TKR Am not dead!

[KathyH]

Ms.fixit I had my MUA at three months and couldn't get more than 70 degrees ROM. During the MUA they bent my knee 90 degrees. Only out for about ten minutes. Wasn't in stabbing pain when I came round, but it ached awfully. After medication that went. My surgon visited me quickly and mentioned the possibility of a second MUA I stayed in hospital overnight and kept the CPM machine going all night. Didn't think I would sleep with it, but I did - even found it therapeutic, wishing I could take the machine home

After a couple of days the knee went extremely stiff, so didn't push the exercises. Thought this would put me back. Started having physio two times a week - not hard physio though.

Yesterday at physio I got to 95 - my best ever. Slow baby steps, but progress still. Have been walking with a limp since the TKR (though everyone says not as bad as before the op). I feel now even that is starting to improve. PATIENCE PATIENCE PATIENCE

I sure am happy I had the MUA and would have had a second one without any doubt if needed, but I doubt that will be necessary now. See what the surgeon says on my next visit in July (six months after the MUA).

 

[Ms.fixit]

Thank you, everyone who has responded!! Man, I'm grateful to have found this site!
Right now I am leaning in favor of NOT doing MUA. It just feels too much like this is something they automatically do to people at the 6 to 12 week mark, if the patient isn't progressing according to their established timeline template. It also smacks of a fear of litigation being the underlying reason, more than stellar outcomes. That way they can say they tried everything if there is an ensuing lawsuit.
When I had my first surgery in 1971 I only had about 45 degrees flexion at the end of PT. I left for college and took over on my own; I would hang a huge old fashioned bonnet style hair dryer from my ankle, hook my leg over the footboard of my bed and let the weight gradually stretch the knee. I ended up with about 130 ROM that way and it took me a good 5 months to get there, but I did!
My feeling now is that I'll do a very expensive 10 weeks in PT, and then hopefully never see these people again. When I extend fully, the new joint feels amazing! My legs are the same length at last! It's very exciting for me, even if it still hurts like a mother..just to stand with my weight on it and feel it straighten and support me..I can hardly believe it.
Hey, if people can stretch their ear lobes over time to accomodate those enormous "plugs" the size of quarters, I can stretch out some old fibrous tissue given enough time and persistence.

 

[60mom]

If I could do it over again I would not have the MUA, at least not at 5 wks when I did. They got me to 122 in PT a few hours after the MUA. But I had a lot of pain. The next day swelling and right back to 90 degrees. It has been 1 1/2 wks since the MUA and my knee is just now quieting down. Still have more swelling then before and in different places then right after my TKR. I fired my PT and now go to the gym every day and work out my way. I do the bike, stretches on a ball I sit on, I do my leg lifts in the water, walk forward, backward and side to side, stretches and bending all in the water. Then I let the jets message my whole leg. Yesterday I was able to walk down the stairs normally. When I bend on the stairs I know it is more then 90 degrees so I am making progress all on my own without someone making my swelling worse and setting me back. Not saying MUA is bad just think it was way too early in my case and it set me back instead of helping. Also I was in more pain then after my TKR. The first day I was so excited 120 degrees but it lasted one day! At least I know I am capable of doing that but it will take time and effort on my part. I figure I am a turtle and not a rabbit but in the end they both get to the same place.

 

[bottomshollow]

by force doing an MUA!

60mom, this is an excellent post regarding MUA and why one should wait until at least 12 weeks to consider it. Your perspective is right on the money. It does frequently set people back in their recovery rather than helping them.

You are doing all the right things to increase your flexion---and you will get there. Once we relax and accept that recovery is going to take as long as it's going to take---things just seem to start falling into place.

Keep up the good work and keep us posted. We care.

 

[Ms.fixit]

THANK YOU, 60mom! You too, Bottomshollow.
It just makes sense to be more moderate about it. Today for example, I cancelled my PT. I was sore and stiff and swollen; I did 20 minutes on the bike yesterday and then had very painful tissue manipulation and heel slides, but with a strap under my foot, pulling the leg toward the butt. I had only done the bike twice before and only for 10 minutes, so it was a lot to jump to 20. (When I did bodybuilding, it was common knowledge that you get stronger on your non-training days, during your rest-interval, not during the session itself,so...)

If my pain had not been so poorly managed from the day the removed the nerve block post-op, maybe I'd be doing "better", maybe not, but what I do know is I've had it with pain and I am not subjecting myself to any more now that I have been healing so nicely. I don't care how anybody tries to scare me.

I also noted that the post MUA patients have PT every day for 2 weeks after, which we have already seen I cannot tolerate pain wise.
Again, I can't help but think there is a profit motive at work here. We determine that the patient isn't progressing fast enough.. book a quick little fifteen minute procedure, completely non surgical..two weeks PT, and bingo! Bill the Insurer for 3 or 4 grand, plus ten PT sessions. Not bad for 15 minutes work! And it covers their asses, too. It's a lot like how they treat new mothers here in the US.;if a pregnant woman is in labor for more than two minutes, they give her a nice lucrative C-section.

 

[referee54]

It is much too soon to think about that MU!

 

[Ms.fixit]

That's what I thought, thank you! I don't even want to consider it at 12 weeks..it just feels wrong for me,period.

 

[Suziepi]

Hi Ms Fixit,
I must admit that I am now feeling the benefit of having the MAU at 9 weeks. But we all have our unique ways of recovering. I was so stuff before the procedure in addition to the poor ROM. I believe that my OS was doing his best for my circumstances. A large proportion of my stiffness has gone although my ROM is poor.

The poor ROM is most probably due to the PT I had in the past and poor management of my rehab.

i have moved on to a good PT and I have seen her today. I will only need to see her once a week. As its her belief that most of the benefits are in the exercises and stretching that I am doing at home. Most of my session was in reviewing the stretching and exercises that I am doing at home. I feel I badly needed this review . I was able to increase my ROM to 80 and that was done by me doing the stretching. She also stressed that I also need to manage any pain.
I now feel even more optimistic in eventually getting to a ROM of 90 but it will still take time.

Looks like some patients that could be candidates for a MUA, can avoid it if they have a good stretching regime going in their rehab. Good luck with you rehab.
Suzie

 

[Ms.fixit]

Hi Suzie, and thank you for your nice note, and for sharing your experience with me.. I like your new therapist's outlook! I know that the first time I had knee surgery I made perfectly decent progress on my own just through sheer persistence. Once you learn the routine, why pay $45 a pop just to have someone count to five while you do it?
You have further bolstered my decision not to have MUA. I figure if I have 90 at the one month mark, I'm doing just fine and more ROM will come.

 

[Ms.fixit]

60Mom..when you said you were in more pain from MUA than from your original surgery, that made up my mind for me! I could not handle the pain as it was, and the thought of voluntarily putting myself through more seems insane. And those passive motion things do too, though my surgeon no longer uses them. Of course, he doesn't seem to believe in pain control either, so that's no indication of anything.
I am very glad I waited as long as I did to have this done..even with the so -called 'advances',it seems to me that this kind of procedure is still in it's adolescence.

 

[60mom]

Yes, I have been very surprised at the pain. I had been off pain meds for about 2 wks except for when I went to PT, prior to my MUA. Now I am back on it and have needed it twice a day but really need it every 4 hours. Could take it more often but I don't want to go through it as I doubt my OS will give me more. He is a bit stingy on them. He gave me Gabapentin but it caused me to have bad anxiety so I had to stop. He also gave me a free trial of Celebrex but I am out. It did help as my pain has been worse since I stopped. I need to call and see how much it costs as I think my insurance may not authorize it but I have a history of ulcers so that may be my only option. I am very frustrated that I still have pain and swelling that is not responding to elevation and ice.

 

[pdx]

OK, so my personal anecdote isn't scientific evidence, but here it goes: The best progress I've made came, and continues to come, via doing exercises in the pool. I'm lucky to live near a warm water therapy pool with lots of different classes -- I do the arthritis one, which includes a fair amount of "cycling". Many communities have pools that offer arthritis programs. Or just water-walking/jogging & cycling while supported by a noodle is great, as are side- and donkey kicks. My PT continues to be impressed, though I still do conventional (and boring) strengthening/straightening, too, to complement. (Not on top of; enough is enough.)
Sure hope you get more relief soon. Oh, on the swelling, PT said to keep doing ankle pumps and circles. So I do!

 

[Ms.fixit]

60Mom..something your Doc will give you without any fight is Methocarbomol (robaxin) the muscle relaxant. It really helps make the pain meds more effective, since it blocks pain signals between the muscle and the brain. Zero potential for abuse according to the literature. Check and see.

 

[Ms.fixit]

.....So today I went in like gangbusters to PT. I had a productive talk with my Therapist, too. I told him one of two things had to happen. Either the Doctor increases my meds to make me able to bear PT and push the way they encourage me to do, or we dial back on the intensity of the PT. I also told him I am not willing to do MUA no matter what the recommendation on the 14th.
To my surprise he said "you're going to be a winner" whether or not I have the procedure, and no matter how short a time I am in formal PT, because he knows I am disciplined about training and always have been. AND he eased up on the intensity of the session, which made a huge difference.

 

[bottomshollow]

Amazing what results we get when we stand up and act like the adult we are and put what we want and don't want honestly on the table.

 

[Dhare63]

Being your own advocate and taking control of your recovery is the best thing you can do. I'm pleased you are seeing the wisdom in our less is more approach. You cannot bend a swollen joint, just not possible. So control swelling, ice, elevate, etc, etc.

I had MUA at 3 months and it was not a big deal for me. The pain was more of an ache than sharp pain. Controlled by meds, it was quite manageable. Just wait it out; there is no magic timeline you need to follow.

Congrats and keep us posted. You will find sage advice from people who have literally walked in your moccasins!

Be well,

Dawn

 

[SAS]

Ms Fixit, I am three months post-op. when I left hospital my ROM was 50, I worked hard at the exercise four times a day, it went from 50 to 70, 70 to 80 and is now 95. I would love to get 100 or more, whether I do or not remains to be seen in the next few months. Just a little bit more would help so much with putting my panties on over my feet and tights and socks, so fingers crossed we can both improve. I did invest in a exercise bike and just use it for 10-15 minutes a day at the moment.

Good luck I am sure you are going to do well.

Sheila

 

[Ms.fixit]

I know, right? I think most people freeze in the headlights when a medical professional tells them they need this or that treatment. I'm certainly not recommending anyone go against medical advice simply to make a point, but if something suggested feels really wrong to you as a patient, I think it's important to listen to that.


Hello Sheila! Thanks very much for weighing in. The more people I meet who are progressing at their own pace the better I feel.

 

[deb57]

Hi guys. Here's a little more perspective. Had my RTKR May 17, 2012 and have had to work through a lot of pain for every degree of bend.
I started physio at two weeks only once a week while doing my exercises 3 times a day at home. I am in Canada so a different medical system to you in the US. Although the surgery is covered by public health care I only was allowed 7 free PT visits. Each one after costs $72.
I have seen my therapist once a month where he never pushed me hard. I was at about 90 degrees at 5 wks but only 95 degrees at 11 weeks. I pushed myself harder and 4 weeks later had achieved 107 then a month later 115. My knee always feels stiff despite this progress and I hit a wall at 6 months. I am now going for PT weekly and my therapist is using some short staccato movements to try and break through the adhesions. It's pretty painful. We have pushed it just beyond 125 but I can only stand it for about 10 seconds. With so much stiffness it seems like it's one step forward, two steps back! My knee flexion without a warmup is still less than 120. I guess I'm still better off than some but would like to be doing better. Thanks for the opportunity to post!

 

[Ms.fixit]

Hey Deb;I've noticed my PT person doing that staccato thing with me recently..I'm in my 5th week,btw. I thought I was well prepared for how difficult the surgery would be..and I was..but I underestimated the difficulty of PT.It's really helpful to read your timeline..I tend to push myself too hard and not let myself rest enough,so it's helpful to learn what is "normal" in this situation.