TKR Almost 5 months post op….struggling, frustrated and worried

[WillB]

Hi everyone, this is my first post and I hope I’m doing this correctly. I had a total replacement of my right knee on 3/15/2023. I’m 53 years old. My recovery has been slow & painful but nothing that seems to be out of the ordinary. My last PT visit 5 days ago, he measured me at 100 flex upon arrival and then forcibly pushed me to 112 by the end. I was almost in tears. The next day I could hardly walk let alone do my home exercises and that’s been the case since. I’m back using a cane and taking oxy. So swollen no matter how much icing/elevating I’m doing. I’m upset because I feel like this will set me back and it just feels so counterproductive. I’m generally a happy positive person but this has me feeling really low and like I’m never going to get my life back :(. I don’t know where to go from here and I appreciate any advice your group has for me.

Thank you,
Christie

You control how your PT sessions go. Do not let them place you into anything other than a mild discomfort. Your ROM numbers will improve over time with normal activities.

Thank you. It sounds silly but I honestly thought I had no choice in what the PT did to me. Thanks to this group I am going to advocate for myself - discomfort ok pain not ok! And certainly not to the point of tears just to gain a few degrees. And honestly, is it really an accurate reflection of flexion when I can only achieve it w/ a grown man pushing down on my knee and me needing 10mg of oxy just to get through it?? How is your recovery going?

Agressive PT is totally uncalled for. My numbers are ok…not perfect at 17 weeks but good enough for now. I’ve developed a significant nerve issue in my L4/L5 spinal area which is really affecting my continued improvement. Will need back surgery…all the best with your recovery

 

[EalingGran]

Agree with @WillB. Aggressive PT is totally unnecessary and may well be counterproductive.
I have great ROM ( 145 flexion) and have never done anything that caused real pain.
I have used pilates for my recovery and my teacher's motto is
Listen to your body. Any sharp or shooting pains back right off.

 

[kneeper]

Oh wow, that’s amazing! I can only dream of the day that I’m not thinking about this knee every waking minute. Thanks for giving me hope!

True, you know you are recovering as the time you spend thinking about the knee goes down and then you start to forget about it being a replaced joint.

I found PT helpful--I liked the guidance and also the monitoring of my progress. But I also had a good PT (especially with my second knee) that treated you as an individual and never forced anything.

 

[Christie b]

Hi all. Feeling rather discouraged at 10 weeks post op. After that setback w/ my PT at 7 weeks I’m still not back to where I was. I was at 112 flexion and now only at 95. My surgeon says if I don’t start progressing in the next couple of weeks that I’ll need a MUA. My knee is so stiff it’s like cement and it makes doing any of the exercises so hard so I’ve been focusing on walking, doing things around the house/yard, and icing/elevating several times a day. It just doesn’t want to budge. How do I know if I truly need a MUA or if I just need more time? Thank you.

 

[Jockette]

How do I know if I truly need a MUA or if I just need more time?

We don’t know, but, we do know that 10 weeks, in this 52 week (one year on average) recovery, is still early.

Your knee proved it could bend to 112. The injury you sustained only 3 weeks ago, so early in recovery, can take a long time to recover.

I was 4 months post op, when I went away for a weekend. Too many stairs, and using a too low toilet, for several days, drastically sabotaged my recovery. It took a month to even begin to get my ROM back. Then, at that point, my son got married and I had another weekend of overdoing, and I was back to square one, again. I had a limited ROM the next few months.

MUA was never a consideration for me.

After a slow first year, my ROM improved quite a lot in my second year, as my whole leg continued to relax and heal.

MUAs can be beneficial, IF you have true adhesions. If your bend is less due to swelling from an injury, the MUA might only add insult to injury, literally and figuratively.

95 is still a decent number, after all you’ve been through.

Regaining our ROM (and also strength, and general healing) does not require forceful bending or painful exercises. That is counterproductive.

Regaining our ROM is more about Time than repetitions of a list of exercises.

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.

 

[Layla]

Hello Christie,

My surgeon says if I don’t start progressing in the next couple of weeks that I’ll need a MUA.

Please know that he can not force you into MUA. So try to keep that idea in the back of your mind for now. I do recall our Nurse Emeritus saying that it can take many weeks to recover from some of the injuries we suffer from early on. I think you're doing all the right things through walking and the activities of daily living coupled with rest, ice and elevation. Hopefully you gradually see it paying off over the next several weeks.
I hope you have a nice Memorial weekend, Christie! Please stay in touch.

 

[Christie b]

How do I know if I truly need a MUA or if I just need more time?

We don’t know, but, we do know that 10 weeks, in this 52 week (one year on average) recovery, is still early.

Your knee proved it could bend to 112. The injury you sustained only 3 weeks ago, so early in recovery, can take a long time to recover.

I was 4 months post op, when I went away for a weekend. Too many stairs, and using a too low toilet, for several days, drastically sabotaged my recovery. It took a month to even begin to get my ROM back. Then, at that point, my son got married and I had another weekend of overdoing, and I was back to square one, again. I had a limited ROM the next few months.

MUA was never a consideration for me.

After a slow first year, my ROM improved quite a lot in my second year, as my whole leg continued to relax and heal.

MUAs can be beneficial, IF you have true adhesions. If your bend is less due to swelling from an injury, the MUA might only add insult to injury, literally and figuratively.

95 is still a decent number, after all you’ve been through.

Regaining our ROM (and also strength, and general healing) does not require forceful bending or painful exercises. That is counterproductive.

Regaining our ROM is more about Time than repetitions of a list of exercises.

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.

Hi and thank you so much for your response. You don’t know how badly I needed to hear this. I really, really don’t want the MUA because it sounds like I’d be starting all over with the pain, swelling, etc. Plus they want you to go to PT every day for 2 weeks after which sounds awful. Also I don’t want to start taking the Oxy again, I don’t like how it made me feel and I slept poorly while on it. Right now I’m taking Celebrex 2x/day and ES Tylenol 2x/day w/ Tylenol PM at night and I’m tolerating that med regimen well.

From reading about the MUA it sounds like only a small percentage of TKR actually have adhesions and need it but yet the MUA seems to be done a lot more frequently. Is there no way for them to tell if we actually have adhesions?

Thank you again for your time.

Christie

 

[Christie b]

Hello Christie,

My surgeon says if I don’t start progressing in the next couple of weeks that I’ll need a MUA.

Please know that he can not force you into MUA. So try to keep that idea in the back of your mind for now. I do recall our Nurse Emeritus saying that it can take many weeks to recover from some of the injuries we suffer from early on. I think you're doing all the right things through walking and the activities of daily living coupled with rest, ice and elevation. Hopefully you gradually see it paying off over the next several weeks.
I hope you have a nice Memorial weekend, Christie! Please stay in touch.

Thank you, Layla. Hopefully I’ll start progressing soon and he won’t try to push me into the MUA. My swelling has gone down but it’s still hard to bend. Like my knee is made of concrete. I’m trying everything I can to get my tight quad muscles to loosen up (massage, cupping, roller thing) in the hopes that will help my bend. If you or anyone can think of anything else, I’m open to trying just about anything.

Thanks again and I hope you have a nice Memorial weekend as well,
Christie

 

[Layla]

You're welcome, Christie.
I am going tag my colleague @Pumpkin and see if she has any ideas for gentle stretches you can try.
Also, consider doing on online search by typing in key words like "exercises / stretches to help loosen tight quads". You will find videos, or diagrams showing the exercise, through that you can decide if it's something you're comfortable attempting. Best of luck to you!
@Christie b

 

[Christie b]

Thank you, Layla. That’s a great idea to research tight quad stretches online. I’ll do that today. I‘ll do anything to avoid the MUA!

 

[Christie b]

You're welcome, Christie.
I am going tag my colleague @Pumpkin and see if she has any ideas for gentle stretches you can try.
Also, consider doing on online search by typing in key words like "exercises / stretches to help loosen tight quads". You will find videos, or diagrams showing the exercise, through that you can decide if it's something you're comfortable attempting. Best of luck to you!
@Christie b

i just realized when I typed my response it looks like I responded to myself lol. In order to respond to another person’s note do I hit the tab that says quote? I’m not super computer savvy, my apologies!

 

[Christie b]

@Jockette Thank you again for your response last night. I clicked on your story and read through your 1st year check up. We are alike in a lot of ways - overthinking & worrying about everything especially. I also regret my surgery and feel like I agreed to it prematurely. Yes, I was in pain but I was still able to walk my dogs 1-2 miles, go to Costco/Target/grocery store, work in my yard for a few hours at a time, etc. I can’t do any of that now. Yes, I’m only 10 weeks post op so I’m certainly not giving up hope and I know I have a long road of recovery ahead but it’s so frustrating to not be able to bend much. I wish there was a way to know if a MUA was really necessary. This is all so hard and depressing, I just want my life back.

How are you doing now? I know your surgery was in 2017 and I’m assuming you never had a revision since it’s not listed below your signature. Did you ever get to the point that you didn’t regret your surgery?

Thanks again. I’m grateful that I stumbled upon Bonesmart as the common sense approach is making a lot more sense to me than the traditional PT/No pain no gain approach.

I hope that you are doing well and that you are still enjoying bowling & life in general.

Christie

 

[Layla]

You're doing it correctly, Christie.
If you want to respond to someone, you can simply tag them, or if you want to respond to something in particular you can use the Quote feature by highlighting whatever it is you want to respond to and then choose
"Quote this Message" You may find it easier to simply tag as you have with the -> @ in front of their name and that way they will receive your message.
How to use the quote feature
Tagging other members and answering tags
How To Use This Forum
I hope the helps!
@Christie b

 

[Jockette]

How are you doing now? I know your surgery was in 2017 and I’m assuming you never had a revision since it’s not listed below your signature. Did you ever get to the point that you didn’t regret your surgery?

Thank you for your kind words. No, I never stopped regretting my surgery. I especially regret my lack of knowledge and trusting the first and only surgeon I saw at the time. It wasn’t until I found Bonesmart, after my surgery, that I learned so much more about knee replacements, especially partials, like mine.

While I have not had a good outcome, I am at a point where it’s manageable. I still have more limitations than I did before the surgery. I’ve had 3 second opinions, the most recent this past January, all in different locations, and none of them have offered any help.

But, like I said earlier, I did have a lot of improvement after that awful first year.

I know how you feel about how tight your leg is. I felt like that, too. At about 9 months post op I considered getting a massage to help, but due to the bad PT experiences I had, I just couldn’t bear to have anyone touch my leg.

One of our former staff members wrote the following, and it makes so much sense to me:

Stiffness/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 has been disturbed and is healing...and full healing takes a full year or more.

Try to relax. You really are still very early in the healing process. Things will improve, but it will take more time than you want, but it will happen.

 

[Jockette]

This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."

It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)
So, if a OS or PT bullies you into thinking your ROM will not improve over time they are wrong. By the way, I haven't been back to see the OS since that horrible appointment at 6 weeks, but I sure am going back when I reach 120 just to say, "Ha! You were wrong, BoneSmart was right!" “

And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. “

 

[Christie b]

@Jockette I’m so sorry to hear that you still regret your surgery and that sucks that none of your 2nd opinions have offered any help. But I’m glad things aren’t as bad as that awful first year. That’s so nice of you to stick around this forum to help people like me that are right in the thick of it. I have my pity party days where I feel sorry for myself and wish I hadn't had the surgery but then most days I realize I can‘t look back and I need to try to do everything I can to try help my situation. I just wish I knew what to do. Like Dory says I guess I have to just keep swimming!

 

[Christie b]

This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."

It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)
So, if a OS or PT bullies you into thinking your ROM will not improve over time they are wrong. By the way, I haven't been back to see the OS since that horrible appointment at 6 weeks, but I sure am going back when I reach 120 just to say, "Ha! You were wrong, BoneSmart was right!" “

And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. “

Wow - this is amazing!! So happy for her! I’m exactly where she was at 10 weeks, 95. I just wish there was a way to tell if my problem is adhesions or not. Do you know how long I can wait on the MUA? Aren’t they more likely to be successful if done early on? I know ultimately it’s my knee and my choice but I do trust my surgeon and I’d have a hard time saying no if he strongly felt it was necessary. I just don’t feel like I’ll be able to make that decision in 2 weeks. Thank you again

 

[Christie b]

You're doing it correctly, Christie.
If you want to respond to someone, you can simply tag them, or if you want to respond to something in particular you can use the Quote feature by highlighting whatever it is you want to respond to and then choose
"Quote this Message" You may find it easier to simply tag as you have with the -> @ in front of their name and that way they will receive your message.
How to use the quote feature
Tagging other members and answering tags
How To Use This Forum
I hope the helps!
@Christie b

Thanks, Layla! Very helpful

 

[Layla]

Hi Christie,
I am not sure if you've read any of the following or not, but I'm leaving several articles on MUA from the BoneSmart Library.

Also, if interested, Type MUA into the SEARCH at the top right of the page and any threads where it's been mentioned will pop up.

MUA (Manipulation under Anaesthetic) and Adhesions
MUA for Stiffness Following TKR
MUA: the ineffectiveness of early MUA (JBJS)
MUA: Who is more likely to need an MUA after TKR?

Have a great week!
@Christie b

 

[Christie b]

@Layla Thank you so much for posting those links! I’m kinda driving myself crazy thinking about the MUA. If what I’m reading is correct then only around 5% of all knee replacements actually develop the adhesions which makes the MUA necessary - yet it seems it’s performed WAY more than that which ends up causing more pain/swelling for so many people. I just wish there was a way to tell if someone actually has the adhesions prior to doing the MUA. I’m off to read those articles you posted, thanks again! Christie