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MUA bs27's TKR Recovery

bs27

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Made it through my first TKR but my proposed 1 night stay turned into a 10 night stay thanks to a rapid appearance of cellulitis post-op. IV antibiotics and now oral antibiotics at home started knocking it out fairly quickly but still the bonus swelling & pain has slowed my initial recovery. Surprisingly, though, that extra time has already gotten me to the point of nearly bearing full weight on the operated knee while using a walker, in & out of bed by myself and same with bathroom duties but really lacking ROM. 1st outpatient PT coming up at the end of this week so I'll move to the recovery thread and put this slow start behind me.
 

sistersinhim

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@bs27, good morning and welcome to the recovery side. I have started a recovery thread for you. If you would like your title changed please let us know.

I see that Jamie left you the TKR recovery articles in pre-op, but I'll leave them here so you don't have to keep going back to read them.

The following are our basic guidelines and should help get you started. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect and what not to do, especially regarding PT.

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
ice
take your pain meds by prescription schedule (not when pain starts!)​
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
5. Here is a week-by-week guide for Activity progression for TKRs


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.
 
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bs27

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Anyone acquire little tolerance for Norco? I have an awful lot of drugs I can not take, but have taken Vicodin/Norco in the past - but, I've never had to take much for very long at all. I do not really need anything but ice and maybe a couple Tylenol when resting/sleeping now, but definitely need something a lot stronger for PT and even gentle stretching at home. After so long in the hospital with lots of pain meds, now at home if I take Norco 10 … then tried half of one …. then down to just one quarter - prior to working on gentle exercising or going to PT, I'm awake for 2-3 hours then completely knocked out for another 4-6 hours followed by a zombie state & just not feeling right for another couple hours - then it's bedtime. A little Norco is definitely not sufficient to exercise even a little. I've sent the dr. office a message asking for an alternative (can not take oxycodone at all) but did not hear back today. Just wondering what pain meds people are using that let them exercise without being asleep the rest of the day. I know I need to be up and moving around more, but it is just not possible. Not as worried about ROM as the PT, but it is depressing to start at 56 degrees and now just 45. I really fear that my slow start due to a long hospital stay is going to be hard to overcome. Icing & elevating as I write - finally awake after PT 9 hours ago - wanting to take several pseudo-walking laps around inside the house before bed. I've read a lot about the post-op blues - I have it bad and that's not like me at all!
 

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@bs27
You are still very early in recovery and need your pain medications, taken on schedule as prescribed. If you skip taking them, you may require a stronger dose to get your pain back under control, vs a lower steady dose.
You had a rough start and your knee is going to need time to heal, it is the swelling that is blocking your ROM, your ROM is there ready to be revealed as your swelling goes down.

Right now your PT should be helping you with find ways to reduce pain and swelling with ice, elevation, retrograde massage, TENS, gait training, gentle exercises, and how to pace yourself so you do not cause additional irritation to your knee.
You should not require additional pain medication to tolerate PT, pain meds masks your pain, and allows your knee to be overworked.

Tramadol is a step down pain medication that might want to ask your surgeon about.
Many of us use pain medications the first 3-4 months, then naturally weaned off as our pain levels decreased.
 
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bs27

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Thanks - I sure can't take even a reduced amount of Norco now (as prescribed) without sleeping non-stop - hopefully tomorrow I'll hear back from the surgeon's office and find a med (Tramadol is not on my list of likely bad drugs - I have one poor metabolizing liver enzyme) I can take steadily without knocking me out for most of the day. As I was leaving the hospital, the PA commented that I had 2 months to reach 90 degrees so I got the sense that they are already accounting for my rough start. I don't see the surgeon again until the end of July so I'm not feeling like I have to push more than I can handle. Love your reasonable advice - Many thanks!
 

Jaycey

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the PA commented that I had 2 months to reach 90 degrees
Complete rubbish! There is no timeline for ROM. It will come when your knee is ready. Please don't let anyone push you to gain ROM. Read your guidelines again.
 

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I agree with Pumpkln and Jaycey, there is no timeline for any part of this recovery. We all recover in our body’s own timeframe. I wish the medical professionals would realize this, and allow our knees the privilege of sorting themselves out.

My ROM continued to improve in my second year, and in my third year!

PT that is painful is not appropriate for this recovery, but it seems too many of us are led to believe it is. The additional complication you suffered early on is even more indication that you should not be doing PT that is painful. You can have a very successful recovery by treating your knee gently.
 

sistersinhim

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what pain meds people are using that let them exercise without being asleep the rest of the day.
You shouldn't take pain meds to exercise. You need to feel that pain. It lets you know your knee isn't ready for that kind of or that much of exercise. Every movement you do is exercise. You don't need to do repetitive exercises. That will cause setbacks. Gentle movements and using your knee normally as you live your life is a great way to rehab your knee without excessive pain or swelling.
 
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bs27

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Thanks all! Heard back from the dr. today and said to stop the Norco (the Norco 'comas' were keeping me asleep all day & evening) …. see if I can tolerate Tylenol with codeine and if not, stick to XS Tylenol. I know being awake during the day and moving around - and getting this brain fog gone - will go a long way towards getting moving again. No doubt I'm rather unique with intolerance to so many drugs. Bummer in so many ways. PT today was gentler - very understanding of my situation and very encouraging. Tomorrow I'll see what the Tylenol with codeine does to me - but if I can't take it, I won't - just feeling decent again will be a big help. Too quirky with meds! Not worried about the '2 months to get to 90 degrees' comment - hope so, but I'll be happy with slow progress. Was very strong pre-surgery and fortunately very active despite the bum knee - can tell that's helping me now.
 

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If the Tylenol with Codeine doesn't work for you, the most effective way to take Tylenol is 2 x 500 mg tablets (Tylenol Extra Strength) 6-hourly, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all the other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular doses, so you stay within that safe 24 hour limit of 4,000 mg.
 
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bs27

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Just an update in case anyone is following my TKR recovery saga. It has been 7 weeks now since surgery. I have been going to an very experienced therapist, doing my stretches at home (with occasional time off as needed) and icing/elevating several times a day. My leg strength has improved significantly, the visible swelling of the knee has gone way down although it remains stiff, I feel well and I have not needed meds for pain for several weeks (just ice). But ... as I feared since I was very slow to begin rehab due to an extended hospital stay, my knee's flexion is very poor - only improving from the mid-40s to mid-60's - reaching 70 degrees with the therapist's assistance. As it nears the 70 degree bend, there is an odd, very distinctive pain that occurs and it quickly reaches an intolerable level. I keep trying, in hopes that whatever is stuck in there will break loose - sometimes it feels like it stretches a bit, but no breakthrough.

I'm quite sure there have been a couple similar, though minor, obstacles that were successfully eliminated during this slow rehab but now I really seem to be stuck. The therapist mentioned early on that the 'manipulation under anesthesia' procedure is an option if necessary but we'd do our best to avoid that. More recently, the surgeon has said that it may be necessary .... and the way it feels, I'm beginning to agree so I can get past this point and whatever may be lurking just beyond it. Every knee replacement patient I've seen coming to PT for their first visit is already at 90 degrees or more .... and now I've seen many of the same ones celebrating their last PT session. I know comparisons should not be made between patients, and I am happy for them, but hard not to think that's the way my rehab was supposed to be. I'm beyond ready to get moving much better and feel sure I will ok the manipulation procedure if my progress remains stalled for another couple of weeks. That's the update - hoping the next one will start off with "Great news! ...".
 

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Thank you for the update, @bs27 .

I'm sorry to hear that you have a problem with extension and I hope that your knee's ROM soon improves. Please don't let your therapist push on your knee to increase flexion, as that can do more harm than good. Your knee did have a bad start, due to the infection, and so allowances should be made for that.

It's still early days in this year-long recovery, so don't feel you have to rush to achieve good ROM,
because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

It may be that having a Manipulation Under Anaesthetic (MUA) will help, but try not to be disappointed if it doesn't. I'd be inclined to wait a little longer, to give your knee some more time.

Try not to compare your knee's progress with anyone else's. I bet those people who seem to be ahead of you now didn't have to cope with an infection at the start.
 
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bs27

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Two weeks after an MUA. Although my extension was generally 0 or very close, my flexion had been stuck at 65-70 degrees for several weeks before the procedure and I would feel a unique, intense pain as the adhesion or whatever would stretch but not break free. I was told the knee was bent during the MUA to 135 with 'lots of cracking & popping'. Immediately after the MUA, I had tremendous thigh/quad pain (very uncommon, I was told) but it calmed within several hours to more of the milder soreness that I had expected and bruising/swelling appeared. I was able to go to PT the next day and got to 90 degrees .... the next session hit 100 degrees. But the exercising prompted significant thigh pain to return and limited my exercising for about 10 days - so I'm stuck again but now at 100 degrees despite recent improvement with the pain, bruising & swelling .... getting the same unique, likely adhesion pain when trying to stretch beyond that point - though I keep at it hoping that it will suddenly break loose. I am still glad that I had the MUA procedure, wish I had a reasonable explanation for the bonus pain & bruising, but if it proves necessary, I would repeat the procedure again. I do have a need to regain my independence sooner than later as my caregiver spouse has been delaying surgery until we can exchange roles.
 

sistersinhim

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It is very unlikely that you have developed adhesions again this soon. Having pain after a MUA is to be expected. In many cases, this sets your recovery back to the beginning again not at the date of your TKR but the date of your MUA. You will treat the recovery the same as you would a new tkr, rest, ice, and elevation. Only gentle movements should be done until the pain and swelling diminish.
 

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Two weeks after an MUA.
Please tell us the date of the MUA, so we can add that to your signature.

getting the same unique, likely adhesion pain when trying to stretch beyond that point - though I keep at it hoping that it will suddenly break loose. I am still glad that I had the MUA procedure, wish I had a reasonable explanation for the bonus pain & bruising, but if it proves necessary, I would repeat the procedure again.
When you had the MUA it tore apart the adhesions that were in your thigh. That's why your thigh is sore. The MUA caused some damage and you're probably feeling pain now as a result of that. That damage needs to heal, so try to treat your leg and your knee gently.

Since your flexion is now 100, a second MUA is unlikely and anyway it's not likely to improve matters. Just give your knee and leg some time to recovery from the MUA because the MUA does set back your recovery for a while - your leg is wounded again.

The red, dotted lines drawn on this X-Ray show where the adhesions are most likely to have been. Does that help to explain why you had thigh pain?

 
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bs27

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Thank you for the info & advice, Moderators! The MUA was on 8/13/20. The adhesion or whatever it was broke free this morning! I immediately gained about 5 degrees of flexion before the too painful thigh stopped the show and knee swelling increased afterwards, too. Yes, my thigh/quads have definitely felt like there was lots up crud up there that must have stretched the muscles during the MUA breakup. It sounds like that much pain in the thigh afterwards is uncommon, but hey, I haven't been very typical during any of this adventure. Each of the 'unique' pains (adhesions or whatever) that has stalled progress at times has been in the area outlined below the kneecap. I've been icing, elevating and gently easing into bending to not lose any ground I have gained. And since the MUA, a heating pad around the thigh has been added to my routine. I go to bed with my leg in the ice machine and elevated on the Lounge Doctor .... but around 4am, I'm usually tossing them off the bed. The good aspect of all this is that the original pain from the TKR is long gone. Thank You.
 

Jaycey

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Sounds like you are making very good progress @bs27 ! Easy does it with the bending. Ice is very much your best friend.
 
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bs27

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Scar - a little over 4 months after TKR
Bruising & Swelling - 3 days after 2nd MUA (rare) broke my tibia (extremely rare)
 

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Pumpkin

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Sorry to hear you have fractured your tibia during your MUA, it is rare but happens.
Do you have any weight bearing restrictions?
 

Jockette

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Please tell us the date of the second MUA and we’ll add it to your signature.
 

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