Bilateral TKR Anxious about upcoming MUA

@Mar 102 deg is pretty good I think. Good luck with your upcoming appointment with your OS. Hopefully, you don't have to go through MUA.
Enjoy your vacation, too!
 
I scanned your post and the responses. There's a term "hard stop" which means the ROM your knee never gets beyond. A hard stop is an indication of scar tissue. I had a hard stop after my first TKR in 2010. Those PTs each insisted that whatever approach they had (yes, very painful) would get me out of the woods. And they all turned out to be, well, liars. I developed a hard stop very early on in recovery (2 weeks). I was at 85 and never went further. (So far I have not told any PT to pound sand but I have divorced myself from them as gracefully as possible.)

Once upon a time, MUA was an office procedure. In 2010 my orthopedist explained that they put you out, grasp the top of your lower leg, and use gentle force to break adhesions. They can hear them pop. My orthopedist heard four small pops and one big pop.

For my revision in 2017 and now this latest fiasco, gentle bending was ordered by my (new) surgeon. When you have repeated surgeries, they cut away the old scar and so each time getting the wound to close is harder, and they don't want any forceful bending. And yet I've reached 90 now.

Please do message me if you would like more support. My arthrofibrosis turned out to be super aggressive and the MUA worked only briefly and ultimately the scar tissue was removed arthroscopically.

I did a TON of research on arthrofibrosis at the time I was in that 85 ROM fix. There is a lot that is not known about it. Yet my second TKR progressed without an issue. The different between my first and second/third surgeries is I've been on a different clot protocol (aspirin) that allows me to use NSAIDs for inflammation/pain. I use two Aleve morning and night. I suspect one of the benefits is preventing formation of scar tissue but this is only my personal belief.

You WILL get there. Keep the faith!
 
Thank you @maryo52 for your input. How is your progress now since your revision recently?

I'm going to see a different OS next Wednesday to get a second opinion from him about the issues I've been going through. Apparently, he's got a lot of great reviews from his past patients. I wish I've researched the best OS in our area prior to seeing the OS that did my surgery. It's been 4 months now since my Bilateral TKR and my ROM are not any better, feeling of stiffness is the same and I'm still in pain even though I've been continuously taking painkillers. I can't sleep well throughout the night due to pain.
By the way, I've also stopped attending the day program (PT sessions) and just been doing a number of 5 min walks around the house and backyard as well as a 15min walk around our neighbourhood. I've been using my pedaller daily twice a day for 5 min each time. Icing and elevating 2-3 times each day as well. Am I too impatient with my progress?
 
Let me explain adhesions or arthrofibrosis. It's white, like cartilage, and so imagine, as in my case in 2010, a 1/4" band tethering the patellar area with the femur. Every time we do PT with those adhesions in there, structures are being pulled, and that's going to result in pain. So it's wonderful that you have institute your own program based on what you've learned about how your knee feels.

No, you are not being too impatient.

I too wished I'd had my TKR with someone who does lots of knees. Instead, I went to the local guy, at a friend's recommendation. Later I found out that that friend's knee had to be revised within a year because the OS oversized the components and the sharp edge severed one of her tendons.

I did do the MUA. Most likely that will put things right for you. The only potential negative in my mind is "they" (you know, PTs and orthopedists) push aggressive physical therapy immediately afterward to "keep" the gains from the MUA. I think the gentle Bonesmart approach is better, at least in my experience.
 
Yes, I decided to go ahead with the MUA to help with the adhesion on both my knees (especially the right one). After I've woken up from the MUA procedure, I was able to walk to my room's bathroom with the use of 2 Canadian crutches. But I now know to ask for a strong painkiller beforehand. The following day, the hospital's physiotherapist came to see me walk along the corridor and practice walking few steps up & down using 2 crutches. The OS came to see me later that day and asked the nurse to put me on CPM machine 2 days in a row until I reach 100 deg while on it. Which I did on the second day of using the machine. I was ecstatic! I was discharged on the 3rd-day post-MUA. At home, there's no more CPM machine to help me bend, I was prescribed to take lesser painkiller meds (Paracetamol to be taken with Mobic and Endone - at separate times), and back to the reality of some light home duties. There's a big difference, of course, there was more pain compared to when I was still at the hospital where they don't have a problem giving me those painkillers whenever I ask for them in due time and the feeling of tightness is worse than pre-MUA.

But since last night, the pain and swelling are lesser with the elevating and icing technique a few times, a couple of pedaling exercises (5 min each time), as well as doing some short walks every now and then. BoneSmart way is finally working its magic to me. I've noticed that since the swelling is a lot lesser, I was able to bend my knees a bit more during some heel slides earlier today.

I've researched and read really good reviews online and found the best Physiotherapist near me where they focus more on alleviating their patient's pain and educating on what to do at home to manage it. Unlike the rehab Physiotherapists I have been with, they only focus on pushing you to do their painful repetitive exercises and then making me feel bad when I was not making any progress with my ROM. I'll update you next time after seeing this private Physiotherapist. I really do hope they could help me alleviate the pain and the feeling of tightness on my both knees.

Oh, by the way, I've just realised... now that I don't attend the rehab PT sessions for 3 weeks now and only follow the BoneSmart approach after the MUA procedure, I was able to drive for 20 min straight earlier today without the normal pain that I used to get with just a 10 min drive. That's another progress I'm happy to consider. I think that's one way my knees are thanking me for not putting them anymore in too much pain during exercises at home.
 
Last edited:
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!
I'm glad I re-read your message just then. This reminded me that I too will get there in time. I have to remind myself most of the time that I might progress slower than everyone else because I've had bilateral done, I've had a clot on my lung, internal bleeding twice on my right knee within the first week of my TKR surgery, and it's only been 4 months post-op. I just got rid of the habit of feeling disappointed in myself every time the PT at the rehab hospital would measure my ROM without big progress to put on their list. Thanks again for this gentle reminder.
 
4 months is 1/3 the way healed in this year long recovery. You will improve as you continue to heal.

MUAs are done to release adhesions, and actually, adhesions are rare. If you do actually have adhesions, you will have much better ROM after the MUA.
they only focus on pushing you to do their painful repetitive exercises and then making me feel bad when I was not making any progress with my ROM.
An MUA will not improve ROM, if the cause of “poor“ ROM is swelling. We all heal at different rates, and we all react to the exercises differently, so ROM being good or poor is in the eyes of the beholder. These repetitive exercises that cause pain keep your knee swollen and inflamed and prevents ROM from improving.
I've researched and read really good reviews online and found the best Physiotherapist near me where they focus more on alleviating their patient's pain and educating on what to do at home to manage it.
This is great news and I hope you do very well with them!
 
If you do actually have adhesions, you will have much better ROM after the MUA.

An MUA will not improve ROM, if the cause of “poor“ ROM is swelling.

Swelling has gone down now since I haven't been attending PT sessions and only doing gentle exercises at home for about 3 weeks now. And I might be wrong about my ROM that hasn't improved at all after MUA because I haven't been measured properly by anyone since I've only been staying home. But hoping that there might be a slight improvement on my ROM now as I was able to bend my knees a tiny bit more whenever I'm doing the heel slides exercises. Though I'd be more than happy if I could bend them more than I can now but it's the feeling of tightness and pain that prevents me from bending my knees more. Should I be concern about that at this stage (18 weeks post-bilateral TKR)?

BTW, I'll be seeing another OS this Wednesday to get a second opinion about my current condition. But any ideas/opinions here from those who've been through the same position as I am right now, I'm more than happy to hear from anyone.
 
Tina_cris, I’m glad you are finding the gentler path is helping… I certainly hope you will continue to improve! It IS amazing how one’s swelling is related to activities that press and try to fit each of us different people into the same protocol!

For what it’s worth, if you really get curious, I approximated my ROM at one point last TKR when my PT couldn’t find her measuring tool: put my leg into the ideal position, have spouse or friend sit beside you and take a photo from the same level as your leg, trying to hold position exactly parallel to your leg. Print photo. Measure ROM! It was pretty close to what we later measured the next time I went to see the PT, too. The same can be done with extension, too…
 
Yesterday, I went to see this other Physiotherapist in my area. Well, he used to work in a rehab department on the orthopedic ward as the PT there. But so far I think he's good. He took time to really get to know my situation and he's more into loosening those tight muscles around my quads as well as doing some stretches that help me bend my knees. He taught me 3 important exercises to do at home that would gradually help progress my ROM. Squats, heel slides while lying on a bed, and forward bend while half squat-sitting (I can't remember what he calls it). He specified not to overdo the exercises where it's starting to be very painful to the point of an uncomfortable level.
My flexion has improved as well - my right knee is now 80, while the left is on 90 deg bend. Pre-MUA, it was just R is just 70, L on 77deg. Also, my extension on right was on 2 deg, the left is ok on 0 deg. Now, both knees are on 0 deg.
So, I don't know if it's the result of the MUA or because I haven't been doing the repetitive and painful PT exercises at the gym and at home. But I'm just happy to have some improvement on my ROM. Also. I have been able to walk without the use of any crutches for more than a week now.
By the way, I didn't end up seeing a different OS to get another opinion as I'll be seeing my Surgeon in 7 days' time anyways.
 
I hope this new PT works well for you! My PT had me do very gentle sit-squats, where you put a chair behind you then pretend you plan to sit, but don’t get all the way to the chair.
 
Last edited:
Yes, that's the kind of squats I have been doing ever since, and what this new PT suggested I do at home, too.
 
What a great measurement again today since my last week's appointment with the new PT that I'm seeing. I have now reached 95 deg on my left knee, while my right knee is on 88 deg. And he truly does help relieve the pain on my quads and calves. He also suggested that I keep walking every now and then for a few minutes after every hour of sitting/resting so as not to stiffen our knees. Also, be consistent with the 4 exercises he prescribed me to do at home.
I'm so glad I canceled all my day programs (physio exercise sessions) at this rehab hospital that I use to go to, follow through the BoneSmart way instead, and found a private Physiotherapist that listens to my current situation and what help I need according to my individual needs. I google-searched the highly rated physiotherapist in my area and read almost all of the reviews, that's how I decided.
I can now clearly see... slowly, we will get there as long as we get the right help we need. Be patient.
 
I've seen my OS yesterday and he was happy with my progress even though it was slow as I had some complications after the surgery. When I asked him if it's normal to still feel the stiffness on the knees for some time, cause I still feel stiff especially on my right knee (which is the slower in progress). He did say, yes it would be for some time. He prescribed me to keep doing the hydrotherapy, keep seeing the private physiotherapist's help with the tightness of my muscles on my legs, keep walking every now and then, wean down on my pain meds, keep pedalling and strive to get to the stationary bike. He was happy to check on me again in a year.
My question to those who still feel stiff on their knees post-op... how long ago you had the knee replacement operation but still feel the stiffness on your knee/s? And can you state your ROM despite the stiffness?
 
I'll be 7 weeks out RTKR tomorrow. Yesterday at PT I was peddling backwards and forwards on the stationary bike;the PT even moved it down one notch to make it harder. With that said, when she went to take my measurement, the most I could do was 90 with her pushing hard to where I almost made her stop! It doesn't make sense because I can rotate the bike.... But can't get past 90 on my own or even close without prodding? Maybe one of the moderators can explain this, but yes, I have that extreme tightness you're asking about.
 
@Gingerbread, 90 deg still sounds better at 7wks compared to my range at that same 7wk time. My right knee which I had a few setbacks were just around 65deg at 7wks. So don't feel bad.
I'm now 21 weeks post-op (BTKR); 95 deg. on left; while just 88 deg. on right; and still feels very tight (especially my right knee). :umm:
 
Having an MUA resets the timetable, Tina. So basically, you are just about 6 weeks out. Early days again. Hang in there. Be gentle. Ice, elevate.
 
Thanks, @Sisterpat! I didn't know that. Good to know... now I'll stress less about the feeling of tightness I still have. Well, in that case, I'm doing alright now compared to my situation pre-MUA procedure. As I'm able to drive further than 10mins with not much pain, I'm able to walk without any walking aides/crutches, can bend more, am now able to climb up and down the stairs, and have no more swelling on my knees.
 

BoneSmart #1 Best Blog

Members online

Forum statistics

Threads
64,908
Messages
1,592,904
BoneSmarties
39,196
Latest member
Eehamm
Recent bookmarks
1
Back
Top Bottom