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MUA 2 MUA’s & less than 90 ROM

jmoward

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Please help me with understanding the procedures for getting assistance here. I’m not replying to this person’s situation, I have a question of my own. Where do I go to begin. I had TKR on 9/11 (2 weeks & 4 days ago) and I have a very concerning situation I would like to discuss. Thank you for any guidance.
 

Celle

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Hello @jmoward - and :welome:

I've moved your post and Jockette's reply to it, so we can talk about your concerns here, in your own recovery thread, without disrupting anyone else's thread.
This will be your thread, where you post all your updates, information and questions and we will reply here, too.

Complete recovery from a knee replacement is a long journey, taking a full year for everything to be completely healed. Your knee is still very new, but it has plenty of time to improve.

If you can tell us now what is concerning you, we may be able to help and advise you.

Meanwhile, here are the recovery guidance and some very useful articles that we give to everyone with a new knee:
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this
6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs

Elevation is the key

Ice to control pain and swelling

Heel slides and how to do them properly

Chart representation of TKR recovery

Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
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jmoward

jmoward

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Thank you. I do not see “Jockette’s” reply. Where do I locate it?
 

Tykey

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Hi, the procedure is all sorted for you by the nice admin people on here.
You just need to post your concerns in the box below, and we can start helping you.
 
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jmoward

jmoward

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Today marks 4 weeks from TKR (left) surgery. Due to multiple set backs up until this week, I am woefully behind on ROM. Currently at 55. Has anyone experienced this as well? I am hopeful that I can gain greater ROM over the next few weeks, as I do not want to be surgically manipulated. Has anyone here ever had to undergo surgical manipulation. If so, in what week?
 

Jockette

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Lots of members are “slow” to gain ROM.

But the real issue is, “slow” according to whom?

Your knee will recover on its own time frame, not your surgeon’s and not your PT’s.

Long story short, it is your decision, by way of consent, whether or not you have a surgical manipulation ( MUA )

Who has suggested you might need one?

Sometimes a “slow” ROM can be due too much aggressive PT, which causes and maintains swelling, which prevents bend. If this is the case, cut back on the exercises and spend more time icing and elevating. You are in very early days of this recovery.

One of our members, Bertschb, kept a record of his ROM process. He agreed for us to post it for those of you that are afraid you're stuck. The key is to have patience! Bertschb says:

“I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):

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 - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.”
 

Pumpkln

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@jmoward, You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:
  • That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
  • If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
  • Having only one thread will act as a diary of your progress that you can look back on.
So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.
 

Jamie

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@jmoward .... it would help us to help you if we knew what those "multiple set backs" included. Can you describe what happened?
 
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jmoward

jmoward

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Thank you for all of your responses. I’m new at this forum/thread format & I appreciate you all stepping in to group my conversations & provide links for me to read to help me follow protocol.

My set backs were related to my intolerance of pain meds. Day of hospital discharge was a day of chaos for the nursing staff. For unexplained reasons I was not given the prescribed hydrocodone for more than 9 hours. PT session was required for 1 hour prior to discharge.

As my pain level was quite high in PT, the decision was made to administer oxycodone. This is what my doctor was advised to discharge me with. It proved to be too powerful of a drug for me. I was taking one every four hours beginning on 9/12, Thursday and throughout the weekend.

My surgeon recommends no exercise over the initial weekend, just elevate & ice which is all I really could do. The oxy drug heavily sedated me.

PT was slated for Monday 9/16. I was so heavily sedated it was difficult to function at capacity in PT. Discussed with PT & doctor & was suggested I space them further apart. During my 1st week of PT (30 minutes Monday, Wednesday & Friday) I would take prior to PT & then every 8 hours.

Still considerable issues... heart spasms, woozy feelings, lightheaded, no energy. Exercising at home wasn’t top of mind with me. Did a little bit of exercise, but not much. Discussed how I was feeling at end of 1st week of PT with the Joint Replacement Center’s head RN.

Asked if I should be switched over to hydrocodone. She suggested that I stay on the Oxy drug but just cut them in half spacing them apart 8 hours. I tried this over the weekend & still had severe weakness - almost fainting after exerting myself to get showered.

During the 2nd week of PT I had the bandage removed by the doctor. During this visit, I became very lightheaded & almost fainted. Again, just walking into the doctor’s office & him moving my knee around created the situation. They ended up having to summon a wheelchair to get me to my vehicle.

During this week I did do more exercises, but was not of the mind set to challenge myself. It was after all these episodes I made the decision to cold turkey the oxy drug during my 3rd week of PT on Wednesday 10/3. My last 1/2 pill was taken after PT on Wednesday.

Unfortunately & unbeknownst to me, I began detox .... the most terrible pitiful feeling I’ve ever gone through. Severe diarrhea started Wednesday late night & continued through Saturday night. Overall feeling of the flu, chills, nausea, no appetite.

By Friday I could hardly pull myself up on my walker so I missed Friday’s PT. After searching the computer I realized the 3 weeks of regularly scheduled meds had created an addiction in my body & now I was going through withdrawals & had probably had 72 hours to ride it out. Finally by Sunday morning I knew I would be alright.

So finally this my 3rd week of PT. I can think clearly & more importantly challenge myself. The consequence of this ordeal is a very stiff puffy knee that does not have much ROM & a thigh muscle that has difficulty firing.

The head PT dude said that my doctor is expecting my ROM to be closer to 100 on 10/14 my follow up visit next Monday. I am still on a walker. The notes I took during TKR class said that typically the walker would not be needed after week 3.

I am taking extra strength Tylenol for pain. In order to help me do my best here at home, I ordered a terrific ROM glider from Amazon. It was invented by the 2 PT guys on You Tube. I have also purchased a bolster.

Prior to the surgery I was a very active 66 year old. We spend most of our time on our vacation ranch & my lifestyle is a very active “cowgirl” , riding horses, walking more than 10,000 steps a day with just regular daily ranch activities.

My lifestyle slowed down in March of this year due to complications associated with CPPD (Calcium Pyrophosphate Deposition Disease) in both knees.
I am a medical mystery, as CPPD typically only affects one joint once in a lifetime. I had it twice in both knees from March,2019 to July,2019. Once we got the symptoms of CPDD settled down, the decision was made to perform TKR, as CPPD breaks down cartilage in Osteoarthritis knees. My thigh muscles had begun to atrophy due to my inability to use them during bouts of CPPD.

So I hope this provides you all some insight to my situation. Any advice is greatly appreciated. Thank you.
 
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Jamie

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Thank you so much for your detailed history. It really does help!

I am so sorry to hear of your problems with medications. It certainly doesn't seem like that situation was handled properly. For any future times that you may need pain medication, it sounds as though you should stick with the hydrocodone or possibly you could even do with Tramadol and Extra Strength Tylenol. Is the Tylenol keeping your pain under control now? Controlling pain is critical, especially during these early weeks of recovery.

Please read all the articles that Celle left for you in a post above. They will provide critical guidance on things to make recovery easier and more successful. Be sure to pay special attention to the icing and elevation articles. Ice is a terrific pain reliever.

One thing I want to stress for you is that you are far too early in your recovery to worry about needing a manipulation under anesthetic (MUA). Your knee and you have been through a lot and things need to settle first.

What are your current pain levels when you are resting and when you are up walking around? If you're going to therapy, do you have pain there or within the 24 hours afterwards? Many times therapists get a bit too aggressive with replaced joints and you have to scale them back. You are in charge of ALL aspects of your recovery. If someone sets goals and deadlines for you, just smile and ignore them. Your body is going to set your recovery schedule. Your job is to listen carefully to the signals (pain) it gives you that tell you when you need to slow down. Your body will also tell you when things are going well and you can try a little more activity.

But since you had so many initial challenges, take a week or two just to regroup, get pain under control and start fresh on recovery. Don't let anyone tell you that if you don't do "x" your knee will freeze up, you won't get your full ROM or any other of the "motivational myths" that people tell joint replacement patients. All you need are gentle bends and stretches though the day along with short walks around the house for 5 minutes or so every hour to keep your joint mobile and minimize swelling.

We'll be here for you and will help you. Let's take things one day at a time for now.
 
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jmoward

jmoward

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Thank you for your prompt detailed response. Your approach is spot on for me.
With regard to pain, yes I’m in pain, but thus far it’s not to the point I can’t handle it. My preference is to not take any drug other than xtra strength Tylenol. I have more of the stuffy stiff knee sensations that just doesn’t want to bend. My PT coach has not been overly aggressive, however, yesterday she performed hand stretches on my leg/knee. This really was difficult to tolerate & has caused swelling last night & extreme pain in knee cap area when I attempt to get out of chair this morning. My plan for today is to do some stretches shown in photos you shared & walk about. I’ll use my glider to
Help with ROM, trying to do all frequently throughout the day. Icing & elevating too.
I’m encouraged by your insight. I feeling a sense of control over this looming doctor visit on Monday.
 

Pumpkln

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yesterday she performed hand stretches on my leg/knee. This really was difficult to tolerate & has caused swelling last night & extreme pain in knee cap area when I attempt to get out of chair this morning.
Be sure to let your PT know how your knee swelled up, and you had extreme pain when you attempted to stand up after yesterdays session. You should experience no more than discomfort during PT or any other activity of exercise you do. Please do not let them touch your leg again, or try to increase your ROM, it will only set your recovery back.
Suggest you cancel PT and give your poor knee a break, it needs a lot of TLC right now to recover from your difficult early recovery with inappropriate pain medications for you.
Saying no to therapy - am I allowed to?
 

DIYSteve

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Today marks 4 weeks from TKR (left) surgery. Due to multiple set backs up until this week, I am woefully behind on ROM. Currently at 55. Has anyone experienced this as well?
55 flexion is about where I was 4 weeks post-op. I got full extension at 6 weeks but flexion progress was late and very gradual. At 15 months post-op (today!) my flexion is around 95. It was only last week that I was able to ride my bicycle with my seat height in the proper position. (I started riding few months post-op at 3cm high, then 2cm, then 1cm). OTOH, my knee has been very stable and strong. I skied 100 days last season, did 3 week-long backpacks (including some rugged off-trail) this summer and quite a bit of non-technical mountaineering. When I hit 90, my OS said NO to MUA.

What was your flexion pre-op? Mine was only 95 pre-op, where I am now at 15 months post-op. I expect it to gradually get better. I would be delighted with 105 (which was my est. max 5 years pre-op), and expect to get there by 2 years post-op.
 
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jmoward

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I wish I knew the answer to that. Because of the CPPD disease (I explain this in earlier thread) I was not able to bend my knee much at all. My doctor &I were focused on not upsetting my knee prior to surgery, as the attack could be brought on by unknown factors. So no pre-operative exercises were done & I was never measured- unless in the operating room he would have checked it before surgery. That is indeed a question I have for my Monday appointment.
 

Pumpkln

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Given your history, suspect your ROM will be slow in coming secondary to your history of CPPD, and of course the trauma we all experience during joint replacement.
Be sure your health care team does not have unreasonable expectations, for your recovery.
 

judgar

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You know what helped me was I bought a cheap skateboard. I would just sit and put my foot on and so back and forth. Eventually you can go further and further. Just be gentle it will come.
 

DIYSteve

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Given your history, suspect your ROM will be slow in coming. . . .
This is consistent with my OS pre-op advice that pre-op ROM is the best indicator of post-op ROM and post-op ROM progress.

Be sure your health care team does not have unreasonable expectations, for your recovery.
Great advice. Key to happiness #1 is reasonable expectations.

Likewise, my advice is to avoid comparing your progress with the progress of others. The primary objectives of joint replacement is to relive pain and improve function. The comparo base line is your pre-op function, not the function others may experience.

jmoward, best of luck to you. You are only one month out. Things will get better.
 

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