MUA Christina’s 2nd TKR Recovery

[KnitChica]

I’m currently two weeks post-op from my 2nd knee replacement and over the past week I’ve developed such severe sciatic nerve pain...mainly along the right (same side as current TKR) buttock. Only when lying down...So, sleep has become elusive.
Prior to this TKR, I was prone to right-sided sciatica, but not to this degree or consistency. And I could relieve it with a heat pad applied for a short time while lying down.
This sciatic nerve pain frequently more intense & unbearably than my operative knee pain. I didn’t experience this with my left TKR a year ago.
I have a slight suspicion that it may be related to using the CPM machine but I’m not 100% sure.
Has anyone else experienced post-op sciatica? If so, what have you done to relieve the pain?
Thank you in advance.

 

[Tykey]

Very rarely do we still hear of the CPM machines, because as far as I'm aware, it has been discredited by the medical industry, surveys showing it gives no benefit.
Can't say if it's responsible for your sciatica, but I would bin it, and see.

 

[Celle]

The CPM machine is still .in use and it hasn't been discredited. It's just that many surgeons now see it as not necessary.

@KnitChica , I'm sorry you have sciatic pain . A lot of people do experience back pain after a TKR. Are you lying completely flat? If so, try to elevate your leg while you're in bed. Your leg doesn't have to be completely straight. A slight bend will not only make your knee more comfortable. It will ease some of the strain on your back, which could help the sciatic pain.

If you're using a CPM, try giving it up for a while. Doing that won't retard your progress.
You might also cut back your PT to once or twice a week - 3 times a week really isn't necessary.

When you go to PT, ask your therapist to cut back the exercises and spend some time massaging your leg and back instead.

You have plenty of time to gain Range of Motion (ROM) as it can continue to improve for a yer or more post-op, so there's no need to rush with exercises.

The first couple of months post-op are a time for healing and gentle movement, not for lots of exercises. Your knee will gradually start to bend more, naturally, as pain and swelling decrease.

 

[Celle]

By the way, @KnitChica ,
You'll notice that I have again merged your two threads together as we prefer that members in recovery only have one thread.
Please don't keep starting new threads.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.

Please keep all your questions and updates on this thread.

Don't worry that we won't see your new question as, between us, the staff read all new posts daily.
If you need an urgent response to a question, just tag a member of staff.
Tagging other members and answering tags

Here are the instructions on finding your thread, How can I find my threads and posts? Many members bookmark their thread, so they can find it when they log on. Please will you do that?

 

[KnitChica]

@Celle My apologies about creating another threadI know about keeping all our posts in one thread, but for the life of me, last night I just couldn’t figure out how to create a new thread within my current one. Pain & lack of sleep may have been contributed to that thought process! Do I just start typing as if I’m typing a response to the last response?

At PT today, my therapist spent the majority of my visit doing stretching, rolling pin, & massage maneuvers....felt so good & I feel better now! He suggested that I decrease the flex angle on the machine but I think I’m going to also (per your suggestion) limit my time on that machine.

And while I am usually lying flat (on my back) in bed @ night, I have been keeping a thin pillow under my whole calf area. Maybe I’ll try sleeping with my incline cushion. My knee is usually bent to some extent at night because it’s just too painful to sleep w/it completely straight.

 

[Celle]

I know about keeping all our posts in one thread, but for the life of me, last night I just couldn’t figure out how to create a new thread within my current one

You don't have to create a new thread. You just post on the current thread, as you have done now. Ask your question and at the same time ask if we will change your thread title for you, to reflect your new question. OK?

We'll try to answer your question and give advice if we can.

And while I am usually lying flat (on my back) in bed @ night, I have been keeping a thin pillow under my whole calf area.

It's really better if you don't put a pillow just under your calf area, because that can slow down the circulation there and just might cause a deep vein thrombosis (DVT).

 

[KnitChica]

You don't have to create a new thread. You just post on the current thread, as you have done now. Ask your question and at the same time ask if we will change your thread title for you, to reflect your new question. OK?

We'll try to answer your question and give advice if we

Thank you, @Celle. I think I’ve got it down now. Sorry about my misunderstanding

 

[KnitChica]

t's really better if you don't put a pillow just under your calf area, because that can slow down the circulation there a

Again, thank you @Celle for your advice. That makes total sense & should know that. I guess I was just trying to find a comfortable position for my leg while sleeping since attempting to keep it straight is while sleeping is very uncomfortable.

 

[sistersinhim]

I slept with a Lounge Doctor every night for at least a couple of months. That will keep a slight bend in your knee which helps with the pain.

 

[KnitChica]

Greetings to all of you

I have a question about post-op knee extension.

I’m exactly 3 weeks post op with this (right) TKR (had my left done July 2019). I remember having difficulty early on post op with the extension of my other knee but I’m having difficulty remembering the details.
Currently my swelling is moderate, I’d say, but I feel as if I have no “give” in my knee to get further extension; vs my flex where I feel that there is “give” & I will eventually be able to flex further. With my extension; I’m guessing it’s at approx 5-6 degrees. Even though I go to PT three times weekly; I don’t let therapist push me to “pain”; only discomfort. Same for exercises at home where I’m really just doing heel slides & extension stretches several times a day.
Am I not feeling an “give” in the extension because there is still swelling & it’s still so early post op?
Thank you in advance for your answers.

Note to administrators: you’re welcome to change my thread to just “2nd TKR recovery” or whatever you feel is appropriate.

 

[Celle]

Am I not feeling an “give” in the extension because there is still swelling & it’s still so early post op?

Yes, you've got it! At this stage, trauma and swelling are inhibiting your ROM development - both flexion and extension.

There's no need to rush to get ROM (Range of Motion) 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

 

[KnitChica]

@Celle : why do I feel “give” in my flex, tho? But not in my extension? If the swelling is prohibiting further ROM, wouldn’t the flex be just was stiff? Maybe I’m overthinking this?

 

[Celle]

It's just one of those things.
It's actually quite common for extension to take longer to achieve than flexion.

 

[newlybionic]

Here’s an article about extension and ways to improve it

https://bonesmart.org/forum/threads/extension-how-to-estimate-it-and-ways-to-improve-it.9529/

 

[KnitChica]

Administration &/or moderators: would you please change my thread title to “Christina’s 2nd TKR Recovery” or something similar? Thank you in advance.

I’m in need of some advice from you awesome troopers out there!

So, I’ve been given the infamous MUA threat/suggestion. “Scar/adhesion” formation is the reason being given. I realize there is a difference between scars & adhesions. And I understand Bonesmart’s opinion of MUAs.

Currently, I’m 7 weeks post-op with my 2nd TKR. Had my left knee replaced in July 2019.

I was given this threat/suggestion last year w/my 1st knee, but I declined. As I learned on here (thank you @Celle ), my lack of ROM was mostly due to persistent inflammation from vigorous PT.

With this TKR, even though I’m going to PT three times a week, I’m not letting them forcefully (to the point of pain) extend or flex my knee. At home, most days, I perform almost all my own ADLs plus a short (15-20 min) walk which all averages to approx 5,000 steps per day. I try to do mild & gentle stretches throughout the day. Not excessive.

Even though I walk unaided, I walk with a limp. My house is a tri-level so the stairs are must. I can do them foot over foot with ascending flowing fairly smoothly and descending being more of a reach or stretch (thus more painful).

I measure maybe 95-100 degree flex and
5-8 degree extension. Those numbers haven’t improved in at least two weeks.

My knee seems to be getting tighter but doesn’t “appear” more swollen then 2-3wks ago.

Pain continues; at times up to a 7-8 out of 10.
I have approx 15-16 pills of 50 mg Tramadol that need to last until...forever! Because...Dr won’t refill anymore. My PT applied kinesiology tape last week which seemed help somewhat with the pain (mainly only when I do the stairs, tho).

I continue to elevate & ice several times per day.

On top of everything that goes with a knee replacement, last week I developed a horrendous urinary tract infection which was resistant to the first course of antibiotics (Bactrim which also made me extremely nauseous). I’m now the middle of 2nd course of antibiotics (Keflex). I’m paranoid that the UTI bacteria is going to travel to my knee joint!

I’m frustrated, exhausted, not sleeping well, and a bit depressed. I feel as if I’ve made absolutely NO progress in the past two weeks (and the degree of my flex & extension numbers reflect the same).

Maybe I really do need a MUA???
Maybe I really do need to be working harder or forcing my flex & extension harder (as PT suggests)???

 

[Celle]

Maybe I really do need a MUA???
Maybe I really do need to be working harder or forcing my flex & extension harder (as PT suggests)???

No to both of those.

At only 7 weeks post-op, with a flexion of 95-100 degrees and extension at 5-8 degrees, you are right on track. What's more, very few surgeons will consider doing an MUA once your flexion is past 90 degrees, and an MUA does nothing at all to help with extension.

Your main problem is that you have some very impatient PT therapists who are trying to frighten you into doing more, so they can demonstrate "good " numbers to show how efficient they are. Tht simply isn't good for your knee.

It really isn't necessary to go to PT 3 times a week. Once a week is plenty.
It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but right now it's prevented from doing so by swelling and pain.

Even though you're doing the right thing in not allowing your therapists to push on your knee, I think that all that PT is contributing to your pain and knee swelling. If it was my knee, I would stop PT, or at least cut it back to once a week, and spend a lot of extra time icing and elevating my knee.

You've been doing your best, but I think you probably need to stop working so hard at trying to improve your ROM.
Have a look at this article, because it says more clearly what I am trying to say:
Knee recovery - Lose the Work Ethic!!

Oh, I've changed your thread title, by the way.

 

[Geoffa]

I am at 10 weeks and have been blessed with a very good recovery, everything being relative of course.
My worst week was 7 th coming off opioids, frustrated because I wanted to be normal and angry over pain levels.
As good as my recovery has been I would not more do 5000 steps in a day than fly to the moon. Today!!
I only had 3 formal PT visits seemed a waste of money, have not seen my OS in two weeks, his advice was keep on keeping on see you in six weeks, take it easy and don't waste your money on PT go see a sports oriented deep tissue masseuse.
Had my second massage today and my biggest challenge is time to get my quads back to strength, this will only happen after a long time. My mobility limitations are almost solely because of weekness in my quads. This is causing instability and a feeling of tightness. Not pain.
My exercise focus is oriented to flexibility and upper leg strength.
I have no knee pain as such.
Improvement for me 7th to 10th week is exponential. Still fatigue easily, and ice as much as I did from day one.
Hope some positive words might help you over your current bump in the road.
Geoff

 

[Jockette]

My ROM continued to improve after my first year anniversary, and after my second, so there is obviously no window of opportunity.

I agree with Celle, what you need most is time to heal.

Recently I compared this recovery to baking cookies. My chocolate chip cookies take 12 minutes to completely bake. If I take them out earlier, at 2 minutes, 4, 8 or whatever, they will only be partially baked, and not all that tasty, because they’re not done yet.

The same is true of our knee at 2 months, or 3 months, etc. It needs time to finish healing.

 

[Jockette]

Maybe I really do need to be working harder or forcing my flex & extension harder (as PT suggests)???

This is not the answer, it will only cause more pain and swelling, which will reduce your ROM, rather than improve it. ROM fluctuates due to our swelling on a particular day.

7 weeks is still fairly early in a recovery that takes an average of a year.

With all the stairs you are doing, and just walking around doing your daily activities, this is what I call natural PT. If it was me I’d stop going to formal PT, you’re doing plenty without it.

 

[KnitChica]

Thank you to all of you for the awesome comments & support.
So...it’s been almost 4 weeks since my last frustrated post. I’m currently 11 weeks post op with this left TKR.
With much trepidation & a huge leap of faith, 2 1/2 weeks ago, I quit PT. It was a very scary move. And now I’m not sure if I made the correct choice.
My ROM has NOT improved one iota in the past four weeks. Flex @ 95-100 & extension @ approx 5 degrees.
I do all my daily activities, take approx a 15 walk everyday, and, since quitting PT, am doing gentle chair/heel slides and extension stretches with no force. With all my that, I average 3,000-4,000 steps. Pretty measly when, prior to surgery, I was walking at least 3 miles a day.
My surgeon still wants to do an MUA. He had suggested the same with my other TKR a year ago. I am actually leaning towards having it done. Mainly because quitting PT, doing gentle stretches have not improved my ROM at ALL!
I’m still icing & elevating several times a day. Taking Tramadol at night & Motrin or Tylenol during the day.
As a note: with my left TKR a year ago, I’ve never gained a great flex (it’s probably at 115-118) but my extension is great @ -2 degrees).
My reasoning towards the MUA is that I declined the surgeon’s suggestion of it with my other knee. So, perhaps, even thought I’m aware of the risks & set-backs, this will ultimately help me.
God bless all of you!