TKR 4 weeks post right TKR dificulty bending

[Jamie]

Marco, I still think you are overdoing things with your new knee. The fact that it swells and becomes uncomfortable once you get back home is proof that the therapy sessions are too aggressive for you right now. Remember...."stiffness" is swelling and pain. Even if the knee doesn't look swollen, it is deep inside in your very compact knee compartment. It doesn't take much irritation and fluid to cause the discomfort you feel. And, of course, any swelling will then limit your ROM.

The CPM is a passive machine. I will be very, very surprised if you realize much of any gain in ROM from using it. But what I am MORE concerned about is that you will be adding more motion and activity to a knee that is already unhappy about being overworked. I cannot see how this is going to benefit you at all. Sorry to be blunt about it, but I am really worried about you not giving your knee the rest and pampering it needs right now.

Things will only be more difficult for you if you go back to work before your knee settles down. How about taking Friday through Sunday as purely "kneecation" days. Don't do any errands. Only minimal walking around the house to get to the kitchen or bathroom or bedroom. Do gentle bends and stretches 4-5 times a day for about 5 minutes. Ice and elevate your knee constantly both day and night and stay on a schedule with your pain meds. I bet if you would just try this, you would see the improvement you're looking for. But....you must give your knee a real break here. From what I read, you just haven't been doing that.

Sorry to sound so firm with you, but I do care about you and want you to improve. If I'm misunderstanding and you have tried the lower activity for several days.....tell me and we'll try to think of something else for you to try. But, I can promise you that more exercise is not the answer for you.

 

[marco4432]

Thanks again, your inputs are very helpful, I've become so isolated I look forward to reading any responses.

Firstly please accept my apologies for boring you all, I'm approaching my 8 th week post surgery, I remember the 6 OS, I have met to discuss the TKR surgery and recovery time, each one saying that recovery is about 10 to 12 weeks, to return to work in my current profession.Why they say this is a mystery to me, I must admit that I don't think I am overdoing it, there have been many days that all I've done is lay on the coach with Ice.

When I talk about pain, it is at a 0 to 5, whereas before the surgery it was between 5 to 10, 20 hours a day, the pain was running across my meniscus line, bringing a 48 year man to tears, the last 18 months were the worse hence heavy opiode use so I could work, post surgery it is a completly different pain I am experiencing, painful but bearable where as pre OP it was unbearable, ( Hence my decision to have a TKR ). There is so much conflicting advice on whats the best way to recover OS, PT and my PCP say to use some force saying it won't damage the inplant but if I don't get it moving then I would need an MUA or having the luxury of taking a year off so it will slowly recover but I would still need an MUA.

Then I recieve information from people who have had the TKR and even worse a BTKR, I trust those of us who have undergone this procedure, but then OS who have years of experience, surely they must know what they are talking about, I wonder if age is a big contributing factor, that young TKR patients have a different recovery then an older patient's, maybe due to tendons, activity level, I don't know. I am going to try the CPM now as I am stronger and not as in as much pain as the first few weeks. I'm not going to force it if it hurts to much, but I will give it some effort, the absoultley last thing I want is an MUA.

Any thoughts would be appreciated

Thanks

M

 

[referee54]

each one saying that recovery is about 10 to 12 weeks,

Why they say this is a mystery to me,

It is a mystery to me, as well. A TKR recovery can take upwards to a year---that does not mean that you have to wait that long to return to work, but many folks have been told that everything is all done by that time. It is, quite frankly, not true

There is so much conflicting advice on whats the best way to recover OS, PT and my PCP say to use some force saying it won't damage the inplant

No, it won't damage the implant, but it does increase swelling---so there is the lack of progress with the ROM. The harder you work the knee, the more the swelling will be.

and even worse a BTKR,

I had a BTKR a little over six years ago. While I admit that the recovery was more challneging, I would make the same decision to do it the same thing again.
.

 

[Knitter4444]

And give me an OS that has had this done to themselves. Or someone like Jo who has seen it all. Or a Bone Smartie who has been through it.



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[Josephine]

My PT and OS suggested the CPM which arrived today. I don't know if it will help but I have to try, otherwise my only option is, I assume, having an MUA.

Well, I doubt there will be any harm trying it as long as you don't set it up to too high a flexion and cause yourself pain.

I'm sure that an MUA is painful and would delay my return to work

Not necessarily. While the first day might be painful for some people, for most it only lasts that day and perhaps two or three more.

PT all exercises are sets of 10 knee bending the PT does is massage and then 3 x knee bends, he bends then tells me to push up against his resistance, then he slowly bends with force until I tell him to stop.
My flex is 80 max but after he bends and massages he can get to 95 then ice with electrodes
Then I leave and even though there is discomfort, it feels good to bend.
Problem is when I get back home and ice with my knee straight and elevated, then it goes back to being stiff

Discomfort is okay. It's just pain that is not. If this is all done under the supervision of your PT then not a lot I can say. Except to emphasise that you are only 6 weeks out and doing too much which is probably why your ROM is not so good. And I'm not convinced that an MUA at 6 weeks is a good idea. But if you are unable to stand up to you surgeon then there's really not a lot more for me to say.

I shall be praying for better times for you, my dear.

 

[marco4432]

Thanks Josephine for your imput, just one more question if you don't mind me asking,

orthopaedic nurse of 53 years experience in orthopaedics and joint replacement,

You must have a great understanding when it comes to TKR and recovery. I have no problem to standing up to my OS, however I have had four surgeries before two arthroscopies for meniscus tears two different surgeons, 2 denervations - 1 surgeon. I found that after each failed surgery, I have found it next to impossible to get information from the Doctors and their assistants, by that I mean I call leave multiple messages, which rarely get returned. I find that I get dumped by the surgeon and his staff when I complain that the surgery failed. If you know why do doctors and their staff behave in such a manner, or is it that they have received theie money and lose interest in the patient and is it the doctor who instructs his assistants not to respond to my calls.

I ask because with my OS who performed the surgery, I don't want to argue with him or say that I've looked on line and have received contradicting advice, as I feel if I do I will get dumped as before.

Sincerely

M

 

[Josephine]

No indeed! That would be one sure way of getting up his nose! The way to play it is to say this is what YOU want and what YOU have decided to do. Nothing more. You are not required to provide 'evidence' for you decision or opinion. You are entitled to voice your own opinion and decide how you want things done. I won't play with you, it's a bit of a gamble as he might be right, we might be right or 'right' might be somewhere in between. But you have to make up your own mind what you want to do, how you want to do and then just tell him.

I'm not too familiar with US doctors - as you can see, I'm from the UK and we tend to have slightly different ways of doing things. In the past we have had a tendency towards the 'unpopular patient' syndrome where patients who are troublesome for one reason or another are ignored or blanked out. I believe it still happens despite the assurances of the 'administration' that it doesn't. So I can fully understand your concern and suspicions. Can't do much about it for you but I understand.

 

[kar1963]

Hi marco .. I had an MUA on Nov 7. I was stuck in the mid 80s range with great extension. The MUA helped me bend. Right now I am hovering in the 96 to 98 range and still great extension. The MUA itself does not hurt because you're knocked out. I was sore for about a week after.

I had pt every day including right after the MUA for two weeks. My knee still gets stiff but not nearly as bad as before and my pain is controlled 98% of the time with Tylenol. I take a half of a hydrocodone only if the pain reaches a 5 on the 1-10 scale.

There are some great readings here on the MUA. Read them and as many as you can. Listen to Josephine on the bike rotation. Do not force it, just rock and that full rotation will come with ease in time. This is a slow process. I never thought I would be still having issues and out of work almost four months later but I have I think finally learned that the knee will do what it wants when it wants and PT should be a non painful helper. Give the CPM a chance. I sometimes think had I been put on one I may not have needed the MUA but I'm realistic enough to also know that may not be true.

 

[marco4432]

Hi Kar1963,and Josephine If I may ask did you decide on the MUA or was it your OS ?, My surgery was 3 weeks after yours my flexation is still at 80 with poor etension -10.
To follow up on the CPM, I went to PT on Wednesday, Thursday morning I woke up with pain in my foot on the side, the top and underneath it is so bad I had to go back to the walker, The CPM came on Thursday but the pain in my feet stopped me from using it, I have been rubbing mt right foot with Voltaren gel and taking Gout medication incase its Gout, but I have never had pain on the sole and side on foot before with gout its always been in my big Toe, it got so bad I was contemplating going to the emergency room, its now sunday and the pain has reduced by about 50 %, I don't know what it is so I'm posting here just in case someone has had the same experience, even my knee seems to buckle when I walk, I went from pain at 1/2 Wednesday to 8/10 Friday $ Sat today is a little better. I see how I feel tommorow or I'll go see my OS ( If he has time to meet ???)

Thanks again any input would be greatly appreciated.

M

 

[chestnc]

So sorry to hear you have to go through this Marco. Really as if a TKR is not enough to collect yourself from, now you have to worry about job and Cobra. From going through the process of SSD with my husband, there is a 6 month waiting period for SSD. If you have private disability like I have, it depends on what amount and when you have signed up to get it. My job offers disability through my union which is minimal. I have FMLA at my job which if I am out for more than three months my insurance stops, though my job position will be held for me. This is because I have a union in place at my job.
Also your pain factor. It is difficult to do range of motion when you are in pain. Do you have a pain management doctor that you see? They could work with you to get the pain part under control. I do understand about opiod tolerance. So sorry you are going through all this and hope something can be worked out.

RTKR Oct 23,2013
RA diagnosed 10 yrs ago

 

[Knitter4444]

I had bilateral MUA 3 months after a bilateral knee revision which was 2 years after my BTKR. I could not bend more than 78 degrees with tremendous effort. Changed my life.. I don't consider it a failure though. Just happens. And grateful that there was a fix.

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[Josephine]

did you decide on the MUA or was it your OS

You surgeon can suggest or recommend an MUA but you and only you can decide whether to have it or not. It's a legal requirement that any doctor has written consent before he carries out any procedure and without it, he cannot proceed. It's the law.

 

[marco4432]

Warm regards to everyone, hope you all had a great thanksgiving,

I'm looking on advice that anyone who has had an MUA could give me, I'm coming up to my 10 week post Op, will be seeing by OS in two weeks which will make it 12 weeks, my rom is -8 to +96 measured yesterday at PT ( PT forced it to the max so really at +90, my PT recomended I get another CPM machine which I did, I have it for a month been using it for 6 to 8 Hours a day, for the last two weeks, plus PT, and doing PT at home, I work on my feet walking, turning and stairs for 8 hours a day, I can not see me returning to work at 12 weeks and my OS agrees that as I don't have a sit down job he cant see it also. I asked him two weeks ago will I need an MUA, he said we really want to avoid it.
I have to get back to work as I won't be able to pay bills ect ect.

I'm unsure why my OS surgeon does not want to do an MUA or should I force the issue, I getting very depressed, constantly worrying about money and the rest.
Please can anyone advise me, Should I get an MUA do they work, will I be able to get back to work, should I find another surgeon and get a second opinion on MUA, I've read that an MUA is best within the first 12 weeks, but I don,t feel that my OS has the same sence of urgency as I do, I can not even claim unemployment, as I'm not able to work in my field, I have one more month of disability insurance then I'll be broke.
Thanks for reading and hopefully responding, especialy if anyone has been in a simmilar situation.

Sincerely
M

 

[Hwa1538]

Marco: I can understand that you are very concerned your financial sitiuation because if you can not go back to work soon, you will not have an income to pay the bill. As a result, you worked hard trying to get a good ROM and even want to try MUA even your OS has not recommended yet. Unfortunately this recovery process can not be rushed. Especially if your keen is swollen, it will not bend. As a matter of fact, your ROM is over 90 that is good for average but is not good for your expectation. Usually, people who's ROM is lower 90 may get MUA. After MUA , the knee is hurt again, it will need more weeks to recover. Thus, MUA should be considered for the last option for those who just could not make any progress on bending. You don't sound not fit in this category. You sound more desperately wanting to go back to work. Every time when I came back from PT, I have to take easy that afternoon and the next day because my knee swollen again and I could not bend. You heard a lot from this site people commented that we go one step forward and two steps backward. We do need paitiences. Unfortunately, you feels do not have the time. Is possible you can find other financial resources in stead of risking your own health? Rush will not do you any good but harm. Just because your OS does not want to do MUA, you want to change another OS. Do you realize that it is not that easy to change another OS after TKR? Do yourself a favor, slow down, give your knee a time to heel first.

 

[Josephine]

I've read that an MUA is best within the first 12 weeks

That's a myth. I've known people have MUAs a year later with good effect. In fact, early MUA is often counter-productive as it causes more of that the problem was in the first place - pain, swelling and stiffness. All that Hwa has said is spot on. Please try not to confuse your anxiety with your recovery. The two don't mix.And you're only 9 weeks yet. Still early days.

But I really feel for you regarding your financial situation. It must be really hard.

 

[sunsetbiking]

That's a myth. I've known people have MUAs a year later with good effect. In fact, early MUA is often counter-productive as it causes more of that the problem was in the first place - pain, swelling and stiffness.

Josephine while I was in the early stages of my recovery, I was having a hard time getting my ROM, in fact it was very slow process. My surgeon kept checking my progress and there was a moment where he did mention doing a MUA. He decided against doing the procedure. After about 4 or 5 months I asked about it, because I only got to 108 degree flexion. He said he wouldn't do it because there is to big of a risk of breaking the joint. Is this just an individual surgeon preference? Or is there a higher risk when doing a MUA a year later?

 

[Josephine]

Neither. I have been present at dozens of MUAs and never seen a bone broken. Surgeons in the UK rarely mention it much and I really cannot fathom why some US surgeons make so much of it because it's a risk but a relatively low one. The main factor is that if the surgeon is careful and skilful, then that risk will be minimal.

 

[referee54]

One thing, Marco---you are in a catch-22---you want to speed up recovery, so you work a little harder, which will slow down your recovery.

Then, you are considering an MUA to possibly get things going, but that, I feel, is too early, and you are in charge of that, as Josephine has pointed out. Will it get you back to work?

The issues is not necessarily about working harder, or the MUA---I believe that it real issue is time,and, as I learned, you really cannot speed up the healing.

I had to learn that---it was very frustrating---but I could not rush things.

 

[kar1963]

Hi marco.. i understand the need to get back to work. But you have to give yourself time to heal as well and your job sounds strenuous. I have a desk job but my os has kept me off work i will go back dec 16 do i feel 100%ready no but i am going back. I had my mua after long long talks with my physical therapist and my OS i was stuck for weeks in the lower to mid 80range on the bend .. only you can say yes or no to the.mua .. mine has helped me but am i back to normal no i still have work to do. I honestly just recently stopped worrying what my numbers were (i am just over 100) and now i focus on what i can do and where i need some.help. stairs and sitting for more than a couple hours at a computer seem to give me knee fits. I still have a bit of a tight feeling but i resigned myself to knowing in time it will go away too.
The mua is a helper not a cure all and you have to take that step.. read the mua posts here and talk to your os and your therapist. But most importantly do not push yourself you will heal in your time, i know the job and finances are a motivation but there really is no rush or quick fix... am i happy with my new knee yes and i am happy i did the mua but again i was at a hard stop ..

 

[mjstark]

Hello, I would like to give my perspective on this. Many people here are stating that pt should not hurt and that being aggressive is not a good idea. I had an amazing surgery but there was quite a bit of swelling. when I came home my pt had me keep my leg elevated, on and off ice, and the only movements he had me do was straightening and bending. I would take my pain med a half hour before hand to help with the pain. and yes there was pain..... a lot of it. I would bend my knee and it would hurt so much I would cry, but at four weeksni had 130 degrees in bend and perfectly straight. it was only after I achievec this that I began my strengthening exercises. I was able to walk without crutches at week three and without a cane by week four. I firmly believe in the extreme therapy I had to help me attain perfect motion. if I had allowed pain to stop me it never would have happened.