwards towards your naval.
I did this quite a bit post op and while it takes a while for the body to wake up and respond, it will and it will help get the swelling moving.
The reason this can help is because many of our lymph nodes are located in our abdomen. Our breathing combined with moderate pressure over our naval can help to "prime" our lymph system.
****

 

[CricketHip]

Interestingly, the numbing agents that they inject into your leg will also "numb" the lymphatic system.
Doing the techniques above will help stimulate and get things moving, you can also lightly stroke your leg using an upwards direction. Believe it or not, a light touch is best, so stroke from below your knee and keep stroking upwards to your groin on that side. This is after you do the above mentioned steps.

Good luck, I hope this helps you as much as it helped me and others on this site.

 

[beachy]

@CricketHip OH! I'm so going to do that!

 

[bertschb]

...He said the knee looked good but he was hoping I would be further a long in my ROM.... He wants to do MUA .... What does everyone think about this?

This is my ROM progression for my first TKR:
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 125 degrees
10 months - 125 degrees
11 months - 130 degrees
12 months - 130 degrees

As you can see, your ROM is waaaaaay better than mine was at the same point in our recovery and my ROM now is fine. There is NO WAY I would let a surgeon do an MUA on me if my ROM was as good as yours is right now. No way!

As for instability-
I had no instability at all after my first TKR but I did experience it after my second TKR. I was quite surprised by it. It was difficult to explain the sensation to other people but we both know what it feels like. I'm not sure what caused it but that too passed! Don't worry about it!

Unsolicited advice:
Skip PT. I found it just caused more swelling and delayed ROM recovery. Just do simple exercises at home.

The most important thing I would tell anybody considering TKR is DON'T WORRY ABOUT YOUR ROM! I'm an obsessed mountain bike rider and was very, very concerned about my ROM after my first surgery. It was six months before I could even make one revolution on my bike. I was wondering if I would ever be able to ride my bike again. As it turns out, all that worrying was a waste of time. Your ROM will improve all by itself on its own schedule. Stop worrying about it and forget about the stupid MUA!!!!!

 

[sistersinhim]

I am afraid you will be very sorry if you have a MUA at this early time in your recovery. You have 6 layers of stitches that are knitting together. Just think of what is happening on the inside of your knee. Closing stitches. Look at all these layers of stitches you have. What will happen to those when your knee is forced to bend and all those stitched-up tissues haven't healed yet? What will that do to your knee? It will cause more inflammation than you already have. That will increase your swelling, decreasing your bend. Add to that, more pain. Having a MUA will set your recovery back to that day, not your surgery day. Please give your knee time to heal before reinjuring it. Time is all it needs for the swelling and stiffness to leave.

 

[volLady]

had my MUA yesterday and I am very pleased with it. My OS did a great job breaking up the scar tissue and now I can bend my knee farther and before. I have some swelling and sore muscles but that is due to the nerve block and the healing. Best decision we made, husband,surgeon and I. 7 wks., NS I WENT <80, so I was slowly going backwards. No more PT cause surgeon said I could do it at home since I have a pedal bike. Ice a lot, rest,and walk at least 30 minutes. He did say that the knee surgery in any one will take up to a year or 6 months before aches, pains, and swelling goes down. I see him again in a week and if I reach 100 or more then he is going to release me. Just the best decision I made because my scar tissue was getting thicker and I didn't want to wait past 12 wks.,and take a chance of having it scoped.

 

[Jamie]

This is certainly great news. There are times that an MUA helps, so I’m glad to hear it worked for you. Hope things continue to improve.