MUA 9 weeks post-op right TKR

ToKnee

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Hi. I've been lurking on the forums for quite some time, thanks for everyone's posts! I felt better prepared for the surgery and the recovery.

I am currently 9 weeks post-op of a right TKR. The knee was so arthritic that it hurt to walk, sitting caused it to freeze up, and going up and down the stairs was almost impossible. Really, not much different than now.

I was never able to get a great flexion, in part due to the hospital PT who, the first time I was getting out of bed, "dropped" my lower leg so there was a lot of flex that was painful. I am always guarding when the PT works on my knee now. At 6 weeks I was stuck at 58 degrees, not enough to sit comfortably, drive, or so much of anything. At the 6 week check-up with surgeon we agreed that an Manipulation Under Anesthesia was the next step, so I had that about 2 weeks ago. Post-MUA flexion was at 80 degrees, and I can push it to 90 and 100 with the CPM (which I had to fight for).
I am currently feeling like the surgery was a bust and I won't be able to gain the movement I want to do the things I want to do. I never thought I was such a baby about pain (I have played flag football with a sprained ankle, walked with a broken ankle and was playing tennis post-break. I even walked a 5k in January), but now I am crying every day at PT. I might not cry so much if I wasn't so frustrated and could swear a blue streak. I realize my feeling stuck and my depression is from the surgery, not sleeping, losing my independence for so long, etc.

1. Sitting with a 50 degree flexion, about 2. Sleeping is a 7-8, I am always waking up to shift to a position that will less painful for about 15 minutes. Flexing the knee beyond 80 is 8-9. My lower back shifts to try and absorb some of the movement (e.g. if I am sitting and trying to get the leg down, my right hip will lift off the table) so it is also getting sore (about a 4-5). I have some swelling in calf and thigh, still quite a bit in the knee. I also have a hematoma in the knee capsule from warfarin, this would bulge out and hit the lateral nerve in knee, causing pain and numbness up and down leg. This was about a 9. The hematoma seems to be getting better.

2. Oxy 5 (largely off this)
Norco

3. Greater than usual, not huge, knee is swollen. Foot tends to swell.

4. Flex 100 on a very good day. Extension -3

5. Icing when home. About 5 hours/day

6. I elevate for 15 minutes at a time, leg up against wall, about 2-3 times a day.

7. During the first week, I didn't do much. I did practice walking in Target and Costco which, in retrospect, was too much too early and just served to stiffen my knee. I also started to do yardwork and housework too early. I was doing some trim painting at 2 weeks and then some vacuuming, dusting, cooking, and washing dishes. At 4 weeks I was helping to build a raised garden bed, shoveling dirt, and planting. All too much, but standing and walking was less painful than sitting or bending. Of course all this did was keep my knee stiff. I was back at work (from home) at 2 weeks, gradually increasing hours. I work at a computer, so it is a lot of sitting.

8. See above for all the yardwork, etc. I do wall slides, and extension board about 1x day. Heel slides while sitting I do while I am at computer. My incision is all healed, and has been for a while, so I do some exercises in pool like kicking, squats on stairs, and extension. Most is just floating, though.
 
I will be 8 weeks on Thursday so not so far behind you @ToKnee. Reading about all your activities made me exhausted! I do very little - elevate and ice most of the day. Walk around to make snacks drinks etc and bathroom visits. Stack the dishwasher. Load the washing machine. Shower etc. Stand for maybe 15 mins at a time. Do about a minute on stationary bike - it still hurts!
The point is - I think you’re doing too much too soon. You have to allow your knee to heal inside and from what I’ve read on these pages the thing that’s stopping your ROM and causing pain and stiffness is the swelling. So I would say you need to ice and elevate more and cut right back on the exercise. I know how frustrating it is - I am also struggling with more pain than I anticipated! Good luck. I’m sure some senior members will be along soon with excellent advice.
 
I was thinking the same thing, too much activity for your baby knee. Rest, ice, elevate!
 
Hello @ToKnee and :welome:! You’ve probably see this reading list while lurking, but I will now give you your very own copy so you will have it handy in your own recovery thread. :)

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

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.
 
I’ll tag @Josephine because I see you’ve responded to her questions.

If you would give us the date of your right TKR, we will be happy to create a nifty signature for you. Having your surgery date in the signature line helps members comment with advice appropriate to your stage of recovery.

You really are doing too much with your new right knee. It’s communicating this in the only way it can (being a knee) by swelling and pain. If you can rest it, elevate it as you’ve read being talked about here, and ice it regularly, that will greatly help it to settle down and the swelling decrease. When the swelling decreases, you will feel less pain... and gain more bend. You will see progress.

Recovery from TKR takes a full year and sometimes longer. People feel much better and can do quite a lot before than, usually around the three month mark, but full healing takes months and months. There’s no way in the world to make your knee heal faster. You can’t push it through to the other side; it has to get there by itself. Every body, and every knee, heals at its own pace.

Just be patient with your new knee. Have you considered stopping PT for now? Give it a rest and see what it can do on its own. :)
 
Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control! This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living! Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new! You have to be patient, though, it doesn't happen quickly! ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you will have a quicker and less painful recovery. We know what works, we've been there!
 
The sitting can be as bad as standing and activity for making the knee swell and be stiff. If you're working from home is there a way you can elevate more? Work for an hour, elevate for an hour in rotation? Work half a day, elevate the other half? :scratch:

In a sense with the MUA you're not as far chronologically as it looks, because it retraumatizes the knee and it takes a bit of time to get that swelling down.
 
ToKnee, I appreciate you answering my questions but you have to do it properly please!

2. Oxy 5 (largely off this)
Norco
2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
3. Greater than usual, not huge, knee is swollen.
swelling.jpg


5. Icing when home. About 5 hours/day
5. are you icing your knee at all? If so, how often and for how long?
6. I elevate for 15 minutes at a time, leg up against wall, about 2-3 times a day.
6. are you elevating your leg. If so how often and for how long?
8. See above for all the yardwork, etc. I do wall slides, and extension board about 1x day. Heel slides while sitting I do while I am at computer. My incision is all healed, and has been for a while, so I do some exercises in pool like kicking, squats on stairs, and extension. Most is just floating, though.
8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)
 
Josephine, sorry for improper format. I copied from another post. I wasn't sure where the list of questions were!

Not doing anything is driving me nuts. I have been an active person, and my back, good leg and brain all feel stiff and sore from not doing things.

Work I must, at least 40 hours a week, as I have no more pto, and can't afford to work half time (my clients would be a little upset, too). Luckily I have the flexibility to take breaks, but being on my back for an hour at a time with leg raise is, well, hard to picture. I work on a laptop and have tried pillows, etc, to prop my head and position the computer so I can read the screen, type, and work the mouse, but nothings been successful. I would love to hear if someone has made it work.
Tonight me knee is telling me that I sat too long. So off to bed.

Thanks everyone.
 
Luckily I have the flexibility to take breaks, but being on my back for an hour at a time with leg raise is, well, hard to picture. I work on a laptop and have tried pillows, etc, to prop my head and position the computer so I can read the screen, type, and work the mouse, but nothing's been successful.
@ToKnee
You don't always have to lie down to elevate your leg. you can do it sitting up, as this photo shows:
elevate-3-jpg.58890

As long as you elevate your toes above your hips, your elevation will work well.
The picture is from this article, Elevation: the do's and dont's ,
which was in the post-op reading that SusieShoes left you.
 
I am currently feeling like the surgery was a bust and I won't be able to gain the movement I want to do the things I want to do.
It wasn't a bust. Yes you will. It's within your control; you have to arrange your life around recovery until healing is complete. Ice, elevation and gentle stretching exercises without pain are all you need
I also started to do yardwork and housework too early. I was doing some trim painting at 2 weeks and then some vacuuming, dusting, cooking, and washing dishes. At 4 weeks I was helping to build a raised garden bed, shoveling dirt, and planting. All too much
Don't. None of it. This is what's inhibiting healing.
Not doing anything is driving me nuts.
It's tough, but it's The Lesson in recovery. Less is more, working your post-op knee will harm rather than help it.
 
I work on a laptop and have tried pillows, etc, to prop my head and position the computer so I can read the screen, type, and work the mouse, but nothings been successful. I would love to hear if someone has made it work.

The picture Celle shows above is one way to do it. A recliner is another way. That's what I used in the early months (first five) of my recovery. I sat in my recliner, legs up with an added pillow or two (as felt best) underneath, and with my laptop on a lap desk. A table beside the recliner held necessary books, my Rolodex (call me old-fashioned), and phones. A snack tray on the other side held pills, beverage, snacks (for taking with the pills), cream for rubbing my knees, and the remote control.

I had a similar set up in my bedroom. The bed can elevate the head and foot, so I would elevate the head, prop legs on my foam wedge, use a lap desk, and off I would go. If your bed can't elevate the head, perhaps invest in one of those sit-up-in-bed pillows that has a firm back. Lying down really doesn't work well!
 
I'm still learning the ins and outs of the forum, so my apologies for not doing in message quotes, etc.

When I was first released I would sit using the chair and pillow arrangement as in the image. It worked well for a while. I then moved to a desk chair with recline option, working at table and my foot on table. Now I have the cpm and I am working on using that and working on laptop and elevating as a break.

Now I know all those things were a mistake. So when I replace the other knee (hopefully NOT) I will be a slug, and will prehab with more stretching than I did

Thanks for input. I feel better.
 
Not doing anything is driving me nuts.
You're not doing nothing - you are healing and getting better after a very major operation!
Josephine, sorry for improper format. I copied from another post. I wasn't sure where the list of questions were!
That's not a good idea. I sometimes edit them to personalise them for a particular member.
 
Have you any advice on restless leg. Had it now for 4 weeks so getting no sleep, up every hour just walking around.
I find my restless leg is linked with sugar, possibly yeast or wheat, tight it band, and a full bladder. If I cut back on sugar, don't drink beer, stretch, and empty my bladder, I keep it at bay.
 
I am 9 weeks in . I think you are doing too much as well. I came here from another forum that advocates much more exercise early. A lot of it didn't make sense to me so I guess I am in between. I do some exercises everyday but nothing painful. I am probably sitting at the computer and walking a bit too much - have walked a mile. I still have some swelling and not great flexion, 95 deg but my pain is less than yours - now. I would follow the cutting back advice above I think.
 
Update: it's almost 4 months post surgery and I've plateaued at abt 78 or so for my resting flexion, and I've lost a little in extension Pt said to take a break. Can't do a full revolution on the bike Sleep is still disrupted with pain

On the good side, I am able to walk without a huge limp or the cane.

I go in to see PA in a couple of days, and I know she will be on me for not getting more flexion. I am ready for another MUA. I have plane travel coming up and dread the thought of sitting in a cramped seat with my leg unable to bend.

Ugh
 
Well, I had another MUA on Sept 14. While each one has given me increased ROM, it is not near what I want. Still going to PT, with a complete shift in approach. No more brute force of bending, now it is massage to loosen muscles and stretching.
2 days ago I got the news that I have significant scarring and a possible heterotopic ossification on the femur. Surgeon is saying that I will probably need a revision and surgical removal of scar tissue and bony growths. I knew something was up that was keeping my knee swollen and unable to get past 90 degrees.

Not a particularly happy camper, as NSAIDs, one of the additional tx for ossification, was causing kidney problems before the original surgery.

I have read that ossification following TKR with symptoms is rare, has anyone else on the boards had this happen?
 
I'm sorry to hear that you need a revision.

Please plan to take more time off work after the revision, and to be less active for the first 3 months.

Try not to think of resting as "lying around, doing nothing." Instead, think of it as working hard, to give your knee the best possible chance of healing well.
In other words, when you are icing and elevating and watching TV, you are not 'lazing around' - you are "engaging in a carefully considered, proactively designed, heuristically programmed, dynamically structured recovery programme".
 

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