TKR Back home in PA

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Good luck and best wishes and prayers being sent your way---post back---please---when you feel up to it and tell us how you are doing and how it went.
 
The MUA went better than I expected. They used propofol and I asked that they do not play, "Thriller", in the background. They didn't. My OS showed me pictures of my bended knee. I asked how many degrees that was and he said, 130°. I was really excited to see that. Now I can possibly get on my bike soon.

Today I went to PT to start a couple of weeks of therapy. He put me through the usual stretches, etc. Now here is my dilemma. He iced my knees before I left PT. After being home awhile, I iced them again. I am now ready for bed and my knees are swollen and difficult to walk and do steps. I expected this, but how am I going to keep working these knees when the keep swelling up? I am past the soft tissue healing from the original surgery but this MUA put another hurt on them. I guess I will ice over the weekend and exercise what I can and then discuss it with the PT guy on Monday.

This is really a long, long road and I did not anticipate all that was involved. It is easy to get discouraged but the people on this Forum have been very supportive, thank you.
 
This is exactly what I worried about for you, John. Let's hope that the PT will be able to reassure you; I'm sure that swelling after MUA is common. She/he might let you know how soon you can expect the swelling to go down. My surgery was in January and I still have a great deal of swelling. Have investigated lymphatic massage and am planning to begin next week. I'll let you know how it goes, but I say, ice as often as you can every time your knee seems to want it. At 6 months I am still icing and elevating (five pillows) four times a day for as long as I'm able. I'm sending you good thoughts and healing energy.
 
I go to the PT again on Monday. First I am going to see a different PT connected to my OS office. I can go there because of my insurance. I just want to talk with him about my situation to see what he thinks. I love to gather as much info as I can. That is why I appreciate this forum so much. I need to find out how to balance working these knees and not getting so much swelling that they stiffen up that I can't work them.
 
You really need to be elevating
[Bonesmart.org] Back home in PA
and icing
[Bonesmart.org] Back home in PA
most of the time. And you need to give your knees time to recover from this second assault on them. It's just a matter of too much too soon to be doing a lot of PT at this point.
[Bonesmart.org] Back home in PA
Re-read the following article from the Library:
Swollen and stiff knee: what causes it?


 
John, your concern--the balance between movement and resting/icing so that you deal with stiffness, ROM and swelling--has been my concern all along. Let me know what you find out and how you're feeling. I know that I got the balance wrong by following the advice I got in my OS office. "People who go back to normal activity as soon as possible are the ones who heal most quickly." That was definitely not true for me. Not at all. I went back to work to soon. Didn't rest my knee enough. I'm doing that more now. Good luck.
 
^it sounds like some docs and PTs are so worried people will sit around like lumps that they overemphasize activity.
 
It will be interesting, if I can get a second opinion from the PT group that is associated with my OS. I keep searching for all the info that I can get so I can make the decision as to what I think I should do.
Thank you all on this BS forum. and it is not BS.
 
I go to the PT again on Monday. First I am going to see a different PT connected to my OS office. I can go there because of my insurance. I just want to talk with him about my situation to see what he thinks. I love to gather as much info as I can. That is why I appreciate this forum so much. I need to find out how to balance working these knees and not getting so much swelling that they stiffen up that I can't work them.

John, the swelling and stiffness that you have after activity is normal. It happens to all of us. Make sure you are resting, elevating, icing and taking your pain meds as prescribed. To get rid of the swelling your knees have to heal and to heal you have to rest them and do gentle exercise. Your MUA aggravated the swelling so you need to ice, elevate and rest. If you do too much activity, work the knees, you will swell and get stiff. You have to be patient!
 
Hi, I really do understand the cycle that you are explaining. My OS did the MUA and wanted me to go right to PT the next day and for two or three weeks. The PT didn't do very much, some stretching some pulling back on legs to get measurenents and a few minutes on the bike to just work pedals back and forth. I did this and then was able to go over the top and pedal a few times. I will not say that anything we did was severe. Then my knees blew up the next day, Saturday. Sunday I was able to do a few stretches but I felt I was pretty close to feeling the way I did when I was released from the hospital/PT. So I know the work/ice/rest/elevate routine but how am I going to go to PT and balance all of this so I can increase ROM and not swell up all of the time?
 
John, I think you are just going to have to give it some time. You just had the MUA so swelling is to be expected. Let's see what Josephine; has to say.
 
John, I feel I owe you an abject apology for not having kept up to date with your thread. I can see you really needed my input and I let you down. I am really sorry about that.
The MUA went better than I expected. My OS showed me pictures of my bended knee. I asked how many degrees that was and he said, 130°. I was really excited to see that. Now I can possibly get on my bike soon.
These are the mind games that get played - unintentionally, of course! :wink: Naturally he could get it to 130 because you were unconscious and your muscles were pretty near paralysed! But the real delusion is that your knee could probably get there anyway IF IT WASN'T SO SWOLLEN! I notice that someone gave you the link to the article about the ineffectiveness of early MUA - did you read that? Early is anything under an absolute minimum of 12 weeks and you are only 10. Much, much to early to have had an MUA, in my opinion.
Today I went to PT to start a couple of weeks of therapy. He put me through the usual stretches, etc. Now here is my dilemma. He iced my knees before I left PT. After being home awhile, I iced them again. I am now ready for bed and my knees are swollen and difficult to walk and do steps. I expected this, but how am I going to keep working these knees when the keep swelling up?
That's to be expected but not for the reasons you think .....
I am past the soft tissue healing from the original surgery but this MUA put another hurt on them.
Well this is the key - you are not past the soft tissue healing at all. You are only 10 weeks post op, much to early to be having an MUA. On July 2nd in post #59, I gave you lots of pointers about all this and lots of links to articles. You never commented on any of them so I am left wondering if you ever read them. Amongst the things I responded to were your eagerness to get results quickly and disappointment at the slow progress and swelling. So I will tell you some of these things again and to anyone else reading this:

1. recovery is not something you 'do', it's something that happens to you
2. ROM is the same but it's a mix of rest and gentle activity. You should never feel you have to 'fight' for ROM. If you give it time and let the swelling go down, you will find that the ROM was there all the time, it just couldn't show itself because of the swelling
3. pain meds are crucial in this - if you have pain and you push the result is excessive swelling and backward steps with your ROM
4. never let anyone tell you "no pain, no gain" and never think it yourself. The proper version is "no pain, MORE gain"!
 
John, I feel I owe you an abject apology for not having kept up to date with your thread. I can see you really needed my input and I let you down. I am really sorry about that.
These are the mind games that get played - unintentionally, of course! :wink: Naturally he could get it to 130 because you were unconscious and your muscles were pretty near paralysed! But the real delusion is that your knee could probably get there anyway IF IT WASN'T SO SWOLLEN! I notice that someone gave you the link to the article about the ineffectiveness of early MUA - did you read that? Early is anything under an absolute minimum of 12 weeks and you are only 10. Much, much to early to have had an MUA, in my opinion.
That's to be expected but not for the reasons you think .....
Well this is the key - you are not past the soft tissue healing at all. You are only 10 weeks post op, much to early to be having an MUA. On July 2nd in post #59, I gave you lots of pointers about all this and lots of links to articles. You never commented on any of them so I am left wondering if you ever read them. Amongst the things I responded to were your eagerness to get results quickly and disappointment at the slow progress and swelling. So I will tell you some of these things again and to anyone else reading this:

1. recovery is not something you 'do', it's something that happens to you
2. ROM is the same but it's a mix of rest and gentle activity. You should never feel you have to 'fight' for ROM. If you give it time and let the swelling go down, you will find that the ROM was there all the time, it just couldn't show itself because of the swelling
3. pain meds are crucial in this - if you have pain and you push the result is excessive swelling and backward steps with your ROM
4. never let anyone tell you "no pain, no gain" and never think it yourself. The proper version is "no pain, MORE gain"!
 
Josephine, I did read the articles that you posted for me and I thank you for that. It is still difficult for me to go against the PT that is trained to do this work and my OS who is one of the most respected surgeons doing TKR in this area. It is even more difficult for me to believe that I can just take it easy and it will all come back. I will give you the time line of my struggles.
5/25 BTKR 3 days in hospital, 7 days in PT.
5/25 released from hospital.
6/1 started PT.
6/8 PT really hurt me by pulling back too hard on my legs.
6/12 saw my OS and told him what happened at PT. He advised I could do the rehab on my own at the gym and pool.
Next four-five weeks I did the list of stretches and heel slides plus working in the pool. With the ice and elevation.
I got zero increase in ROM. I had two methods to measure this. First is how difficult it is to ascend and descend stairs.
The second is how difficult and how much I have to pull my legs back to get into the passanger seat in the car.
This is how I know that there was no progress. I could do all the walking, yard work and vehicle washing, etc, with no problem. I thought it was going well for how my legs felt but I could not get the flexion that I wanted.
7/16 Not being satisfied with lack of progress, I saw my OS and when he checked me out, he said he could stretch them with MUA.
7/19 I had the MUA. I don't think you believe that MUA is not required to free up the scar tissue. I don't think it was going to dissolve on itself. I see that you feel I was two weeks early to have it done. I need to deal with this now.
7/20 started PT again and had a miserable weekend.
7/23 Went back to PT did light exercises. Later in the day went to the pool. Not feeling TOO bad right now.
I feel like I am pretty much starting all over again. Which is what I am doing since the MUA is such an assult on the knees. My plan is to go to PT for two weeks and then try it again on my own.
Thank you again for all your time and for the information on this forum.
 
Woke up this morning at 6:00 with the most pain in my knees that I have had since day one. I took a pain pill, went down on the lounger. elevated and iced. I was able to sleep for two hours. Made it through the day. Tomorrow I go back to PT and start this thing all over again. Oh, by the way, I stopped in to see another PT Mgr. about my situation and he said to tell me that he would call me. Of course, he never did. They are not going to bad mouth another PT group, I can forget that.
 
MUA. I would really like to hear from others that have had this MUA procedure done. I would appreciate hearing all the details of what you went through and how your recovery went and the end amount of flexion degrees you were able to reach. Are you glad that you went through MUA, would you have done it again with what you learned?
 
John, I don't know if you've seen or read my thread so I'm posting my newest entry here. I think you may be as impatient as I am/was and I totally understand. What's going on? I kept thinking. This is taking me far longer than it should. And everyone I talked to or saw in person seemed to agree. Only those Bonesmarty-pants didn't agree. Patience. Listen to your knee. None of the docs or PT people were saying that. But I'm thinking maybe the BSers are not BSing us.

Here's the post.
Well, I'd like to change the name of this thread. How do you do that? I have had a huge breakthrough. And most of it doesn't have to do with my knee, although I am able to walk a bit better. Here's what happened. The other night I had really bad stomach pains. Then back pain. I decided to try to sleep to see if I could get through the night, then go to the doc's the next day.

Woke at 1 in the morning and pain was awful. Moaning, rocking pain. So I called the doc, had the answering service wake him. He got back and said, "Well you're right, it might be diverticulitis. Go to the ER. My husband is in CA. taking care of his dad who had fallen and was in hospital. I drove myself to a friend's, she took me to nearby ER and stayed with me as I waited two hours groaning, calling out, breaking into sweats, vomiting, then getting chills.

Just horrible. I thought Appendicitis, I thought infected intestinal walls, I thought emergency surgery. But I had to wait my turn as other people who actually looked as sick or sicker, went first. By the time I had seen the one doc and gotten pain killers and stopped sweating, I was taken for a CAT scan. They had to wait while I stopped vomiting and trembling. Turns out the nurse, not the doc, knew what I had. She'd told me, "You're rocking with pain like you have a kidney stone." I did. I stayed the night in the ER dozing a tiny bit. My friend had stayed too, rubbing my back, never once telling me I was a baby. I slept a lot that day. Drank two gallons of water, took only ibuprofin, the pain never got unbearable again, and slept some more. But I'd been off it except for a short walk because the evening air was like silk and so beautiful I needed to be out. And watered the garden (even though I said I couldn't) because I knew it would make my husband happy.

Today, more pain, I took some meds, passed the stone (I think it's just one) and realized I hadn't stretched, elevated or iced my leg at all yesterday. I think the intensity of the pain from the kidney stone made me realize that my knee hurts and I wish it would bend more easily when I walk, but really it's not that bad, in fact, it's pretty good considering. And today, my knee feels pretty good. I think maybe it just needed more rest. A lot more. And while I don't expect to feel completely exuberant about my progress, the experience shifted things for me. Both the intense pain, the real rest and waking up to merely a tight knee. A door opened, or a corner turned.

When Josephine wrote this post: CindyLu, I can promise you 110% that nobody ever had problems from not doing enough. Quite the reverse! I absolutely didn't believe it. Jo, I remember you told me that you "never ever said not to do any exercise at all." Well....that's sort of what you're saying to Cindy Lu. But no matter. I think that all along I didn't really understand what "less is more" means. I don't recommend kidney stones, but perhaps you could shut a door on your fingers, or try skigirl's head slapping exercise, with a really hard slap, to wake yourself up. Sometimes I just need someone or something to translate what my knee is trying to say to me. What a wake up!​
Juniper RTKR January 23 2012
 
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