Bilateral TKR Anxious about upcoming MUA

[tina_cris007]

Hi, everyone! I've just joined this forum this month of July 2021. I have had Bilateral TKR on 17 April 2021 due to chronic osteoarthritis on both knees (44 years old from Sydney, Australia). I've had internal bleeding on my right knee a few days after the surgery on 2 different days which was excruciatingly painful for few hours non-stop. I've also been diagnosed with PE (clot) on my lung. My previous GP (general practitioner/doctor) would not prescribe any strong painkillers after seeing her a week after my discharge from the hospital (1 June 2021) as well as halved the dosage of my slow-release painkiller as she said I might get addicted to them if I keep taking painkillers. So, for the whole month of June after being discharged from the hospital, I was in pain 24/7 especially during PT and at-home exercise. So the flexion regressed from 70 degrees, it went down to just 60 degrees. I have found another GP who understands my situation and needs for a painkiller to help manage the pain during exercise. After being back to taking 1 painkiller tablet 30 minutes before exercise, my R knee flexion is now 72, while L knee is on 75. Extension on R is -2, L is 0.

Almost all PTs assigned to me while I was an in-patient in the hospital after the surgery has pushed me to force my knees to bend even if it hurts. They said it's normal to feel pain when bending during exercises. The first PT assigned to me even said that I won't be able to bend my knees if I don't force myself to bend them as much as possible. That kinda embedded in my brain at that time during the first few weeks post-op, that's why I have pushed myself to bend it crazy even if it causes me too much pain. My PT suggested seeing my surgeon to consider scheduling me for MUA. After seeing my OS, he booked me in for MUA this coming 31 July as he thinks there are scar tissues on both knees. But I feel very anxious and now having second thoughts about going through MUA 14 weeks post-op TKR.
Now, my questions to those who went through MUA; 1) Is it worth going through MUA? 2) What should I expect after MUA? 3) What are the things I should do after MUA that would help me progress my flexion on both knees? 4) Should I cancel or postpone the date of the scheduled MUA to give my knees some more time to heal?
Please help and advise anything as I'm so anxious about the upcoming MUA.

 

[MerlinWizard]

The benchmark for the orthopedic clinic I go to uses 90 ROM as a guideline for MUA. If you haven't reached 90 by X time, they will schedule it and get it done.

From personal experience I had my own MUA but it wasn't under anesthesia, I fell and bent my right leg to the point my heel hit my butt in week 8. While very painful for about 30 seconds, it could have been a lot worse. I found that shortly there after the ROM in my right leg caught up to my left leg but not without a lot of swelling and rest. Let's just say I know why they do it under anesthesia now! I also don't recommend that route!

It's very normal to be anxious so I really hope someone here has personal experience with an MUA.

Chin up - it will get better!

 

[Roy Gardiner]

The first PT assigned to me even said that I won't be able to bend my knees if I don't force myself to bend them as much as possible

BoneSmart holds that this is incorrect

Everyone has scar tissue. You may need MUA if you have adhesions, where tissue in the leg(s) have stuck together and will need to be freed. This is done by forcing bend to the point this happens - hence being asleep!!

I would be quite cautious about MUA at this stage; it sounds like you've been forced to overdo things, which in our view causes swelling and pain and doesn't help recovery.

Here are our recovery guidelines for your further information; please ask anything, it's what we're here for.

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

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Care In Hospital​

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.

 

[Roy Gardiner]

I have found another GP who understands my situation and needs for a painkiller to help manage the pain during exercise.

BoneSmart says not to take painkillers for exercise, it enables you to endure more pain, which is bad for you.

I have pushed myself to bend it crazy even if it causes me too much pain.

So we say, stop. Do your stretching exercises, but not to the point of pain.

Ask them why they say that pain is good. Pain works for training, where you damage muscles and they recover stronger. We don't think this philosophy works for recovery.

 

[Mar]

I am in a similar sitauation. I am scheduled for MUA Sept. 1. My LTKR was April 26 so almost 12 weeks out. However, this past week I am starting to see some improvements. In fact just now I would guess I might be about 95. My PT taped my leg today for additional help with swelling not sure if that’s why the increase in flexion. I could only bend to about 75, 2 weeks ago. I don’t do any aggressive PT. I just get lymphatic drainage. I have started just doing stretches focusing on my quads, IT band and hamstrings. I ride a bike and can finally rotate around. I had my RTKR 8 years ago and healed very slowly and they did the MUA at 5 weeks. It really set me back with IT band issues, major swelling. So I really don’t want to do it again. I’m trying really hard now to let my knee rest a lot. My plan is to be able to cancel my MUA.
What if for the next two weeks you cancel all PT. Or find a PT who just massages and tries to drain the fluid from your knees. Just do gentle things, ice and elevate a lot and see what happens. Maybe if the swelling goes down you’ll see improvement then you’ll feel more confident to just give everything more time. I think some of us are just slower healers then others who seem to just glide through this with great flexion. Prayers it all starts getting better for you.

 

[BBCG]

Mar and Tina-Chris007,

I was also being told I would "need" a MUA back in 2016 after my first TKR. But, the painkillers they had me on back then didn't work, so for 3 weeks I was in horrible pain, couldn't sleep and had too intense PT! It was awful! So, when I found Bonesmart, I was so relieved!

I refused the MUA at 3 months despite being only at 90 degrees because I felt if I had more time for the still-intense swelling to go down, my bend would be there. Bonesmart's philosophy agreed and I got wonderful support here. I did NOT do the MUA, as it seemed too early, and unnecessary as I had not had enough time to recover and heal, I didn't feel. Doing a MUA I understood might set me back further from my eventual recovery.

My OS wasn't pleased, but he listened and agreed to wait... it was indeed, MY knee! So, I skipped my 6 mo appointment because I wasn't yet at 125, the next point he wanted me at by 6 months. And, by 8 months I was there! I went in then and he was happy that I did it my way and it worked.

There are some of us that seem to just heal slower, some of us swell more easily, and that keeps our knee from bending as soon!

Mar has good ideas, too: she is skipping PT and having gentle lymphatic drainage massage done, which I also did in 2016 and this time twice, as well. See if being gentler to your knee makes it happier....

I didn't need a MUA really, at all, and having one done would add to their pocketbook and decrease from my insurance account to what end? I did get the bend on my knee's time-frame instead of theirs, and I'm very happy I avoided it.

That 2016 knee is in great shape! It has been the "working" knee for the past 3 years as my right one went down hill and I was unable to have it done until this year. I work a very much on-my-feet kind of job, owning a retail store and I carry customer's' products to their cars, 20 pounds at a time. I did deliveries during the pandemic from March through February, of 60-200 pounds at a stop. So, that knee is solid as a rock!

So, I understand your worry about having a MUA done; it worried me, too, as I just felt deep inside that it wasn't necessary and their ideas didn't really apply to my situation. I was right in my case and I'm glad I waited and gave my knee more time...

You need to do what feels right to YOU as it is YOUR knee! But, I tell my story so you know there are those of us out here who politely said, "No. I'm not having a MUA at this time; I want to give my knee more time to recover." And it really WAS the right decision for us...

 

[Jamie]

It is perfectly fine to tell your surgeon that you want to wait a bit for an MUA and try a more gentle approach to your therapy - more stretching and no pushing past more than just mild discomfort for several weeks to see what happens. Thank heavens you found a surgeon who understands that some type of pain medication is needed in recovery for most people. Also, if you're not icing your knees as much as you can day and night, try that as well. Just be sure to have a towel between you and the ice source so you don't damage your skin. Be sure and ice both front and the back of the knee joint.

If you have spent the first part of your recovery pushing and stressing your knees, it's going to take a while for things to settle. Give yourself that time if you want to. Your knees are not going to "freeze up" or necessarily be stuck at the flexion you have now. You're still early in recovery.

An MUA will set your recovery back a bit and that might not be the best thing for you right now. While it's possible you might have adhesions that are holding back your flexion, it's also possible that the problem is swelling and inflammation from all that early pushing and pain.

 

[Ghostpipe]

Tina, I had bilateral on 9th March, and so agree with Jamie’s last paragraph.
Firstly, I had a drain in both knees for the first three days in hospital, and a lot of blood came out, which they measured, and a daily blood test. They ended up infusing a bag of blood. So I was well cared for in that respect.
Until I found this forum at 9 weeks, I did a lot of pushing through pain, worried about scar tissue forming and keeping ROM. Then I realised that every bit of healing that my knees were achieving, I was undoing immediately by forcing things. Like picking the scab off a graze when we were kids.
Been relaxed ever since, and now doing very well indeed. It’s not been plain sailing by any means. The less activity I do, the more my ROM improves. Overall, it started to improve once I stopped forcing things, and giant strides only started to happen from 12 weeks onwards.
Remember that your body is healing two knees, progression will be slower than with one, it can only do so much at a time.
I have read a thread on here from ctTony, who had MUA at 12 weeks, and is now going through another procedure to clear out scar tissue. I feel that if that had been done to me then, it would have caused so much unnecessary damage and I would not have been where I am now with ROM at ca. 150/140. But that was only achieved after two days of being unwell followed by two days in hospital, hence total rest. It’s not been that good since, but I know it’s there.
please think very seriously about MUA, maybe get a second opinion. If you read enough threads about successes on this forum, you will see that good ROM comes with time, healing and decrease in swelling, all by itself.

 

[Cjackso21]

I agree with Jamie too. I had a MUA many years ago on my right knee due to many surgeries. It was within 8 weeks I think of the latest surgery then. Ended up with an injury and had to stay off of my knee for 2 weeks and had to take off 4 more weeks from work. Not sure if it really actually worked. I have had ROM issues with my left and after my last surgery thought I would never get further than 95 to100 but because I took the advice of not pushing to hard but continuing to stretch it, I have made my way to 120. Not sure if it was the surgery, which was just to add a prosthetic knee cap or just finally working on it. Good luck!

 

[VolFan0927]

Cjackso21
Good news on flexion. How long did it take to go from 95-100 to 120 (after surgery?), and how often/type of stretching did you do?

 

[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. “

 

[tina_cris007]

Thank you all so much for your responses and for sharing your personal experiences going through MUA and for others who refused to have it done.
Since joining this forum, I have learned to listen to my new knees. I wasn't pushing myself during exercises to the point where I feel so much pain. I've also been elevating my legs after exercise, with ice packs, still taking my morning and night pain medications as well as my blood thinner meds as prescribed.

By the way, since being discharged from the hospital on 1 June, I have only been going twice a week to Physio - Day program as an outpatient for 1 hour at the gym for exercises and followed by 30-40 min of hydrotherapy. The PT's are not pushy just like the ones assigned to me while I was an in-patient in the hospital. Although I find that the exercises they tell all patients at the gym are almost all the same for everyone. One size fits all kinda exercises, not an individualized program.

I fear I have been forced by some PT's and so I pushed myself during exercises early on post-surgery as I think it has done more damage than help heal my new knees. I fear I now have adhesions, especially on my right knee. I've read some articles about it. I must say, I have all the symptoms they have mentioned - eg. continuous and increasing pain over time, swollen, warm feeling, bent knee/s while walking, and tightness in the area. Reading all the comments/suggestions from this thread, MUA is not the best answer to our baby knees.

I would definitely call my OS to tell him to postpone the scheduled MUA. I'd give my knees another month to do the BoneSmart approach, normal range Physio exercises, and just doing normal daily activities to give my knees some time to heal. Hopefully, my ROM would get better with no swelling. I'll update you all later.

Hope things go well from here on.

 

[Spex10]

I had an MUA at 12 weeks. It was the best thing I could have done. I was so pleased I went ahead with it.
I'm sure the continuing stiffness was due to a PT just pushing on my knee to bend it. My knee was so swollen it was completely obvious it wouldn't bend. However, it became very inflamed and ROM was reducing. It was 60° at best. I used to see the patients who'd had their TKR on the same day as me with their feet flat on the ground and at least a 90° bend.
Anyway, the MUA didn't set me back much at all. I was so thrilled to wake up and could achieve a 90° bend myself. It soon improved beyond that.
Needless to say for my second TKR I rehabbed the Bonesmart way, sacked the PT and did very well.

 

[tina_cris007]

@Spex10... Thanks for sharing your experience. Just wanna know... after your MUA, how was the pain like? Was it the same as when you had the TKR surgery? And what exercises or aftercare plan did you do after MUA that you think made it work for your knee?

 

[tina_cris007]

@BBCG I'm now at my 3rd-month post-op and my ROM is not doing so well. I'm just at 70 (Right knee), while it's 75 (Left). Did you have any adhesions or scar tissue? I mean, why did your OS suggested for you go through MUA? Is it just because your ROM is quite low to his expectation at 12 wks?
I think I have adhesions as I have all the symptoms (warm, swelling, stiffness, bent knee when walking/standing, increasing pain throughout the day).

@Jamie, did any of your members here had to go through MUA because of that? And if so, would it be the right decision to go through MUA? I'm really torn, as I had a chat with my podiatrist friend (who lives in a different state). She said that if I have adhesion, MUA should be the thing to fix it.

 

[Spex10]

@tina_cris007 . After my MUA my main feeling was of relief! I well remember that first morning sitting down with ROM at 90° and being so happy. Pain was never a big issue for me somehow. Paracetamol did the trick. As to excercise, all I did was just walk about for a bit every hour. I had a little pedaler that I sat pedaling as I watched TV. In time I walked a bit further round our grounds and built in going up and down steps and stairs. Surgeon was very pleased with the outcome. As I said, for my next TKR I sacked the PT and followed the same walking regime. Worked well.
Good luck.

 

[BBCG]

It sounded like PT and you, yourself, were both pretty assertive or aggressive about bending and exercising, when I look back…am I right?

So, if you really want to give your knees their own chance to make progress if you are “nice” and gentle to them and not aggressive, then you could certainly consider postponing a MUA for a few months. It may be that you have no adhesions and they will improve not “harassed” by being over-zealous about pushing them.

My doctor (and at that time, this entire surgery center when it came to TKR surgeries) had an arbitrary “schedule” that he used to determine how well a patient was recovering; it had nothing to do with MY knee: it was their standard protocol! So, no, he never said I had adhesions at all. He didn’t know, but since I fit in the “getting ROM too slowly” camp, that was his recommendation.

It’s really your choice when it comes right down to it. For me, though, I really prefer not to be put “under” any more than absolutely necessary, I wanted to give my knee its chance to recover on its own, and I had been pushed too much initially anyway, so really was finding the system I was in was not really as caring about the patients as it should have been, thus losing some of my trust. They had changed by the time I went for my 2nd TKR in April 2021, though, and I was VETY firm and careful to ask waaay more questions this time!

My two wonderful new knees are doing great, so I’m very glad I resisted their pushing me to do the MUA. My knee just needed to be more gently allowed to heal in its own timeframe, not that of a self-interested medical system that was then, not nearly as patient-caring as later has become the case. There ya go! My 2 cents!

 

[tina_cris007]

@BBCG
Yes, from the very first day after the surgery, almost all PT's that was assigned to me have ingrained in my mind that if I don't push my knees to work hard ("no pain, no gain" they said), I won't be able to get the ROM that I should be. According to them, in 6 wks time, the range should be at 90 deg. Otherwise, I would need to go through MUA right away. So they said I have to accept that it is painful during physio exercises but it is doing good for my knees. I did physio in the hospital for 6 weeks as an inpatient where the PTs were pushing me to do the exercises they tell me to do even if it hurts me so much. And then continued physio in another hospital as an outpatient. This time, the PT is not forceful at all with my exercises. Unfortunately, I've only found out about this forum 10 wks post-op. I'm now 12 wks post-op. After taking a lot of time reading other threads in this forum, I have to learn to be kinder to my new set of knees and how to look after them at home.

I really appreciate you sharing your previous experience. Thank you so much!

 

[tina_cris007]

I am in a similar sitauation. I am scheduled for MUA Sept. 1. My LTKR was April 26 so almost 12 weeks out. However, this past week I am starting to see some improvements. In fact just now I would guess I might be about 95. My PT taped my leg today for additional help with swelling not sure if that’s why the increase in flexion. I could only bend to about 75, 2 weeks ago. I don’t do any aggressive PT. I just get lymphatic drainage. I have started just doing stretches focusing on my quads, IT band and hamstrings. I ride a bike and can finally rotate around. I had my RTKR 8 years ago and healed very slowly and they did the MUA at 5 weeks. It really set me back with IT band issues, major swelling. So I really don’t want to do it again. I’m trying really hard now to let my knee rest a lot. My plan is to be able to cancel my MUA.
What if for the next two weeks you cancel all PT. Or find a PT who just massages and tries to drain the fluid from your knees. Just do gentle things, ice and elevate a lot and see what happens. Maybe if the swelling goes down you’ll see improvement then you’ll feel more confident to just give everything more time. I think some of us are just slower healers then others who seem to just glide through this with great flexion. Prayers it all starts getting better for you.

Just an update on my situation.... I have been diligently doing the BoneSmart way of not doing painful PT exercises, doing gentle exercises that are listed in this forum, I have been taking my pain meds on time, icing, elevating, walking around, resting, and massaging my knees. It's now 14 wks post-op and my knees are still stuck in 70 deg (right) and 75deg (left). The swelling on my knees are not as bad since following the advices of the members of BoneSmart, but the feeling of stiffness is the same.
I have met one lady at my PT rehab session who just had a MUA 8 wks post-op. She's back to PT rehab exercise sessions twice a wk and her ROM has improved 20deg better pre-MUA. She also said that she was discharged the following day, there's swelling and pain afterwards but good pain management helped her, also it's not the same level of pain as the Knee replacement surgery we had.

@Mar are you still going ahead with your MUA this Sept 1? How's your progress now following the BoneSmart way?

 

[Mar]

Well I’m now stuck at about 102. Having more pain but I’ve also been walking a lot more. I’m nearing 14 weeks PO. Not elevating or icing as much just so busy lately. Leaving for vacation Sunday so will be interesting to see how things go. I’m actually just trying to live my life and forget about the knee as much as I can. I have appointment Aug 26 to see if I will go ahead with the MUA.