• REGISTER for Joint Replacement Awareness Day on May 9th, 2020!

    Surgeons, patients, and other medical professionals will talk about topics you've told are important to you. You can ask questions LIVE of the participants. Please "like" and "share" our JRAD notice on your Facebook page too!

    Register and learn more in this announcement:

Watch 2019 JRAD Videos

MUA 8 weeks and still not sleeping. ☹️

Gatorchief69

junior member
Joined
Dec 30, 2019
Messages
26
Age
69
Gender
Male
Country
United States United States
I’m 8 weeks post TKR and MUA at 6 weeks with only 87 ROM and still not able to sleep more than 2 hours a night. PT has forced ROM to 100 right after MUA, but it swelled up and returned to 87 in two days. The pain is still severe when moving knee two 80 plus. Am I looking at revision soon??
 

Jaycey

FORUM ADMINISTRATOR
Administrator
Joined
Jan 27, 2010
Messages
30,779
Location
Yorkshire
Gender
Female
Country
United Kingdom United Kingdom
@Gatorchief69 Welcome to BoneSmart! My first advice is stop all that forced PT. The only thing it has accomplished is pain and lack of ROM. Forcing your knee does nothing except create more swelling and trauma. It is the swelling that is keeping you awake and hindering your ROM.

Are you icing and elevating several times per day? Ice is a natural pain killer. If you ice that knee for 45-60 minutes you will soon start to see some improvement.
Am I looking at revision soon?
No - technically you are only 6 weeks out as your MUA set you back in recovery. I am not sure why your surgeon suggested the MUA so early out but now you have had to start again.

Please read our recovery guidelines below and try our approach to this recovery. Your knee doesn't need force. Time is what allows you to regain your ROM.

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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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 Activity progression for TKRs

6. Access 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.
 

Jockette

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Aug 29, 2017
Messages
16,477
Age
64
Location
Delaware
Gender
Female
Country
United States United States
Hi and Welcome to Bonesmart!

I agree with Jacey, the MUA and this aggressive pushing on your leg is not helping you. Honestly, I don’t understand how surgeons and PTs can think this helps.

Your knee/leg has been through a traumatic surgery and it needs time and gentle treatment so it can heal. It’s a newborn baby knee and should be treated as such.

Stop allowing all this forcing. You do have the right to say no, it’s your knee, not theirs
Saying no to therapy - am I allowed to?

Try following Bonesmart’s gentle approach to recovery. Many have and had very good results.


Regaining our ROM is more about Time than repetitions of a list of exercises, or forcing the bend.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
 

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
37,091
Age
78
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
Hello @Gatorchief69 - and :welome:

Please will you tell us the full dates of your knee replacement and MUA, and which knee it is, so we can make a signature for you? Thank you.:flwrysmile:

In spite of what you've been told, there's no need to rush to get ROM (Range of Motion), because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

Don't worry about possibly needing a revision. That's not likely to happen, as long as you allow your knee to heal without being forced to stick to a one-size-fits-all, theoretical deadline.

Your poor knee isn't lazy or unfit - it's wounded from major surgery and it needs time to heal, and for swelling to go down. While that's happening, your knee needs gentle treatment and gentle movements, not lots of exercising and forcing to bend. It will bend, when it has healed enough and the swelling keeping it stiff has gone down.
 

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
37,091
Age
78
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
Sleeping is a problem for most people after a knee replacement. Until your normal sleep pattern returns, make up for lost night-time sleep by taking daytime naps. Sleep where you can, when you can, and how you can.

Complete recovery from a knee replacement takes a full year, although you'll feel heaps better long before then. It is a major surgery, and not one you can bounce back from in just a few weeks. It's going to be worth it in the end, though.
 
OP
OP
Gatorchief69

Gatorchief69

junior member
Joined
Dec 30, 2019
Messages
26
Age
69
Gender
Male
Country
United States United States
My TKR 11/04/2019
The MUA 12/17/2019
 
OP
OP
Gatorchief69

Gatorchief69

junior member
Joined
Dec 30, 2019
Messages
26
Age
69
Gender
Male
Country
United States United States
The OS used the “Zipper” to close the incision on my TKR. I can barely stand to have anything covering it, long pants, blankets, etc. It burns like fire when the material rubs against it from walking motion. Has anyone else experienced this from that type of incision closure? How long did it last and did it go away?
 
Last edited by a moderator:

Helizabug

graduate
Joined
Nov 4, 2019
Messages
693
Age
59
Gender
Female
Country
United States United States
I am a few weeks behind you, but I’ve had several knee surgeries, and I have certainly had exquisitely painful sensitivity on my knee after surgery. In fact I’m lying here, early morning, with just my knee out from under my blankets for the same reason. Oddly, I find a compression bandage helps by applying firm, not tight, pressure all around. Some people can’t bear the thought of wrapping their knee, so I might be weird, but it helps.

There’s a lot going on in there, as far as healing, and not a lot of room, as the knee is a tight space even without the swelling.
 

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
37,091
Age
78
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
@Gatorchief69 - It is possible to de-sensitize your scar.
Start by touching it with a soft piece of cloth. Progress to gently rubbing it with the material, until you can tolerate that. Do that in short sessions, just a few minutes at first.

Once you're comfortable with the soft material touching your scar, gradually increase the harshness of the material, until you can touch your scar with a towel, with denim, with any cloth you choose.

Make sure you wear loose-fitting pants at first. Eventually, you'll find you even feel OK wearing jeans.
 
OP
OP
Gatorchief69

Gatorchief69

junior member
Joined
Dec 30, 2019
Messages
26
Age
69
Gender
Male
Country
United States United States
Had appointment with my OS yesterday 2 and half weeks out from MUA. He took X-rays of my knee and of course said they looked good. (Only 3 views) I protested saying the ROM continues to be under 90 (87) until pushed to extreme pain level that gets it to 92. I did mention that I researched alternate methods of PT and stopping the forced movement to extreme pain.

I believe the last PT session I had, the therapist went to far forcing my leg back while on my stomach. I now have sharp pain on the top of my knee that becomes unbearable when turning my leg in towards the other leg. I was walking 3/4 mile with minimum pain before MUA and aggressive PT. Now it painful going around the block again.

The OS took a fluid sample (because I rested my knee several days there was minimum swelling and very little fluid barely enough to culture) and ordered a tomography of my knee. I’ll know the results Monday. We did discuss the possibility of revision if the ROM can not reach functional range. (his interpretation 95-100).

Full disclosure, I traveled to Memphis TN about 200 miles from my home to have this OS do my knee. He has been doing TKR for 31 yrs, with many rave reviews! The only negative factor was his age, 73. He was still doing 5 or 6 knees a week. I wanted someone with extensive experience as my knee was injured 22 yrs ago (fell 12’off a ladder on cement). I was and still am going to the gym 4 days a week doing elliptical (40 min) and rowing machine (20min) before surgery.

This is getting too long, but to make things much worse the OS had a car wreck two days after my surgery and his leg was broke in 2 places. So I’ve been pretty much on my own for the first 6 weeks. Believe it or not he came to the practice in a wheelchair and did my MUA! He’s still in the wheelchair and says he would do the revision! Thoughts??
 

Jockette

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Aug 29, 2017
Messages
16,477
Age
64
Location
Delaware
Gender
Female
Country
United States United States
You are only about 2 months post op. This recovery takes an average of a year.

You have had an MUA (way too early, in Bonesmart’s opinion) and very aggressive PT. These things cause a lot of trauma to the knee/leg, in addition to the trauma of the original surgery. Your knee has not yet been given a fair chance to heal.

I was and still am going to the gym 4 days a week doing elliptical ( 40 min ) and rowing machine ( 20min ) before surgery.
Do I read this correctly that you are currently doing this type of exercise? If so, it is far too much for a 2 month old knee.

In light of all this it is too early to even think about a revision.

I suggest you scale back your activity level, stop the aggressive PT and rest your knee and give it a chance to settle down. If you continue to overtax it, you could end up with chronic pain, and no one wants that.
 
Joined
Nov 1, 2019
Messages
268
Location
Southeast Michigan
Gender
Female
Country
United States United States
Yes (almost three weeks out myself), it all sounds too intense IMO as well. Too fast, too much.

My sleep is just improving with the help of herbal tea and a mild approved sleep aid with my Tylenol.

I make sure to rest my knee (or alternate what I do with it) the day after rigorous bed/ chair exercises/ steps/ walking and or the PT. Or I am finding it am extra sore and not sure that's helpful.
 
Last edited:

Jockette

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Aug 29, 2017
Messages
16,477
Age
64
Location
Delaware
Gender
Female
Country
United States United States
I am finding it am extra soar and not sure that's helpful.
Any extra activity that causes increased pain is not helpful.

Granted, many of our necessary activities do cause us pain, by default, in the early months, but extra things like a list of exercises or unnecessary activities, are not in our best interest just yet.
 
OP
OP
Gatorchief69

Gatorchief69

junior member
Joined
Dec 30, 2019
Messages
26
Age
69
Gender
Male
Country
United States United States
Sorry, the regular gym activity was prior to TKR. I still go but concentrate on upper body only and only for 30 min a day. I’m taking your advice, since I joined this site I’ve cut back on any painful knee exercise and stopped PT for now, I think that’s why the swelling was down and the fluid was low. If the night pain and movement issues continue I was asking him to consider revision in 8 to 12 months. But I’m still not sold on him doing it.
 

Jockette

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Aug 29, 2017
Messages
16,477
Age
64
Location
Delaware
Gender
Female
Country
United States United States
I’m really glad to hear I misunderstood you regarding the gym.

I do think you need to give yourself a lot more time before thinking about a revision. I “only” had a partial, and my entire first year showed very slow progress. I saw much better improvement in ROM and function in my second year, and even more, now in my third. It took my particular leg that long to heal and relax from the trauma of the surgery.
 

kneeper

FORUM ADVISOR
Forum Advisor
Joined
Dec 11, 2010
Messages
12,558
Gender
Female
Country
United States United States
Sorry, the regular gym activity was prior to TKR. I still go but concentrate on upper body only and only for 30 min a day. I’m taking your advice, since I joined this site I’ve cut back on any painful knee exercise and stopped PT for now, I think that’s why the swelling was down and the fluid was low. If the night pain and movement issues continue I was asking him to consider revision in 8 to 12 months. But I’m still not sold on him doing it.
I'm glad to hear you cut down on the painful exercise. I found you don't have to do a lot of exercise--what I did was take the knee through its bend (heel slides)--maybe 3x a day for 5 repetitions--and try for the most you can get (but not pushing to the point of intense pain.) Lots of ice and elevation and a little walking.
It took me a good 6 weeks to get to 90 (with one long plateau) and then I continued to gain after I hit 90.

It seems early to expect to be without pain--are you talking pain with or without pain meds at night? Even after I was off the pain meds I was taking tylenol before bed. The activity of the day definitely catches up with you at night.
 

Jockette

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Aug 29, 2017
Messages
16,477
Age
64
Location
Delaware
Gender
Female
Country
United States United States
I took Tylenol for quite a while, also.
 
OP
OP
Gatorchief69

Gatorchief69

junior member
Joined
Dec 30, 2019
Messages
26
Age
69
Gender
Male
Country
United States United States
I’m very sensitive to pain medication and only took the opioids for the first 10 days. Than I took tramadol for PT appointments. It makes me nauseous and the other thing opioids do to people, so I don’t use them very much. I haven’t taken any tramadol for a week or so, I may try some tonight as the 2 hrs of sleep a night is making me so irritable and tired. I read a thread that recommended tramadol and Tylenol for night time so I’ll give it a try tonight. Hopefully you won’t see me online tomorrow morning at 2 or 3 am.
 

sistersinhim

MODERATOR
Moderator
Joined
Dec 4, 2015
Messages
20,082
Location
Virginia
Gender
Female
Country
United States United States
I agree that it's much too soon to even think about a revision. You need to give your knee at least a year to let it completely heal. Remember that having the MUA last month set your recovery back to almost the beginning. Those tissues that were knitting back together were pulled apart again and have to reheal. Gentle movements is what your poor knee needs for the next few months.

Sometimes I think an older surgeon is stuck in the old way of doing things. Younger OSs have adopted the Bonesmart thinking and realize that it takes time and gentle activities to better heal a joint replacement. Aggressive movements keeps the knee inflamed increasing swelling resulting less bend. It just takes time. Getting that swelling down, inside the knee and out, is the key!
 

Top Bottom