MUA 11 week post RTKR

[Lori1973]

I am currently 11 weeks post RTKR and 2 weeks post MUA. I have a follow up with my surgeon soon but I am still having pain/problems with flexion extension. I have gained some ROM in my flexion, I went from 74 degrees to 90 degrees (a little more on a good day) however, my extension is still 25 degrees. I have a lot of swelling around my hamstring despite my PT working on the soft tissue.

I do my exercises regularly and am going to PT once a day. They are currently focusing a little more on my extension and have me lying on my stomach with weights on my leg. It can be pretty excruciating at times and I break out in a sweat from the pain.
After sitting for a short period of time, it seems I lose what progress I made during PT.

Is it normal to still have so much trouble at 11 weeks post op??

 

[Pumpkinseed]

Hey @Lori1973. I had my 2nd MUA at 11 weeks two and gained extension which I've kept most of it but lost a little flexion. It is totally normal to have pain and swelling after that especially doing pt every day. I know that "laying on your stomach with weight on your leg" technique they do and I absolutely hated it! It hurt sooo much. Plus having an MUA just delays the healing process for us so again yea it's normal to hurt. Make sure you ice, elavte, and medicate. And speaking from experience I would back off on so much pt. I know your OS probably won't want to hear that but it's your knee and your pain.

Sent from my SM-G900T using Tapatalk

 

[tigz]

Hi Lori
You're not just dealing with healing from the surgery, you're dealing with the inflammation/swelling/etc from the MUA, too. While I had good success post-MUA I had a heck of a lot swelling for a bit afterwards. The daily PT is to keep you bending and improve on the bend but it's very hard on that still recovering knee, too. My swelling started to ease up when I stopped the daily PT. Keep icing and elevating - I found that helped tremendously.

Someone'll be by shortly to give you some reading material.

 

[Pumpkin]

Lori1973,
Welcome to the other side, sorry you are having trouble with stiffness and lack of extension after your MUA.

I do my exercises regularly and am going to PT once a day.

You may be overdoing it and irritating your knee by all this activity. Listen to Pumpkinseed and Tigz, they both have been in your shoes with the MUA and found cutting back helped their knee heal.
Here are two gentle exercises you can do for your ROM.
Heel slides and how to do them
Extension: exercises for improvement

Here is the post op reading for you, the articles 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

 

[Josephine]

They are currently focusing a little more on my extension and have me lying on my stomach with weights on my leg. It can be pretty excruciating at times and I break out in a sweat from the pain.

That is horrible ! You must stop them doing it as it's just plain torture. Apart from which, the ensuing swelling will block the very thing it's supposed to be treating!

You will find it much more effective to do this on your own at home by using these stretches just for a few seconds each, about 4-5 times a day and only 3-5 reps each time.
1. put your heel on a foot stool and let it hang for as long as it remains comfortable. When I had to do this (I had an extension of about 5 degrees) it was intolerable for the first few days so I could only do it for a few seconds. But as the days rolled on, I found I could do it longer - first 5 second, then 10 and so on. I never ever pushed on it or added weights.

2. put your leg on a stair or a low stool and let your knee go straight as it can then push on it very gently for a few seconds until it gets mildly uncomfortable

3. walking with the correct gait, heel, toe, heel, toe

After sitting for a short period of time, it seems I lose what progress I made during PT.

Of course you will but it's not the sitting, it's the aftermath of the PT. Swelling from such punishing 'therapy' doesn't happen at once, it might not even chow up into the day after but it will show up and will very effectively block your ROM. Best treatment for this kind of reactive welling it to stop whatever it is that's causing it!

 

[Lori1973]

I am 15 week post RTKR. I have had several issues with ROM and I'm currently wearing a JAS splint several times a day for extension but my question is about sweating. I am currently sweating all of the time and it's rather embarrassing. I understand that it is a hormonal response to pain and adrenaline but I was wondering if anyone knows of a way to keep from sweating so much. I go back to work next week and don't want to be a constant puddle!

 

[Pumpkin]

Have you talked to your GP about your sweating?
I have not heard of sweating, there may be someone that has had this same experience.
I will tag @Josephine about your sweating.

 

[Lori1973]

Thanks.... I mentioned it and they just said that it's not uncommon :-/
I may need to ask again...

 

[Pumpkin]

Thinking back, I was very hot when I cut back my pain medication too soon. Seems like you would be past that.

 

[Celle]

Have you tried these exercises to help with extension?
Extension: exercises for improvement
They work quite well, without the need for using a splint.

 

[referee54]

I merged your two recovery threads as per forum protocol---that way, we can see where you have been, where you are and what your issues are, without hopping from one thread to another---it is so much easier for all of the members to give you the advice that you need.

 

[Lori1973]

Hello... I am currently 16 weeks post op RTKR and unfortunately, I'm having issues with it. I have done all of my exercises and followed the directions of my surgeon and my therapist. At 8 weeks I had to have a MUA because I didn't have 90 degrees flexion. It seems since the MUA my progress has decreased on my extension. I finally made it to 90-100 degrees (depending on the day) of flexion and 20 degrees extension. I am currently in a JAS splint to help straighten my leg that I wear several times a day (it is pictured below). It's quite frustrating! I feel like I should be walking without pain at this point... but I look like I'm 30 years older than I am when I walk. (I'm currently 42 years old).

Here is my issue.... while I was taking my sick leave, I had PT several times per week where they helped me bend/straighten and had me do exercises. They have been puzzled all along because my hamstring is incredibly tight and they would spend time massaging it. (It was quite painful but needed and seemed to help release a little). Now that I have returned to work (just last week) I am going later in the day and all they want me to do is balance exercises (standing on one leg, wall squats, stepping over cones).... all of this is great but they are no longer paying attention to those tight muscles despite me saying that I hurt and they are tight. In fact, last week, the PT measured me and I have lost progress: 84 degrees flexion and 24 degrees extension. I was hoping they would help me to relax when I told them how tight it was but instead, said to me that they will have to release me if I'm no longer making progress.

I have occasional pain around my knee but it is mostly behind my knee. The pain goes from pretty high up on my hamstring (I have had a knot pretty much since shortly after surgery in the middle of my hammy) down to the outside of my knee (around the popliteus muscle) and down into my calf and down to the outside of my ankle. It gets intense right behind my knee all the way down to my ankle. Has anyone else encountered this? What did you do to help it? I have an appointment at the end of the week with my surgeon but he doesn't seem concerned about my muscle pain when I have brought it up in the past.

I appreciate your help/insight!!

 

[Randi]

Hi Lori. Sorry to hear you are having so much trouble. I'm sure some of the moderators and @Josephine will be along shortly with tons of advice. I personally would be concerned with the attitudes of both your OS and the physiotherapists. None of them seem to be really listening to you. Have you considered talking to another surgeon about what's going on and changing your therapy venue ? I know it's all so hard, especially when you're back at work but you must be so uncomfortable and you really do need to look after yourself.

Sending hugs

 

[skigirl]

I agree about changing the PT---if they will not listen to you what good are they?

I am going to @Josephine but in addition, I think you might consider a massage therapist who could work on the tight knot in your hamstring. I used a massage therapist with both of my TKRs and she did help a lot with the tightness and pain.

Once the knot is resolved, you will have to consider whether you have tight muscles or some adhesions that are presenting your progress. If it is adhesions, they sometimes remove the rear capsule--of the knee (which is like a liner, which does grow back-hopefully without the wrinkles and adhesions.) I believe that @Dhare63 had that surgery and it was quite successful for her. I will tag her so that she can tell you about it herself.

Since it is a simpler problem to solve, it seems like getting help from a massage therapist might be a first step.

 

[Josephine]

@Lori1973, This is the second time your threads have had to be merged. Please, please keep to this one thread for your own recovery posts. It's so much better for us to be able to read all your history in one thread than having to keep popping in and out of other threads.

 

[Josephine]

Anyway, I'm am most concerned about your situation as I feel there is something going on you need advice about. However, before I can do that, I'm need to ask you some questions. It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

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!

) Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

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 knee and for how long?

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

5. What is your ROM - that's flexion (bend) and extension (straightness)

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

7. what kind of PT exercises and exercises at home are you doing? How much and how often?

Can you detail it like this

Exercises done at home: 3 sessions a day
Heel slides x10 (reps)
Strait leg raises x10
Steps x10

At PT
Squats x5 (reps) x2 (sets)
Wall slides x5 x2
Clamshells X5 x2

 

[Lori1973]

Here ya go @Josephine

Pain:

• My pain is typically a 6 but when I take pain meds regularly, it goes down to about a 4… when I walk, the pain goes back up to a 6.
• The majority of my pain is behind my knee, hamstring, calf and ankle (where it is all very tight)
• Occasionally, I have a very sharp stabbing pain along my incision. I imagine that may be scar tissue hitting the nerve. Luckily, it only lasts a split second to a few seconds but when I feel it, it is an 8.
• I have pain on top of and the sides of my knee but it is very manageable around a 1
• I have trouble walking, this is most frustrating. The more I walk the more I hurt.
• I have the most pain in the afternoons/evenings
• It is tight to the touch behind my knee
• Pain to my outter knee (if you drew a line from the spot I have the most pain behind my knee to the front of the knee)

Medication:

• Hydrocodone 10-325 up to 4 times/day
• Tramadol, 50 mg twice/day
• Motrin, as needed

Ice/Elevation:

• I ice my knee daily, usually in the evenings after I get home from work
• I elevate my knee daily. I elevate it several times/day during work and again when I get home. During the weekend, I keep it elevated as often as I can.

ROM:

• Flexion: 90 degrees
• Extension: 20 degrees

Activity:

• Walking from my car to my office at work (about 1000 steps)
• At work, I sit a lot during the day. I try to walk around a couple times/day if nothing more than to walk to the end of the hall to go to the restroom or walk around my office suite.
• I cook dinner every night
• I go shopping once/week. It’s easiest to hold on to/push a shopping cart
• I do the dishes but standing for long periods of time causes pain
• I go to PT and I try to go to the gym and use the bike on days I don’t have PT. It is still hard to make rotations and I am slow…. But I do it.

Exercise:

At home/work (at least 3 times/day – more if I can especially when sitting at my desk)

• Heel slides x10
• Straight leg raises x10
• Lunges (a few times per day)

At the Gym twice/week
(I just started this and am trying to fit this into my regular schedule. My goal is to do this 4xweek):

• Recumbent bike 15 minutes
• Treadmill 15 minutes
• Leg press machine (no weight or very little weight) – in the seated position I let the sled lower where my knees are bent and I hold that position for 10 seconds. I do this for about 10 minutes.
• I sit on the row machine with my feet firm on the floor and roll so that my knees are bent and repeat several times.

PT (twice/week)

• Stepping over cones
• Balancing on a foam pad (alternating weight) and throw/catch a ball
• Wall squats or squat while tossing a ball
• Balancing on half ball
• Recumbent bike/ Nu Step/ Treadmill / Total Gym squats (I alternate these each session sometimes doing 2 per session)

Also, I don't know if this should matter or not, but they did not use cement on my knee. They said it was "cementless". Additionally, my surgeon is the doctor that developed the Stryker prosthetic knee that I have implanted.

 

[Celle]

@Lori1973

I agree that you would do better if you changed your PT. Balance is important, but you do need help with flexion and extension. Extension often takes longer the achieve than flexion, so there is hope yet.
It sounds as if your knee was bent for some time before your surgery. Is that right? In that case, your hamstrings and the other soft tissues could have contracted and it will take some time for them to relax and lengthen again.

That JAS splint looks like an instrument of torture!
Instead of using it, you could try some of these exercises, which you can do gently at home.
Extension: exercises for improvement

 

[Dhare63]

Hi Lori,

I am sorry to hear you are having these issues. I know how frustrating it can be. I have a few suggestions that are similar to those mentioned before but my personal experience as well.

I think finding a good massage therapist that can help you with your tight muscles is a good idea. My OS agreed that I had a muscle contracture from years of walking partially on my tip toe to accommodate my left leg not having full extention. Depending on how much swelling you still have, they might start you with some heat before massage to help warm up the muscles to help with stretching them.

I would cease pt because at this point they are not helping you, and you are both frustrated. Save your money. I woul keep trying to be mobile at work. I too had a desk job and made sure I got up and moved around a lot. I also bought a small ottoman that I could put under my desk so I could stretch my leg out on it many time s a day. I still use it even after 4 years.

You also might try warm water therapy, again, if your swelling is not a problem. This will also help like massage, in that a good therapist can help with exercises that will improve strength, flexion and extension. This was very helpful for me.

In my case, after a year, my extension was still only at 15 or so which is not acceptable. I had a revision, which was not a hardware exchange but something different. They opened the TKR incision up, took out the spacer and removed extensive adhesions that had formed behind the knee. They did a posterior capsular release, cutting the capsule that surrounds the joint to create more freedom of movement. The scar tissue had grown into the joint actually, which my OS said I could not have broken through without surgical intervention. The scar tissue went up and down the joint. I had post surgical bruising that was horrendous, all behind the knee. He warned me that it would be very painful for several days post op, and then it should feel much better. He was so right. After a few days, I could walk with a noticeable improvement.

Post op, I followed a different regimine to recover. In hospital, I made sure I had ice all around the joint. at home, I iced and elevated a lot. I did gentle stretches and did not use any aggressive therapy. I went to a different pt and let her know that the recovery was on my terms. She did lymphatic massage to help push fluid from the joint area to flush out of my system. After I iced, I would use those terrible TED hose with the toe cut out, to help keep swelling down, they were much easier that way. I did water therapy and within 10-12 weeks, I had full extension and 125 for flexion. It was a miracle. Less is more in my opinion.

My path may not be yours, but don't give up either. Listen to your body and don't let anyone marginalize you. It took me a long time to find my solution, and a great deal of encouragement and support from my friends at Bonesmart. They helped me to see things differently and trust my instincts. And just because your OS developed the Stryker knee, which I have as well, doesn't make him an expert in recovery. Your body is unique and will determine your best course of action.

Try some of these ideas, keep searching, and stay in touch. You will find that these are the most compassionate, practical people in the world. I credit this community with helping me get my life back and to keep my sanity at the same time.

Please let me know if you have questions, as I am happy to help! Please take care
,

Be well,

Dawn

 

[appaloosa girl]

Hi @Lori1973, what your pt is doing is not helping your issue at all. You are doing more at the gym.
At 16 weeks you are still early in your recovery. Stiffness and pain are going to be issues for you to deal with. Even your hamstrings being so tight. For that I would suggest light gentle stretching. As it loosens up you will be able to stretch harder. But not right now.
How do you feel after all of the exercising you do? If you say pain then you need to pull back on it.
Believe me it does get better, in time. Healing can and does take a year and in some cases longer. It is a very tough surgery on the body and it demands being nice to yourself. It won't be long and you will be working out to your fullest!! For now be more gentle to that new knee!!

Dana