MUA Concerned and frustrated

Kandy

junior member
Joined
Aug 26, 2022
Messages
34
Age
55
Gender
Female
Country
United States United States
I had right TKA on 11/23/2021 and MUA on 2/8/22. In-home PT was great and I was ahead of the norm when I changed to clinic PT. Clinic PT was not a good experience for many reasons and I made no significant progress. The main complaint is that they did not believe I was doing enough at-home exercise and encouraged me to push "past the pain", despite 2.5 hrs of exercise at home daily.

I ended up having MUA at 11 weeks (which helped ROM tremendously). Changed to a new therapist who said the knee was continuously swollen from doing too much at-home exercise. Turns out that the knee is very sensitive to overdoing it. Recovery has been a process of doing too much, backing off, then increasing again. I have continued (paying out of pocket) with the new therapist but backed down to 2 sessions per month, still doing strengthening and balance exercises at home. My new PT gives me an exercise app with specific exercises to do at home, personalized for me.

At end of July, I had a big trip/conference where I walked 20,000+ steps daily for about 4 days. Fitbit logged 44 miles for the week. Clearly overdid it and iced it at night, and had increasing pain as the week wore on. It was a real setback. When I saw the therapist 2 weeks ago, he was able to relieve some of the fluid and made my knee feel a little better. When I saw him yesterday, nothing he did seemed to help.

Most pain is mechanical pain. I have been limping since my trip. I have painful crepitus upon extending my knee. I also have severe pain going up and down (worse going down) the stairs. Before the trip, I could alternate on stairs. Now, pain keeps me from bending my right knee so that I go up/down stairs one step at a time. Two weeks ago, the therapist said I didn't do anything other than irritate my knee and that it just needed rest, ice, and compression. So, I have been babying it and only doing isometric exercises and working ROM in the hot tub. Yesterday, he said it should have recovered by now since it has been 4 weeks. If not better next week, he wants me to go back to the surgeon.

I am back to constantly thinking about my knee. The knee is just achy when at rest. When extending it or stepping/walking, the pain is on the lateral side of the knee cap, in line with the bottom half of the knee cap. But, it almost seems to be deeper, like deep in the joint. It is puffy there from the joint fluid. The knee is still swollen and warm to the touch, but it has almost always been swollen and warm to the touch since surgery. It is definitely several degrees warmer than good knee so much that you can feel temp difference through my jeans.
Has anyone else had an experience of overdoing it and then just not getting over it? Or, does anyone experience pain in that location and know what caused it for them? It has only been 9 months and I know it takes 12 months. But, I am frustrated beyond measure and concerned that I may have done some damage with overuse.
 

benne68

Staff member since February 4, 2022
BoneSmart Staff
Joined
Sep 5, 2021
Messages
1,554
Location
Connecticut
Gender
Female
Country
United States United States
Welcome to BoneSmart, @Kandy. I'm sorry you are having such a hard time with your recovery and I'm glad you found us.

While this is a year-long recovery and we all have different aches and tweaks as our body heals, experiencing severe pain at 9 months isn't the norm. If you haven't seem any improvement after 4 weeks of resting, icing and elevating, then it may be time to have your surgeon check it out.

I'm sure others of our senior staff members will share their thoughts.

For now, I will leave you with our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
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
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital


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.
 

benne68

Staff member since February 4, 2022
BoneSmart Staff
Joined
Sep 5, 2021
Messages
1,554
Location
Connecticut
Gender
Female
Country
United States United States
@Kandy, I noticed from a post you left in someone else's thread that you have also had back surgery. Would you share some brief details on what and when? It might be helpful for us to have that information as we share suggestions with you.
 
OP
OP
K

Kandy

junior member
Joined
Aug 26, 2022
Messages
34
Age
55
Gender
Female
Country
United States United States
Thank you @benne68 for your response! I have read some of the articles you posted about, but not all of them. I will most certainly read them and get educated!

Apparently, I have a knack for growing bone spurs (like many others on this forum) in addition to a congenitally narrow spinal canal. Here is a list of my other orthopedic surgeries:

8/18/2015: Right knee arthroscopy
9/12/2018: ACDF for for C4/C5, C5/C6, and C6/C7
7/13/2020: Lumbar laminectomy with posterlateral fusion and instrumentation for L3/L4
12/22/2020: Posterior revision with instrumentation for C6/C7
 
OP
OP
K

Kandy

junior member
Joined
Aug 26, 2022
Messages
34
Age
55
Gender
Female
Country
United States United States
I had my TKR Nov 23, 2021. Despite working it hard (and subsequently working it TOO hard), my recovery has been very up and down. I continued with PT (thru last week) because I have not met my goals. Finally in July, I had days where I did not think about my knee for half a day. That meant that pain was around a 1-2. I counted that as a HUGE win for me. Another big win was when I could finally alternate up and down stairs, which did not happen until June.

Since surgery, there has always been noticeable swelling, some days worse than others. There has always been warmth on that knee compared to the nonsurgical knee. The past month has been a big setback because of overdoing it at end of July. Now I walk with pain in every step. Well, I mostly limp with pain in every step. Pain keeps me away from stairs unless it is inevitable. Then, it is one step at a time. I am back to where I was in the spring.

I have taken it easy for 4 weeks and I have not recovered yet from my overdoing. I have come to believe that in addition to all of us having our own healing journeys, some of us tend to have very sensitive knees.... knees that get irritated very easily at the slightest abuse. In PT, I would do leg presses and think that is barely challenging, that I could most certainly handle more weight. I even told my therapist to increase the weight, but he wouldn't. Then the next day, my knee would be angry and more swollen and hot than normal.

It's like the rest of my body, including my brain, thinks my knee is a slacker and not fully pulling her fair share in the recovery. On the good side of things, I have heard that even in the same person, knees can all have their different healing journey. So, if this one did not go so well, perhaps consider what could have made it better. Then, proceed with the next knee hoping to make a few changes to effect a different outcome.
 

sistersinhim

Staff member since March 20, 2017
BoneSmart Staff
Joined
Dec 4, 2015
Messages
28,072
Age
71
Location
Virginia
Gender
Female
Country
United States United States
I copied your post for seasick's thread to your own thread. This is all information about your recovery and you should have it in your thread, too.
 

sistersinhim

Staff member since March 20, 2017
BoneSmart Staff
Joined
Dec 4, 2015
Messages
28,072
Age
71
Location
Virginia
Gender
Female
Country
United States United States
You had an MUA in February. That sets your recovery back to that date, not your surgery date.
Finally in July, I had days where I did not think about my knee for half a day. That meant that pain was around a 1-2. I counted that as a HUGE win for me. Another big win was when I could finally alternate up and down stairs, which did not happen until June.
That goes to show you that it can be good when you don't over do it.
There has always been warmth on that knee compared to the nonsurgical knee. The past month has been a big setback because of overdoing it at end of July. Now I walk with pain in every step. Well, I mostly limp with pain in every step.
This is perfectly normal. Warmth is a sign of healing. As long as it's not hot and red, you should be fine.
some of us tend to have very sensitive knees..
I think this is true.
In PT, I would do leg presses and think that is barely challenging, that I could most certainly handle more weight. I even told my therapist to increase the weight, but he wouldn't. Then the next day, my knee would be angry and more swollen and hot than normal.
Oh my, leg presses are really bad on a new knee. It let you know that it's not ready for that yet.
I have heard that even in the same person, knees can all have their different healing journey.
Very true. Each knee going into surgery is also different so the work the surgeon has to do is different.
 
OP
OP
K

Kandy

junior member
Joined
Aug 26, 2022
Messages
34
Age
55
Gender
Female
Country
United States United States
I had a visit with my surgeon today. He said there is some loose cement on the outside of my knee joint (near where the fibula attaches). He mashed around that area and it wasn't tender. So, he doesn't think that is problematic. He thinks I just over-used my joint and need to give it another month of rest, and go back to cane/walking stick for at least a week to see if that helps. He did prescribe some stronger NSAIDs, which I hope will help.
 

Snookums

new member
Joined
Jul 17, 2022
Messages
14
Age
59
Gender
Female
Country
Canada Canada
Dear Kandy I here your pain and frustration. I saw my surgeon 3 days ago and he wants to do MUA. I'm anxiety and depression from the knee surgery is so great I can't even consider it. I know I have picked the long road but mental health has to be considered. The surgeon and PT make you feel inadequate and this I am still struggling with. Be kind to yourself with what ever decision you make. TKe care.
 

hawk2go

Staff member since January 6, 2022
BoneSmart Staff
Joined
Jun 16, 2015
Messages
1,474
Age
63
Location
PA
Gender
Female
Country
United States United States
He thinks I just over-used my joint and need to give it another month of rest, and go back to cane/walking stick for at least a week to see if that helps.
@Kandy - how's it going? I'm glad the diagnosis wasn't dire.

I was not hesitant to return to my cane when I needed to give the knee a rest. This recovery is not a straight line and as you find your balance between doing too much and too little, you'll be on the recovery roller-coaster.
1662753802908.png
 
OP
OP
K

Kandy

junior member
Joined
Aug 26, 2022
Messages
34
Age
55
Gender
Female
Country
United States United States
@Snookums , I am just now seeing this. Looks like you chose not to have the MUA. Everyone is different and what is best for one is not necessarily best for another. I can only share in your pain and struggles. Hearing your doc recommend an MUA is scary. There is a window of when it is best to do it and have the best effect. I know it is depressing and frustrating, but know that needing an MUA is not your fault. Once I surrendered to the anxiety and frustration, it was what I needed to kick start my recovery. I was so hesitant to do it. Even my husband really did not think it was a good idea. But, I trusted my therapist who had no skin in the game. And of course, I trusted my surgeon. It was a life changer for me and helped me to get my ROM back. I am so thankful that I did it. If surgeon thinks the MUA will help and if the mental part stands between you and getting the MUA done, I encourage you to get the help you need with anxiety and depression so that you can get the MUA done sooner than later.
 

Jockette

Staff member since March 18, 2018
BoneSmart Staff
Joined
Aug 29, 2017
Messages
32,454
Age
67
Location
Delaware
Gender
Female
Country
United States United States
There is a window of when it is best to do it and have the best effect.
MUA can be done at any time. The only window is the one each surgeon personally believes in.
Everyone is different and what is best for one is not necessarily best for another.
Indeed, we all recover differently.
 
OP
OP
K

Kandy

junior member
Joined
Aug 26, 2022
Messages
34
Age
55
Gender
Female
Country
United States United States
@hawk2go , I love that sketch, but it is lacking some of the big dips down (and up) that recovery seems to embrace. I had my appointment today and still no answers. My surgeon said sometimes we just don't know the answer to why. He is optimistic and thinks my knee just needs more time. So, prescription is to go back to PT but don't do anything that makes it hurt. Reminds me of a song by Chicago, "Hard to Say I'm Sorry." But we should change the lyrics to:

"Every knee needs a little time away",
I heard him say,
From working so hard.
Even knees need a holiday
Far away from therapy.

Ice them now
It's hard to reach for the cane again
I just want them to heal

After all that we've been through
So many things I want to do
Please promise to
And after all the surgery that's been done
You're just a part of me I can't let go

Couldn't stand to be kept away
Just for the day
From my exercise
I just want to be swept away
Far away
From the pain of recovery

Ice them now
It's hard to reach for that cane again
I just want them to heal
Ice them now
And do those heal slides once again
I am ready for recovery

After all that we've been through
And all the things I want to do
Please promise to
And after all that hard recovery
You're just a part of me I can't let go
After all that we've been through
All those things, I'm gonna do
I promise to

I'm gonna be the lucky one
 
OP
OP
K

Kandy

junior member
Joined
Aug 26, 2022
Messages
34
Age
55
Gender
Female
Country
United States United States
@Jockette, that is interesting because you are right in that my surgeon said it is best to do the MUA around 11-12 weeks, with a window of 8-14 weeks. I did not realize that each surgeon has his/her own time frame.

So, reality is that I am so very frustrated and angry that my healing has not gone as I had expected. I got news last week that my polyethylene insert was recalled for packaging issues that could lead to oxidation that could lead to premature failure of the knee. In fact, it has a 3 to 7 fold increase in premature failures starting at the 3 year mark.

Is my insert likely the culprit of my current knee problems? No, or at least the doc doesn't think so (I don't think so either). He said it would be very rare to be problematic this early, but I have been on the "rare" side of the curve before. He said I worked hard to get my ROM and the alignment looks good right now. He can't explain why the pain has returned. He can't explain why 2 months of rest hasn't improved the situation. He said that xray looked good and doesn't want to do CT and cannot do MRI. A nerve block won't help because there is no nerve to block with regards to my pain location, according to my surgeon. He won't do a steroid yet because he doesn't want to introduce anything to start an infection. I really want to embrace his optimism, but deep down I am gravely afraid that my knee won't heal itself from this problem. Twice before, I have been down the road of unknown, rare, and unlikely where it took 18 to 20 months to arrive to the conclusion of surgery. In those cases, surgery fixed the problem completely. Early on, I felt that nagging gut feeling that it wasn't an issue to just be given more time, like an over-stretched nerve, or myriad of other missed diagnosis. At least my surgeon is honest and can say "I don't know."

I poured through people's stories here who had similar experiences. I have researched the topic until I am blue in the face. I want to believe in a miracle recovery. My concern is that it could be a sensitivity to metals, a deep infection, a loosening to the implant, or scar tissue. There has been a clunking noise that showed up at about 3 months, but my therapist said that was common and would go away (it hasn't yet). When the pain returned at the end of July, it also happened that I started to have grinding that you can feel on that area. The pain is deep inside, on the lateral side, lower edge of my knee cap. If you put your fingers on the lateral side of my knee cap, you can feel the grinding and that is also when I feel pain. It's almost as if I never had the knee replacement surgery as this is what I complained about prior to surgery.

So, I am battling the mental game with all of this. It's hard to wait on recovery. And the weird thing is, I want to punish my knee. Like, I am angry and want to just make it do the hard things I want it to do (leg presses, knee squats, kneeling). It's kind of a weird. I am not going to do those things, but a part of me wants to make it do those things and then add "You're going to like it" at the end. That sounds ridiculous, childish, and kind of funny. But, that is where I am at today in all of this knee recovery journey. I did not think I would be here at 10 months. I go back to surgeon 2 months from now at my 1 year mark.
 

Jockette

Staff member since March 18, 2018
BoneSmart Staff
Joined
Aug 29, 2017
Messages
32,454
Age
67
Location
Delaware
Gender
Female
Country
United States United States
So, reality is that I am so very frustrated and angry that my healing has not gone as I had expected.
I felt the same way! I had a partial, and thought I would be totally recovered in about 2-3 months. Well, that didn’t happen!
So, I am battling the mental game with all of this. It's hard to wait on recovery.
A lot of this recovery is a mind thing.

I did have a very rough first year, but I had a lot of improvement in my second year. Hopefully you will too!
 

sistersinhim

Staff member since March 20, 2017
BoneSmart Staff
Joined
Dec 4, 2015
Messages
28,072
Age
71
Location
Virginia
Gender
Female
Country
United States United States
You just passed the halfway point of your year-long healing. Remember, the MUA sets your recovery time from that date now, not the actual TKR date. MUA causes a lot of internal inflammation and possible damage that your knee has to heal from. You need to try more patience, not easy, I know!, but I think time is your best friend right now and that's what you need, more time.
 

Snookums

new member
Joined
Jul 17, 2022
Messages
14
Age
59
Gender
Female
Country
Canada Canada
I am seeing improvement after doing less exercises for a week while swelling lessens. I am very determined to not walk with a limp so low and purposefully is the order. Is there anything else i can do for swelling? I'm confident I can get there without MUA. Anxiety and depression still rule my life. Meditation Escitalopran takes 4 weeks to kick in?
 
OP
OP
K

Kandy

junior member
Joined
Aug 26, 2022
Messages
34
Age
55
Gender
Female
Country
United States United States
@Jockette . thank you for sharing that with me. I hope that I see bigger results in the future than the results I have had. So, I will hold out for that hope, especially knowing that you made more strides in year 2.

@sistersinhim, To me, the MUA was much bigger in my mind before the procedure than the reality that it was. My doctor said it was fairly easy for him to manipulate to 122 deg. My pain after was minimal (compared to TKR). So, I haven't really thought that my recovery started over at that point. It was like my recovery plateaued before the MUA, and the MUA kicked it into gear. Perhaps if I think about February/MUA as my starting point, then I am probably only a little behind of where I think I should be. I am looking forward to going back to PT this week, as I haven't been in about 6 weeks. I want to have someone tell me what exercises I can be doing that won't irritate the knee.

@Snookums, I have learned that paying attention to what the knee is telling you is of the utmost importance. Backing off exercise is sometimes what is needed to move forward with recovery. Things that help with swelling are: icing at regular intervals, compression socks, massaging the knee, perhaps a lymphatic drainage massage, topical NSAID cream/ointment, oral NSAIDs, and of course, trying not to overdo it or irritate it. As for Escitalopran, I do not know. Geneally, most antidepressants require 2 weeks at a therapeutic dose before you know if the dose is enough for you. I wish you the best in your recovery!
 
OP
OP
K

Kandy

junior member
Joined
Aug 26, 2022
Messages
34
Age
55
Gender
Female
Country
United States United States
@Jockette or @sistersinhim, Can you tell me of a revision specialist in my area?

I have been to PT (very gentle) twice now since my appointment with my surgeon. I mentioned today (to my therapist) that in my surgeon's notes, it said I had a positive anterior draw test. Therapist did the test today and there was an audible pop and some pain. He did not pull very hard. He also said that anterior drawer test was positive and did not feel like my other knee. He has mentioned both times now that he thinks I should get a second opinion. So, if I get a 2nd opinion, I want to go to someone who sees knees that might be complex or a little complicated, not just a general ortho who might not have much experience with knees that have trouble.
 

Jockette

Staff member since March 18, 2018
BoneSmart Staff
Joined
Aug 29, 2017
Messages
32,454
Age
67
Location
Delaware
Gender
Female
Country
United States United States
So, if I get a 2nd opinion, I want to go to someone who sees knees that might be complex or a little complicated, not just a general ortho who might not have much experience with knees that have trouble.
I reported your request to the rest of the staff for their input.

Yes, this is the type of surgeon you want for a second opinion. It’s also a good idea to go a bit of a distance away so that you see someone who has no association with the current surgeon, to get an unbiased opinion.
 

BoneSmart #1 Best Blog

Staff online

Forum statistics

Threads
61,721
Messages
1,537,712
BoneSmarties
37,574
Latest member
Cal1100.
Recent bookmarks
1
Top Bottom