TKR 2½ Years Post Right TKR<

That is an impressive problem list for your knees. You know, that kind of history is in fact a risk factor for adhesions. Those of us prone to adhesions must be vigilant to stay the comfort zone and keep our knee as cool as possible (minimize inflammation).
 
I think the reason why my right knee was so bad off is that after I blew my ACL out I continued to play sports for a year, which included volleyball and basketball. I did a lot of damage and tore a significant amount of cartilage in the process. After my ACL reconstruction and PT I continued to play volleyball, basketball, and baseball. I finally stopped playing high impact sports around 2001.
 
7 Weeks post RTKR, went to see my OS today and because my flexion is only at 45 degrees he scheduled me for an MUA on Sept. 27th. He tried to break the scar tissue while I was in the room but became to painful. So no choice but to get it done. Of course I'm nervous as hell and wondering how much pain I'll be in after?


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It may still be early for MUA but looking at your history, it's no surprise you would develop scar tissue. Some orthos think early MUA is preferable. Best thing you can do is rest like crazy, and ice and elevate like crazy, until your procedure. And the same afterward. Scar tissue thrives on inflammation. So pain and swelling are clues to combat inflammation. And a word of advice: post MUA some or maybe most PTs think that the more you "work" in PT, the harder you push, etc., etc., the greater your chances of increasing range of motion. And I believe that the opposite is true. The more you rest, the better your chances. But it's important every day, maybe twice a day, to do some good, long, slow stretches (both extension and flexion). You want to encourage that range of motion but never to pain, only to the discomfort stage. If you stick with that -- stretching daily, keeping your knee as calm as possible -- your chances of good ROM will be better. I've done it both ways. I also used CPM while watching TV. I do believe that this is one of the few situations where CPM can be an aid. I started low and increased the bend very slowly, again, never in the pain zone.
 
My insurance denied my 1st CPM and chances are I won't get it after my MUA. I'll have to work a little more on stretching due to no CPM.


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My thinking about the CPM -- it was moving the knee without my knee doing anything whatsoever, therefore movement without minimal inflammation. I couldn't beg borrow or steal a CPM. So I bought one secondhand, found it on craigslist, of all things. You want it? Pay shipping and it's yours!!
 
Maryo52 I would definitely be interested. Please provide an e-mail address and we can go from there.

Thanks,

Vince


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7 weeks out is extremely early to be doing an MUA. Far too early in my book!

Tell me, is your leg very swollen? Because that's the most common cause of lack of ROM at this stage. He may well get a pretty good result under anaesthetic as he can push against that swelling and not be held back by your pain. He may also tell you that he got a really good result and then urge you to 'work hard' else you might loose it again! But that's also a fallacy. All the MUA will do is increase the swelling and pain so your ROM may even go down some. But underlying this it that your knee had the bend in it right now. All it needs is for you to get on top of the swelling so it can show itself. You need to read this to see what I mean Swollen and stiff knee: what causes it?.

You might also like to read these articles
MUA (Manipulation under Anaesthetic) and Adhesions
MUA: the ineffectiveness of early MUA (JBJS)
 
Hi Vince,

Welcome to Bonesmart. You will find much insight and first person experience to help you through.

Please listen to the advice you have gotten so far. Controlling swelli
ng is key, especially for someone who has had so many surgeries. I have had my fair share as well but never really understood the concept of controlling swelling until I came here. Think of a hose full of water; it's pretty hard to bend right? That's what is going on with your knee. You can't bend a swollen knee.

I would suggest you wait on the MUA. There's no magic window to have it done if needed. Work on the swelling and read through what Jo sent you. She and so many others helped me find my solution, and they know what they are talking about. Had I followed the Bonesmart mantra from the beginning, I don't think my recovery would have been so challenging.

If you have to have the MUA after you try the less is more approach, don't worry. It's not so bad, yes it will be painful, but not as bad as the original surgery. There have been many members who have gone through this and their stories vary. I am sure there will be others who will offer advice. Just keep your chin up, you will improve. This is a test of your patience. I know I had very little supply of that when I was at 7 weeks. That was about when I got the talk about MUA.

Hang in there and please post your questions and concerns. We are a very caring and supportive community!

Be well,

Dawn
 
One more day closer and am wondering after the MUA is complete what exercises and stretches should I focus on durning the weekend? I have a feeling that my quad, and calf are going to be very sore from the manipulation.


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Please read what folks have written here for you again. You should NOT be focused on any exercises. You should focus instead on resting, icing, elevating and taking pain meds if you have pain. A few gentle bends and stretches are all you need to be doing several times a day. You want to give that knee a chance to recover.
 
Let me rephrase that...I meant what gentle stretches would be recommended? Also my PA said that I should only put a pillow under my ankle when I elevate it. I truly believe this guys doesn't subscribe to the elevation mantra.


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Find a way to extend and then bend your knee a little bit each day using whatever method works best for you. You might even have your significant other simply move your leg through the range of motion per your guidance while you relax your leg. I think in there is some superstition that the scar tissue will re-establish itself if you don't immediately "work hard," but I there's a lot to be said for gentle movement.

What I ended up doing was getting an exercise ball at Walmart. Not in the first week, but after that, I would sit on it with my TKR foot planted on the floor and roll gently forward. Just use your ingenuity to devise a method that works for you. Or you can simply dangle your leg. I know the hardest part for me was resisting the urge to push it, especially when you immediately have so much less ROM than the surgeon got "on the table" followed by what seems to be no progress.
 
That's very good advice, Mary.

vnmarino, your PA is wrong. Look at this for advice on how to elevate your leg correctly and safely elevation is the key.
 
I'm back from my MUA and so far I can bend it and estimated 80 degrees. I didn't get to talk to the OS after the procedure to see what he achieved when I was out. Extension feels better as week. The only thing that is sore right now is my quad, which I figured would hurt. I will be doing some gentle stretching throughout the day, as well as elevation and ice. Tomorrow I have a PT visit lined up, so we'll see how that goes.


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I think your PA's advice to only put a pillow under the ankle means this -- he doesn't want you elevating your leg in a bent position because they want to encourage your extension. He's simply saying, keep your leg straight.

I have to confess I didn't follow that advice. I had so much pain that when I elevated, I positioned my leg in the most comfortable way possible. I still eventually got full extension. BTW it's rule breakers like me who dispel false beliefs.
 
Three days after my MUA procedure I was able to go around on a stationary bike for the 1st time. I actually rode the bike for 3 minutes before I was out of breath. Very happy to be able to bend my knee!!!!


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I also had an MUA on Friday ( 3 months after my RTKR) . Surgeon got 130 degree bend in OR, and I have been able to get to 120 since then, however am finding today I have less bend and wondering if you are experiencing the same thing? I don't seem to have more swelling & if that was the cause for the decrease I would have expected it to occur sooner -24 hours post MUA. I,m becoming upset as I was so thrilled to have such a great result and am very anxious about losing it. Sorry to take over your thread don't have one of my own, but wondering if you are having the same experience as I am?
 
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