TKR Can 65 ROM really get better without MUA after 14 weeks

Josephine · Jan 19, 2014

Maddi, I have some questions to ask you:

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

6. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! reps, sets and session and all that)

Incidentally, you don't need to quote a post to reply to it every time.
Just scoot on down to the bottom of the page and start typing!

class dunce · Jan 20, 2014

Hi Josephine - what a great site you have here! Thank you!! Regarding highlighting things now you know why I am class dunce!! Haha!

My pain level is up and down between 3 and 6 and worse when I lie down.

I take paracetamol - 2 x 500mg every 4-6 hours - I gave up Endone 9 weeks ago, Tramadol 7 weeks ago, Gabapentum (Neurotin) 8 weeks ago.
I also take a natural medication called Resillian 3 caps morn and night and natural penicillin drops, tabs and cream prescribed by my naturopath morning and night.

I get Bowen Therapy once a week for lymphatic drainage on my swollen knee and nerve release in my operated leg

I ice my knee when I come back from walking my dog twice a day as well as when I go to bed and when I get up and at other times if I have been to the shops or something where the activity may cause it to flare. So I ice it a minimum of 4 times a day and more if needed.

I sit with my leg along the couch but need to get a proper wedge to elevate it properly. I do often lie flat on the couch and put it up high on the back cushion/top of the couch but I need to elevate it above my nose more often. I do rest my leg constantly through the day and night.

I am retired and have trained my husband to be independent so I don't spend a lot of time on housework, cooking, shopping etc. I have even hardly spent time with my 8 little grand kids so I don't have to run around or lift them. I am a lucky woman with my helpful understanding family. I have had such a bad couple of years with my knees they just want to see me better again so I am not over doing things.

As of just before Xmas I was going to rehab 3 times a week for 8 weeks doing 45mins of PT in the gym on motoped, stairs, usual lunges, squats, stretches with rehab PT's with a 10 min break and then 45 mins in the heated pool doing water rehab exercises again with the PT's supervision. These were similar to gym exercises but in the pool. I do quad stretches in bed along with ankle pumps, circles and some stair climbing. I wonder if I should do more as my knees stiffen up if I don't challenge them, but blow up if I do. It's a delicate balancing act.

My knee kept blowing up and one physio kept pushing and telling me I was running out of the window of opportunity. I had enough and made a decision not to go back. I quit formal PT and now just walk the dog in a very stop start fashion 2to 3 times a day for about 20mins - 30 mins each time.

Josephine, my query is this. Everyone says my knee looks really swollen but in truth I think it is getting better and it isn't as swollen as people think. I think it's bigger than my other knee and a different shape to my other kneecap. Can it cause problems if they put in a knee that's too big?

Also I have another question that I can't seem to find a straight answer for. Is it possible that while I needed a new knee, which apparently I did due to osteoarthritis, could I also have medial ligament disorder, which was never fixed properly and is the root cause of the burning medial pain I feel? Could it be that this swelling and heat and pain isn't really coming from the new knee any more but from this old injury?

My current pain is not the bone on bone pain but the pain I have had 2 arthroscopies to fix previous to my TKR. It feels exactly the same in exactly the same place! If it is this, will it eventually heal around my TKR or will I need other treatment?

I fell walking in water and twisted/jolted my new knee around new year and this burning medial pain has really flared since then. My ROM is between 60 on a bad day and 70 on a good day. But I can walk, drive and sleep thru the night.

I wish I had a crystal ball!

Any guidance from anyone who has been through this post-op medial problem would be really appreciated. You know I don't even care about the ROM now - I just want to know I haven't caused my medial ligament a problem I should be getting fixed.

Ummmppphhhh!!!!!!! I'm soooooo over it

I'm not even game to work out how long it's been since I had sex!! :beg:

I feel so old! :whistle:

mrs cricklewood · Jan 20, 2014

hi..interestingly my knee still feels really hot on the right hand side,( been about 4 and a half months now since my op ) and at night when I sometimes use a frozen blue freezer bag on my knee ( as opposed to my ice bag ) the right side of it melts way before the left hand side and sometimes when I show my husband he says he can feel heat in the cold pack from my knee ! My surgeon did give me a sheet of info before my op and said you could expect to have heat in your knee for quite a few months but it did not mean there was anything wrong...he also said he did not want his patients taking any form of antibiotics at all to speed up recovery.... regarding the sex part..hey I doubted I would ever be able to bend my knee to be able to have sex too....!! ( I did get there eventually ! My hubby was very happy about that hahahha :yes!:

) Like you I have a lousy ROM but I am walking my dog..going on bushwalks....driving the car..and spending most the day on my feet, so I am doing what my physio told me to do ..get on with my life..do my knee bending exercises when I can and it can only improve over the months.... All the best X :flwrysmile:

Josephine · Jan 20, 2014

class dunce said:
My pain level is up and down between 3 and 6 and worse when I lie down.
I take paracetamol - 2 x 500mg every 4-6 hours - I gave up Endone 9 weeks ago, Tramadol 7 weeks ago, Gabapentum (Neurotin) 8 weeks ago.

Gal, if you have pain, you need pain killers! The paracetamol is good but times when it spikes to 6 or more, you need Tramadol. Maybe just 50mgs but do take it.

Interesting you say it is worse them you lay down.
Can you tell me the location of this pain using this chart?
Each square needs a double reference like so BR1 and say if it's front or back..

[Bonesmart.org] Can 65 ROM really get better without MUA after 14 weeks

class dunce said:
So I ice it a minimum of 4 times a day and more if needed.

Ice more. It's nature's natural pain killer why stint on its use? And how long do you ice it for? If it's less than an hour at a time, it's a waste of time!

class dunce said:
I sit with my leg along the couch but need to get a proper wedge to elevate it properly.

You don't need to buy a wedge. Just use a stack of pillows of cushions like this

class dunce said:
My knee kept blowing up and one physio kept pushing and telling me I was running out of the window of opportunity. I had enough and made a decision not to go back. I quit formal PT and now just walk the dog in a very stop start fashion 2 to 3 times a day for about 20mins - 30 mins each time.

Good for you! Take your destiny in your own hands ev ery time, I say! And as for that nonsense about thw window of opportunity, it's an urban myth! Read the article Jamie left you in post #6 for more detail.

class dunce said:
Everyone says my knee looks really swollen but in truth I think it is getting better and it isn't as swollen as people think. I think it's bigger than my other knee and a different shape to my other kneecap. Can it cause problems if they put in a knee that's too big?

It's possible but extremely rare. Most surgeons spend a considerable amount of the operating time making sure the implants are an appropriate size for the patient. It's more likely your knee is more swollen than you think it is! Wouldn't be at all out of place for knees to still be hugely swollen at 12 weeks.

class dunce said:
Is it possible that while I needed a new knee, which apparently I did due to osteoarthritis, could I also have medial ligament disorder, which was never fixed properly and is the root cause of the burning medial pain I feel? Could it be that this swelling and heat and pain isn't really coming from the new knee any more but from this old injury?

Of course it's possible and is very likely connected with the pain you are having. Which is why earlier I asked you to identify the site of your pain.

I'll be back!

class dunce · Jan 20, 2014

Hi Josephine. Thanks for being such a kind lady. We all keep you very busy with our constant questions!

My constant knee pain is BR4 between C and D. My tired leg pain is BR2/BR3 running down the calf from C-F and this is my "in bed" pain also. It feels like a torn medial with a bakers cyst.

I was prescribed some natural Meds from my naturopath in the form of anti inflammatory drops called "Formasan", natural Penicillian in the form of tongue drops and scar cream called "Notakehl" and a tablet called "Quentakehl D4". It seems to take the sting out.
I won't take Tramadol since I had that 3 week horror withdrawal from that and Gabapentum.

My 6 pain is relieved best by rest and ice and doesn't last long and is induced by over use so paracetamol works most times ok.

I didn't know you had to use ice for a min of 1 hour. We were told to only use it for ½ hour at a time!!!!! Can't believe how badly informed we have been by a rehab hospital of all places!!! Makes you mad!!!

Thanks for being there for so many of us Josephine and thanks to everyone else who supports as that is half the battle with this op I reckon. Having someone who KNOWS give you their ear. It's been my saviour. :puppysmooze:

Jamie · Jan 20, 2014

Your letters/numbers are a bit confusing. Do you mean the constant pain is at R4C and R4D?
And the tired leg pain at R2C thru R2F? I'm thinking you added the "B" when you shouldn't....and that you don't have pain at the B level of your right leg.

class dunce · Jan 20, 2014

Hi there Mrs Cricklewood ..... Hahaha! Glad you have a happy husband!!! Mine can live in hope then :egypdance:

If only the underlying pain would disappear life would be OK really. The ROM is workable. Not ideal by any means but I am like you...still getting on with life...just at a slower pace!! Sometimes it becomes an intellectual battle for me...a bit of a "whodunit!" And I can't understand why such clever people who become surgeons aren't interested in delving a little bit deeper and rising to the challenge of checking if they could actually solve some of these problems quickly rather than ignoring them for months and years and then all of a sudden getting interested enough to try looking where the patient was asking them to ages ago. I find it incredulous. Often it is just healing at a slow place but often it isn't and I don't get why it isn't a first option to get to the bottom of the problem rather than ignore the patient and plough on with the standardised version even tho it isn't getting anywhere! So frustrating! It's time you don't get back in your life and it can be negatively life changing for some because of it. I find it arrogant and irresponsible really.
Anyway, sorry for the vent! Just can't help it when you should have a knee that works and so should I. :headbang:

Take care. Let's just forget about our stiff knees and do something happy....take our dogs for a little walk :puppysmooze:

Look after you. :cheers:

class dunce · Jan 20, 2014

Sorry Josephine. Opps!! Sorry Jamie!! I didn't look properly at the poster!! Typical of me these days! I put the "B" to indicate "back of leg" as opposed to the pain being in the front of the leg. Thought it said to do that but I am the class dunce :angel:

The pain is in my right leg

Jamie · Jan 20, 2014

Ohhhhh.....well, that makes perfect sense then. The pain is on the BACK of your leg at those points. I'm sure Jo can work with that.

kneeper · Jan 21, 2014

I used gel packs. I'd keep it on until it warmed up then take a short break and then get the next gel pack.

class dunce · Jan 22, 2014

I am really conflicted here. My RTKR is stuck at about 65 ROM. The pain, swelling and heat is getting much better but the knee just won't respond in kind and bend any further. Sometimes it is worse, but not better! It is very interfering as I can't sit in shallow water or on a low step for instance, in a theatre isle unless at the entry, walk thru thick grass without tripping! Doesn't sound much but it is very intrusive.

My OS advises a MUA but I wanted to see if it would get to a minimum of 90 on its own when swelling went down, as it was pretty angry when I saw him around 2 weeks ago. I have rested and iced and the swelling is going down but the ROM is not increasing. It's seriously like it is locked. Feels like it's locked but only sore on the medial joint. Anyone who has had this poor ROM and had it increase on its own accord thru normal use to at least 90 could you please let me know how long that took?

If you had an increase in ROM over time but started at around 90 I think that's normal. It's the very stiff, locked knees that I would be really grateful to hear about because if it is unlikely to regain decent ROM on its own from 65 then I need to reevaluate my stance on a MUA before it gets too far along and the knee gets very hard to manipulate without other consequences.

Any success stories or non success stories from low ROM'ers would be really appreciated. I need to make an intelligent decision here sooner rather than later and I just don't have enough info so feel very worried. Thanks to all.

Jaycey · Jan 22, 2014

maryo52 · Jan 22, 2014

You are describing a "hard stop" in your ROM. That's not the same as slow progress or very slow progress.

A hard stop is a strong indication for MUA. You have developed strong adhesions that require more force than PT to break. You can always bargain for more time, but the more you try to bend your knee, the more inflammation you stir up which in turn causes more adhesions.

How about this as a compromise? Tell your doctor if you are still stuck at 12 weeks you'll be happy to have MUA. In fact, you can go ahead and schedule it for that time and cancel if you don't need one. This will give your knee another month to settle down, and in the meantime, you can be careful not to do any PT that hurts.

My knee had a hard stop as well. My MUA was successful but my scar tissue growth was so aggressive that things quickly backslid and I needed arthroscopic lysis of the scar tissue in order to progress . . . and even then, after the arthrolysis, it was 3-4 weeks before I hit 90. Some of us get the short straw. I'm 130 now and probably could get more if I tried, but I'm happy and I've learned not to push my knee.

bottomshollow · Jan 22, 2014

@class dunce. I agree---talk with your OS. An MUA may be just the ticket for you. You will need to take it easy for the first 2 or 3 weeks after---which means not overdoing the PT.

Take care and keep us posted. We care.

class dunce · Jan 22, 2014

Hi maryo2 and bottomshollow. I appreciate your help. Unfortunately I am already past the 13 week post TKR so need to make up my mind pretty quickly. I am travelling from Oz to USA early April for 6 week cruise and don't want to put myself back to a place of deep pain for that long haul flight. My pain levels are abating as is my swelling and I can walk ok. Just can't band my knee much so it causes problems with sitting, fitting into smaller spaces etc.

I have read so many MUA people who say after initial success it was a real flop and they are in greater pain. I don't want this to happen to me before our trip, but if I thought the recovery time was long enough before now and beginning of April and I wouldn't be any worse off than I am now re bend and pain, I'd bite the bullet and give it a shot.
My OS agreed it was best to do it now but he could do it after I return from USA early June if my bend was still bad.

Everyone on the forums seems to say it's too late then - 33 weeks post TKR. He says it's not ideal but certainly not unknown to work then and he's happy to do it that way for me - wait and see and get my pain level to next to zero for my holiday and give my knee time to bend on its own. Then MUA at 33 weeks if nothing has changed.

Do I take up this offer to be cautious or do I take the risk now and try and get a good bend to take on holiday with me knowing I might be back to this point instead with constant aching, bad bend and no time to improve it further before heading off on a 20hour flight x 2?

I really don't know what option is the most beneficial at this point in my circumstances. HELP someone who has been there, please!!!! :headbang:

skigirl · Jan 22, 2014

I have not had an MUA, but I think that when you have a hard stop as Mary described it, the indication is for one. Most of the people on the forum describe them as pretty easy, although some folks seem to have pain for a few days. I will tag @Josephine for you, but do you trust your doctor? If you do, then ask him more questions about the MUA. I went into the office before my tkr and talked to the nurse for about an hour---that is certainly an option too.

NetballKnees · Jan 22, 2014

CD ... I feel for you. I don't know what to advise as I am likely facing having to choose whether to have MUA or not next week. One of the forum members has just had MUA yesterday - stellar knees soon - I think it was. Maybe look for her post and have a read. I would give you the link, but I am hopeless at those sorts of things. I got excited the other day when I finally managed to put a quote in properly. :whistle:

I would think that maybe a manipulation would not make things worse than they are, and if you have one in the very near future, you have until early April to recover. I think I have read where intensive physio is needed for a few weeks after, which you may need to allow for. I gather it is either a same day procedure or an overnight one, depending on doc I think. Maybe you need to have a think about whether you wish to go on your holidays having managed to get less pain, but be restricted in where you can go and what you can do, depending on movement or go on holidays with much better movement of the knee and therefore more choices in activities.

I am sorry I can't be of solid help. Let us know how you get on and what you decide. I will be thinking of you.

Take Care ... and good luck with the decision making.

Ellen

class dunce · Jan 23, 2014

Hi Everyone.
Well my dilemma has been resolved for me. I rang my OS to make an apt to try to work out what to do but can't get an apt before 11 March with no chance of a cancellation apt and he doesn't do phone consults so that's that. No time to get it done and have any recovery period before I fly out on 9 April. At least it is settled. I no longer have to worry if I am making the wrong choice as the choice has been made for me and I am quite the fatalist so am settled now. Will just go with the flow, try to get pain free before I go with good nursing and hope to naturally regain some bend. Otherwise back to the OS when I return in June and go from there.
Feel relieved actually now it's been taken out of my control.

Thanks Skigirl for trying to help me. I really appreciate it very much.

Ellen, I feel for you. It's a constant second guessing game. All on a wing and a prayer. I know stellar knee soon - we rehabbed together. I admire her so much. Been thru too much for a young one and am delighted she has had a positive outcome. Hope it continues for her because she deserves a good knee.

You had very good advice by the way. Thank you and take care. Hope your knee is kind to you!! Let's know how you go.

Take care also.
Maddi

class dunce · Jan 23, 2014

Maryo52 I am going to bookmark you if that's ok with you because I would like to come back to you after I visit the OS in June re my "hard stop". I would like to get your advice when I am facing the MUA or the knife. Thanks so much for your help - I will be bugging you for more I am certain! :mcoffee:

Hope you don't mind. :groan:

In the meantime take care of you and thanks again. :sleep:

Maddi

Josephine · Jan 23, 2014

I merged your threads as per this request One thread for your recovery please?

Please also don't quote a post to reply to it every time.
Just scoot on down to the bottom of the page and start typing!

TKR Can 65 ROM really get better without MUA after 14 weeks

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