after knee replacement manipulation

[justjuls]

I am scared to death. I am a 39 yr old female who had a TKR 08/28/08. I am not in pain persay but I do not have any function of my leg. I can't straighten it and I can't bend it. I was using home therapy until last week which is where I place a majority of the blame. I now go to therapy at the local hospital but the therapist think I may be past that point.

So, today after yet another emotional breakdown I called the doctor and he actually called me back and advised that he thinks I need manipulation. He said to make an appointment in the morning and we'd go over it when I saw him, but someone please tell me what to expect, I mean as far as the total thing, how do they manipulate with out tearing the muscles?

I know he said I'd be put to sleep but, will this be as painful as the replacement? What happens after the manipulation? Will I go to a rehab facility or go home? I am really sick to my stomach about this entire process and can not say at this point I'd recommend it to anyone.

Help me please! I'm scared to death

 

[Linda2]

I'm not an expert on manipulation, but I do know there is no muscle ripping involved. What he will do is break up the scar tissue that is healing in a way that restricts your range of movement. There are threads on manipulation on this site--and most people have been much helped by their manipulations. I will let them answer you more completely--and Jo of course will tell you all about it. Good luck and let us know how things are going. I will send thoughts and prayers your way.

 

[Josephine]

As Linda says, it's the scar tissue - or more properly, adhesions - that get broken up. The surgeon will only put your knee through a perfectly normal range of motions, just like you do in your PT - but he applies some pressure to the flexion to make it go back to a good angle. It's sounds an awful lot worse than it really is, so please don't fret on that score.You'll read some posts about the danger of fracture but believe me when I tell you that the surgeon has the skill and expertise to know how much is enough and how much is too much. I've seen hundreds of MUAs (manipulation under anaesthetic) done in my time and NEVER seen a fracture occurr. Not once!

Now, as for the aftermath, that varies a bit. Most people have some pain in the first 24hrs but nothing some pain meds and icing can't handle. Nothing near as bad as the TKR itself. A very few have pain a day or two longer but not many. After that, it's back to the PT to make the most of your new 'freedom'! Often before you even leave hospital. One or two have been sent home with a CPM (continuous passive motion) machine to use.

As for why does this happen, I have explained that elsewhere but since you are new to the forum and doubtless don't know how to do a search, I'll explain it again ...

All the structures in the body, muscles, tendons, ligaments, even gut and lungs, need to be able to glide over one another smoothly to let our bodies work. To do this, the body produces a special viscous fluid that acts like the oil in your car engine and lubricates everything with great efficiency.

Now when the surgeon opens up any part of our body, the internal stuff gets exposed to the air which is, by comparison to the body, cool and dry. The natural reaction is that the fluids evaporate and the tissues cool. This can make the organs and structures dry so when the wound is closed, part of the healing process is for the body to go into overdrive, producing extra fluid to replace what is lost. This is one reason why you need IV fluids during and after an operation.

Now as a general rule, 95% of people manage to make up this fluid loss and normality is restored quite quickly. But in the other 5%, for a variety of reasons some known, a lot unknown, their bodies are deficient in making up this loss and lacking the necessary lubrication, the ligaments and muscles lose their 'glide-ability' and beging to stick to one another. This is called adhesions. If this happens and the function of the joint is affected, the answer is to work the joint with some force, thereby freeing the structures from their locked-in state. Much as you would if you got a sticky or rusty lock and put some oil in it, you'd work it back and forth to free it up. That's all a manipulation is.

Don't be fearful (if you can!) but look forward to a new oppotunity to get your function and ROM back in full again.

Let us know how you get on, ok?

 

[Nursepair]

Welcome Justjuls. Don't be scared, it isn't as bad as you fear. I was also petrified, more nervous than when I went in for the TKR. I had my MUA (July 7th) done with an epidural so was awake. My OS came in and spoke to me all the way through it. He just lifted my leg and started to bend it up. It was amazing, I heard the scar tissue tearing like velco but didn't feel it of course. He got ot to 120 ROM while I was numb. After the epidual wore off it wasn't that painful. I used my meds to control pian. More achy than painful really. I went to physio the next morning. Got it to 97 (93 when I went in for MUA). I have gradually got it to 107, I am at 9 months now. So it has been slow for me but it can take 12-18 months sometimes.

Hang in there and try to relax. It really isn't as bad as you think. Keep us posted.
((((((HUGS))))))) Sue

 

[justjuls]

Thanks to all of you for your answers. I just came from PT and they too tried to calm my nerves by telling me that it is a good thing. However, I still very scared.

I had my TKR on 08/28 and was in the hospital Labor Day Weekend, while I was in the Orthopedic Wing, I was cared for by staff that normally works in other departments and had volunteered to work the holiday weekend. So I do feel cheated because, I was only put into the CPM machine twice during the 4 day stay and each time was only for about an hour. The day after surgery I was put on a morphine pump so that I could handle the pain of the CPM but never was put on the CPM. So, although I felt no pain, I also gained absolutley nothing. Another thing that hindered me was that I had some serious ankle pain after surgery. My doctor says it is tendonitis from where he put the knee in. So the home healthcare therapist felt they should back off the standard therapy and let the ankle heal. Which in the end I think has cost me once again.

Thanks again for listening. I try not to vent at home, my husband is disabled and doing the best he can, me being upset has only upset him more and scares my kids. So it is great that I found a place to dump

 

[Josephine]

Indeed it is and that is exactly what we are here for!

Can you tell me, though - what exactly is it that is scaring you so? Perhaps if you would share that with us we can try and put your mind at rest.

Is it the possibility of failure? Another complication? The anaesthetic? The pain? Maybe something I (we) haven't addressed.

 

[janet2008]

Hi Justjuls, dont be sreared i just had this done and i to was sceared to death but im glad i had it done i now got 104*rom and was stuck at 95* so you will be fine. and it sounds wers than it is so hang in there ok.

 

[justjuls]

more pain and the fear of being stuck with the "step drag" thing I have goin on now. I am a sissy when it comes to pain. I am just afraid this will lead to another surgery and another, if that makes sense.

 

[janet2008]

Yea me to i have no pain leval ether but you no thay dont open your leg again thay just bend it because we gat scrar tussie stuck in it and i havent had to use many pain meds only 3 so dont be sreared we need to live a good fulfilling life and i know i could not the way my knee was keep the faith you will do good ok!

 

[justjuls]

Thank you all so much. Now I want this done like tomorrow! Did you all stay in the hospital or was it out patient?

 

[Nursepair]

I was out as soon as my numbness wore off. I walked from the car to my house with my cane. Good luck

 

[Josephine]

Day case. In and out the same day.

 

[schoust]

Hello Just Jules,
I just noticed your post and I just wanted to wish you the best of luck from a one of the Mini club! I will also be getting the very same treatment in a week or so and I can tell you this I am real worried! I'm worried about what the results might be not the pain of the procedure,heck I have been there already and it can't get much worse than what I have already experienced! My biggest concern is the Doc wanting things to be perfect and I have already told him or should I say reminded him that my Rom has been limited for the last 24 years and the leg and knee has served me very well! All I need to get is another 20% and I will be happy as a Lark! And then some!!! The procedure that I will be undergoing has a epidural involved which has me thinking the the old Doc has a bit more Rom in mind for me?????
Keep me posted to how you did I hope you do well and good luck!
Ralph

 

[Josephine]

Epidural or general - still the same procedure and same objectives. Doesn't alter anything, Ralph. Don't worry about that.

 

[justjuls]

I know that when I had my surgery I was given a spinal and a mac. I had an epidural during labor/delivery of my daughter and it didn't work. So my doc decided he would go with the other. I am not sure what he'll use this time. I go this afternoon to discuss the details with him. I'll keep ya'll posted!


Juls

 

[Josephine]

A mac? Not heard of that!

One thing to be assured of - an epidural doesn't work it's not to do with you it's to do with the doctor's 'expertise'! (or lack thereof!

 

[Nursepair]

Yeah, mine didn't work when I had my third baby, oooooooooowwwwwwwwwwww!! It worked with my RTKR though, really well zzzzzzzzzzzz, awake, zzzzzzzzzzz, awake, chatting, zzzzzzzzzz, awake............!!

 

[justjuls]

My manipulation is tomorrow 10/08/08 so I guess I will be talking to you all in a few days. Thanks so much for your support!

juls

 

[RickB]

Juis,

Good luck to you tomorrow, I hope everything turns out great! We all will be thinking of you.

God Bless,
Rick

 

[schoust]

Hi Jul's I hope it's not to late for me to say good luck and I will remember you in my prayers tonight. I can't wait to see how things work out for you! I will say this I have been thinking about this procedure Day and Night since I saw the Doc and I can only say that I am more worried now than the day of the tkr surgery.... Please keep us posted Jul's and as soon as you are able post up about your experiance....Good luck..... R.S.