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

[Josephine]

So this is the site of your pains, yes?

The orange site looks like it could be tendinitis in the lateral (outer side) collateral ligaments and the green one, maybe the ham strings. Try icing the back of your knee and doing hamstring stretches.

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.

Then mind you don't over use it! More cases of tendinitis are caused by over use than anything else!

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!!

I don't knowwhy they say those things! It's daft! I know I iced for hours at a time, even slept with the ice wrap on.

I am really conflicted here. My RTKR is stuck at about 65 ROM. My OS advises a MUA but I wanted to see if it would get to a minimum of 90. Unfortunately I am already past the 13 week post TKR so need to make up my mind pretty quickly.
Everyone on the forums seems to say it's too late then

You never read that here! What forums? Stay away from them! And why conflicted? There is no 'best' time to do an MUA. I've known people have them a year or more post-op. Read this It's never too late to get more ROM!. I shall leave you more articles to read

First are the mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!

Next is a FAQ (Frequently Asked Questions) thread.

And then the articles in order of importance .
Group A
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Progression of activity for TKRs

Group B
How Long Does Healing Take ......
Chart representation of TKR recovery
Energy drain for TKRs
Elevating your leg to control swelling and pain
Using ice

Group C
Knee Replacement - Where Am I in Recovery?
So What Is It Going to Take? The Five “P’s” of Knee Recovery
Work “Smarter” and not “Harder”
About recovering a knee - from one who knows!
Some suggestions for home physio (PT) and activity progress
Myth busting: The "window of opportunity"

Group D
MUA (manipulation under anaesthetic) and adhesions
It's Worth the Wait for ROM
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

 

[class dunce]

Hi Jo
Thanks for the advice. I asked why they say not to use ice for more than 1/2 hour at a time and was corrected 20 mins! Apparently it is because the cold can restrict blood flow if it is applied at a constant cold temp. The theory over here is 20 on 20 off to encourage dilation but not coagulation. My OS tells me that he has performed many an MUA after 12 weeks up to a year but that there is greater risk of bone damage the longer it is left because the OS has to put greater pressure on the bones because the internal scarring is much greater and much harder to break up. Just kinder on the body around 12 weeks. He said 6 weeks is too early to tell and causes damage because knee is usually already inflamed and swollen and 12 weeks is best because swelling is usually a lot better but adhesions are still soft enough to break without too much pressure. That's what he says just out of interest and he specialises in MUA's.
Have had my MUA now as you will see in my post. In my case needed it and am now bending well and best of all am pain free at last.
Complicated joint the knee. Complications not uncommon then I suppose. I feel very wise now I'm on the other side!!! Feels great to recover once you find your own personal path to that recovery that actually works for you! YAY!!!
However this site provides a wonderful ear when you are searching for that personal path!! Thanks to all the wonderful members who provide invaluable support which we all need and without we are fearful and isolated. Cheers dears!!!

 

[NetballKnees]

Hi Maddi ... Okay I appear to have gone to sleep and missed something. You have had your MUA? I can't find that post on here, but then again, sometimes I have a "man" look. That is fantastic that you are now bending well and pain free.

This should mean your holiday cruise will be fantastic and you will be able to do as much as you care to.

My OS did not wish to do MUA - he is quite content for me to plod along slowly. I am a teeny bit concerned though as I do have what is pretty much a "hard stop" when I get to a certain point, but maybe my return to the gym and pool work will help. I go back in April with new x-rays of the knee. I have not yet reached 90.

I hope everything goes so smoothly for you now, with no setbacks or concerns.

Take Care ... Ellen

 

[class dunce]

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

Maryo52 I would like to update you on my progress.

I had never heard of a "hard stop" so with this information in mind and stellar-knee-soon's story regarding her decision to have an MUA I got in touch with my OS to take him up on his offer of an MUA as a "hard stop" is exactly what I had, in fact.

Upshot is I had an MUA at 14 weeks yesterday and it turned out not to be an aggressive painful one. My knee was just locked at around 65/5 ROM caused by constant swelling due to my having been on Warfrin for the first 6 weeks after surgery. I also had a knock to the knee which locked it up more.

My OS said it would not have corrected on its own but he only needed to lightly adjust it and click it into place. Yippee!! Came out MUA 70 ROM so was pretty disappointed. They put me on CPM all night and good pain Meds and gradually increased ROM on machine. This morning - 18 hours later - I was 100/0 on CPM and pain free. Don't know what my ROM is without CPM but I know I can bend my knee back under a chair and slide it back and forward on floor so it well bent - all pain free!! Could not manage these excercises even once at physio rehab in the 10 weeks of that gruelling time!!!

So Mayo52 thank you for your post and stellar-knee-soon thank you for your advice. Glad all is well with your knee Jules and best of luck with yours Ellen. Maybe you could approach another OS who is a specialist in MUA's Ellen just for a chat and a second opinion if you are feeling unsure and wish to have someone who daily deals with these problems take a physical look at yours. You don't have to go ahead but it might help you feel more settled in your future choice or protocol for that troublesome knee.

Can't believe I'm on my way at last! Good luck everyone who feels conflicted. And thank you to all those who have contributed and helped me when I was one of the confused masses. Take care.
Maddi

 

[icep707]

This is great news. Just read your whole thread. Im getting closer so im reading whole threads now. I must of slept too. I thought you had to wait till after your vacation for the MUA. Nevertheless your path is your path. Im really glad to hear you are bending and pain free. can you pin point what went wrong ? Was it the meds or the fall ? And can I get one words of advice as im pre op and feel very well prepared but theres always something I can learn ! Thanks and congratulations on the Successful MUA

 

[class dunce]

Sorry everyone I have left out some vital info here. Still a bit addled!

After I refused the MUA I was happy until stellar-knee-soon, a friend of mine, took a deep breath and took her OS's advice and had her MUA which was a huge success. After this I took stock of why I refused the MUA - fear. I got in touch with my OS rooms and his PA cut me off at the pass telling me no way until 11 March - too late before my Big USA holiday.
Kneeper replied to my thread and asked if I was sure it was too late if I explained the circumstances so I then sent my OS an email asking for a reassessment and why, explaining the time frame. He was great and put me in yesterday. Today is a brand new day because of all the help and encouragement of other "bonesmarters" so that is how I happen to be on the other side of ROM and pain in January instead of June!!
Thank you guys. You just never know how much you are helping someone. In my case I would still be sitting around, dragging my dodgy knee all over the world just because I didn't have the courage to give it one more shove, even tho my very experienced surgeon couldn't guarantee a good result, but would bet on it. And in my case, it didn't really hurt. I woke up with a knee that isn't even swollen! It is weak from the spinal block and I guess it would be sore if I stopped taking my Meds but I am only on 2 x paracetamol every 6 hours and 1 x Endone every 3 hours so I can use the CPM machine and do my stretches and bends properly. I feel no pain. A bit of pressure when I reach max bend - 105 and max stretch - 0. Sleeping like a baby! If you are not progressing with your ROM which should be around 90 by 6 weeks but if not creeping upwards by then give or take a week or two, then you should try to identify why. Especially if your pain level is increasing. I thought I could cope with 70 but that started to aggravate my hip and knee joint because of my half gait. More pain, especially when I was resting, ice or no ice. Anyway, it's always easy in hindsight. Especially if you have a good result. But my revised theory which got me the immediate MUA was it was getting worse, not better, so if it did work then I had time to get it right before my trip and if it didn't work I had time to calm it down before I went away and I would at least know and not be putting my dodgy knee thru a late post op MUA, instead of a safer earlier one. 14 weeks is better for a regressing knee then 32 weeks.
Thanks Kneeper and stellar-knee-soon. And thanks OS Professor David Campbell!!

 

[kneeper]

I'm so pleased your doc was responsive and you are on the road to a recovered bendy knee.

 

[class dunce]

Thanks Kneeper. Me too.
Icep707 my only advice is to do what your OS tells you to do. Don't overdo it. DO your bending and stretching exercises and work out your pain Meds with your OS and insist he/she either puts that in writing or speaks to nursing staff so you don't have them contradicting your OS re post op Meds. This is way too common and you don't need this complication straight into your recovery phase. And if you find your Meds aren't working get them changed. My body reacts well to morphine based Meds but not narcotic based ones. Fentinal, pethedeine, tramadol - shockers for me. Morphine patches, drips, Endone all work. So discuss before surgery with your OS and make sure they don't let nursing staff try and over rule his orders. And don't take 'as needed'. Take your phone, set an alarm and take per the clock for first few days until theatre Meds have worn off and you can get a better idea of pain. Nurses will wait till you ask so set that alarm! Good luck.

 

[NetballKnees]

Hi CD .. it is marvellous how your MUA has resulted and I am so happy for you. I am so glad that you are now on your way. Your ROM improved so much in just a day. Good and brave decision of yours.

Hope everything continues to go well for you.

Take Care ...
Hugs .. Ellen

 

[maryo52]

Just catching up with your news. So glad you were able to move forward. It really does feel like diving off the high board for the first time! What relief I felt after MUA when I went to get off the stretcher and my leg dangled normally. It was as if the leg had been sprung from prison.

I don't completely understand why you were stuck but no matter, it was cleared up. The fact that your surgeon explained that your chances were good for improvement but couldn't guarantee it proves that he's a good surgeon. Knees can be dodgy and there are no guarantees.

Stick around the forum for a while. There are others standing on the high diving board who need encouragement.