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MUA 8 weeks and still not sleeping. ☹️

Just got back from a walk and the tight band across the front seems to be inhibiting my normal gate as well as the ROM. I remember the OS telling me that my right knee was replaced by a Smith and Nephew Genesis ll tibia implant with a Legion femur I think. I didn’t know anything about implant parts. Any way he mentioned something about shaving 1 or 2 cm of the tibia base if he did a revision to give the knee more room. The more I think about it, the more it sounds like the knee he put in is too big, but I’m not a surgeon so I’m just asking questions. I’ve been taking it very easy to keep the swelling down, but I noticed after the walk it swells a little and gets warmer. I guess the question to ask is should I limit any activity that causes swelling until it doesn’t swell anymore, but if the implant is too big, won’t it swell up all the time with activity anyway?
 
At your stage of early recovery swelling is going to happen with most activities. This is normal. It takes a long time for things to settle down. Walking is very good for you, maybe take a shorter walk next time. Ice and elevate when you get back.

Please try to put revision out of your mind. Many issues in the early months are normal happenings in this recovery and resolve themselves as time goes on. I like to quote Josephine, our Nurse Director, who likes to advise, “allow your knee the privilege of sorting itself out.”

If you need a revision, much later on, it will be addressed then. But right now you are causing yourself a lot of stress. Your knee doesn’t feel right, at the moment, because it has been surgically assaulted and it’s naturally upset, with a lot of normal swelling. That swelling feels very tight. It’s the nature of this recovery at this stage and we all felt it.

I know patience is very hard, but it’s what we all need most in this recovery.
 
I read this that one of our other advisors wrote:

“Many members think PT is needed to alleviate tightness. Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.”
 
@Gatorchief69 I hit the 4 month mark on Friday, January 3, 2020. I still have moments after activity with swelling or tightness, I rest ice and elevate and feel better within a very short period of time (like 45-60 minutes). This recovery is one year, as you've heard often on Bone Smart....I'm just 1/3 of the way through this... You are not even 4 weeks beyond an MUA.

I'd ask you first, are you sure your implant was too large? We all tend to overthink this recovery and each set back as something more permanent.... a warmer knee and swelling will be with you for quite sometime and really just means you're still healing. My PT mentioned to me that she has patients who are still icing as they approach one year and this is very normal. I was worried about over-icing!

I agree with @Jockette, you can be very slow and gentle about this recovery. Patience is the key and it is hard for all of us at this point. I honestly saw pretty rapid improvement, hit quite a stall when I returned to work full time and now am see a small recovery. I did cut way back on activity over the holidays and plan to move my activity up very slowly. We will all get there! Please hang in there and be kind to yourself!
 
I’m curious as to why when I sit over 30 minutes at a time, I experience real intense pain in my knee when I get up, but laying in bed all night and only a stiffness the resolves after a few steps. The MUA setting me back to the beginning of recovery again?
 
It does set you back for sure. Do you have the pain after you get to standing? It's putting force through damaged tissue that causes the pain, and standing up certainly puts force through!
 
Yes , for almost a minute while walking it out. When getting up from the bed it’s 2 or 3 steps and back to the normal 4-5 pain. Difference in thigh stress?
 
4 months post op, 2 months post MUA here.

As others have said, and my own experience, it takes time!

Ice, elevate, keep moving with normal activities, ice when not moving, stretch gently.

I found the tight band would be there at beginning of walk, go away when warmed up, then come back, telling me I over did it.

We don't heal on "our" schedule for sure! That knee is in charge!

:good-bad:
 
Gatorchief69 said:
The MUA setting me back to the beginning of recovery again?
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Unfortunately, it does, especially with a knee as young as yours was when you had it. Those tissues that were cut during your surgery were just starting to heal. Suddenly, they were stretched and pulled on again. Some of them were probably pulled apart. All these poor baby tissues have to begin to heal again. The best thing you can do is to be very gentle with your knee. Are you elevating while sitting? How about icing? Are you doing that everytime you are down? That will help with the pain.
 
@Gatorchief69 Hello there I too cant sleep comfortable. Im on my 2 month and still having a hard time some nights. I tell you,what has helped me. I bought a wedge pillow and its super comfortable for my back. I dont sleep with that awful uncomfortable wedge between the legs I substituted it for a regular pillow. How about you? Are you still sleeping with that wedge they give you at the hospital.You may want to try checking that wedge pillow. I got mine in amazon. Let me know. I hope you can find a comfortable position and that you will be able to recover your sleep. Sweet Dreams!!
 
Thank you for the response, I did not get a wedge pillow in the hospital so I just use regular pillows between the legs until they start aching enough for me to turn to my other side and reinsert the pillows again and try to rest until the pain forces me to move again. I do have 8 pillows that I can use with different configurations for some temporary relief, but it’s never for more than 2 hours and generally 8 hours in between them. After 9 weeks it’s been vary taxing on me.
 
I’ve been icing and elevating 5-6 times a day and every night when going to bed. It does help but not quite enough to stop me from waking.
 
Has anyone looked at or tried the X10 knee recovery system? They are advertising great results in avoiding the MUA treatment. I looked at it, and they’re approach was interesting and somewhat logical. The cost without being insurance approved was high, but avoiding the start over in recovery is tempting.
 
Gatorchief69 said:
Any way he mentioned something about shaving 1 or 2 cm of the tibia base if he did a revision to give the knee more room. The more I think about it, the more it sounds like the knee he put in is too big, but I’m not a surgeon so I’m just asking questions. I’ve been taking it very easy to keep the swelling down, but I noticed after the walk it swells a little and gets warmer.
Click to expand...

Being a victim of aggressive PT, I could barely walk and was in extreme pain for days following the 2x a week sessions. I quit PT at 4 weeks. I started on my own by walking short distances to a bench, sitting down, and then walking back. Now I can walk 2 miles a couple of times a week, but not every day so hang in there.

i read your post several times and am shocked you had a MUA and so soon.
Now your OS is talking about a revision that includes shaving off a couple of cm of your tibia. Rave reviews or not, I would get a second and maybe a third opinion if you are even thinking about this.

Welcome to Bonesmart. There is a lot of information here. Marty
 
It’s 2 am, my knee and right glutinous Maximus just woke me up. I went to sleep around 10:30 so 3 and a half hours is some improvement in sleep length I guess. Ice and elevation now, knee feels better, hip hurts more I think from the elevation. 33 days since MUA I don’t know what is more important, a little more sleep, or less pain while walking. Before the MUA I could walk a mile with a 3-4 pain level. Now it’s around the block and it’s a 5-6 at the end with swelling and stiffness at end. Is this from MUA setback or deterioration in the knee? Just walking now with a few knee exercise during the day trying to rest the knee and keep swelling down. The swelling has gone down noticeably and the ROM has not increased any at all. The knee is so stiff after about 87, it doesn’t hurt significantly more try to bend it more, it just doesn’t move. I must say the knee looks too big for my leg! Many people with TKR comment on how big it looks. My OS still has not released my surgical notes so I’m still guessing.
 
Gatorchief69 said:
Is this from MUA setback or deterioration in the knee?
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The implant will be as it was, it's hard to damage it. The setback is reaction in your soft tissue.
Gatorchief69 said:
My OS still has not released my surgical notes so I’m still guessing.
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It seems reasonable to me that he should tell you whether MUA freed up adhesions or not.

Please, don't do anything that causes pain or swelling. Your recovery, unfortunately, must be considered as starting the day after MUA.
 
Been resting my knee all week, I tried to do some bending today. I don’t have a knee compass but I didn’t have much ROM starting out, I’d say 64. After a few bends Igor close to 85, but it seems to stop there again. The ligaments in the back of my leg are are still very tight and sometimes make a snapping sound while doing knee bends. The pain is about a 5-6 when it snaps. It seems to be swelled up some, But the ice and elevation isn’t making it go down. Any thoughts on this?
 
Are you elevating toes above nose? You can ice the whole time you're down as long as you have a cloth between your knee and the ice pack, you can ice all day and all night if you want to. I had an ice machine that circulated ice cold water. It stayed cold for about 4 hours. I'd get up and walk a bit and then hook it right back up when I sat back down. Once it started to warm up, my knee would start to ache again. I found ice to be a great pain reducer.
 
I-am now wondering if my new knee is too big for me. It is so tight at the bend of my knee that I don’t think there is enough room for me to bend it beyond 85 with out extreme pressure or pain when that is applied. At 85 the stiffness across my knee is extremely tight. I can’t make it go anymore pulling or having my wife push on it too either. The swelling is minimal at this point , so why is there no gain in ROM ?
 
Gatorchief69 said:
The swelling is minimal at this point , so why is there no gain in ROM ?
Click to expand...
On the contrary - swelling is what is preventing that knee from bending. Keep icing and stop pushing that knee. You will gain ROM with time.
 
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