Bilateral TKR Double Manipulation scheduled - What to expect?

[Celle]

Funny thing about PT - is the more I do, the more sore I am.

no matter how fast YOU want to heal, your body will do so in its own time, and you can slow things down by overdoing.

Have 90 degree bends on both knees with some help from my PT. Can walk around the block outdoors with a cane. The more activity I do - the stiffer my knees are, after PT sessions,

Just had my 6 week post op visit with my surgeon. I am just a little better than 90 degree bend on both with no force.
Surgeon said he would like me to be closer to 120 bend and has scheduled a manipulation next week on both legs.

All I have quoted, above, tells me that you have been overdoing your exercise. Since your knees already bend to 90 degrees, you don't need a manipulation. Further bend will increase naturally, if you stop overdoing things and let your knees recover from the surgery. Doing too much has kept your wounded soft tissues swollen and inflamed and that - not scar tissue or adhesions - is what is preventing your knees from bending further.

Unfortunately, it appears that you also have an impatient surgeon. Most surgeons don't even think of doing an MUA once your flexion has reached 90 degrees.

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

And 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 it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will gradually increase.

At this stage, I think a manipulation is unnecessary. It will further upset your wounded soft tissues and will probably result in increased pain and swelling. In addition, the surgeon you have will probably recommend aggressive PT afterwards, which is counter-productive.

Your knees aren't lazy or unfit, needing lots of painful exercise. They are wounded after major surgery and they need gentle treatment, so they can heal.

You don't have to have the MUAs, even though your surgeon is keen to do them. They're your knees and only you have the right to decide what happens to them. Your surgeon can't do anything without your permission. You also have the right to decide whether or not to accept the advice of professionals. You can always ask for more time, as there is no critical time by which an MUA must be done.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

If you do go ahead with the MUAs, resist the urge to do lots of PT. All your knees need is to be kept moving gently. The manipulation will wound them again, so be kind to them and don't overwork them. Expect increased swelling and a decrease in ROM for a while.

Spending less time on exercises and more time elevating and icing your knees could be a big help, reducing inflammation and swelling and, thus, helping your knees to bend more, without the need for manipulation.

No matter how much you want to speed up your recovery, it's going to take a full year before your knees are 100% healed. Of course, you'll be able to do most things long before that, but healing will still be happening beneath the surface. That long recovery time applies to everyone, no matter what their age or fitness prior to surgery.

 

[Jamie]

I have to agree with Celle's post above. For people who truly have adhesions (and that's a very small percentage of patients), an MUA is called for. But your own description of what happens indicates this is not your problem. You have swelling and pain after exercising. That is a sure indicator that your knees are not ready for that level of activity just yet. It's your body telling you to slow down a bit. If you truly had adhesions, you'd feel a more like your knees reached a "hard stop" when you try to move them during exercise and you probably would not have a great deal of pain and swelling afterwards.

You were wise to listen to your body and start giving yourself a break of a day or so between exercise sessions. On your "resting" days, all that's needed are gentle bends and stretches throughout the day and your normal movement around the house or short walks outside. Lots of ice and elevation too are great for keeping swelling down. You are still very, very early in this recovery process AND you've had two knees done. That lengthens your recovery just slightly.

Why not give your body a chance to do this on it's own time schedule. Tell your surgeon you'd like to work on your own for another month. Then, during that month, only do exercises that you can accomplish with no pain while they're being done and very little pain or swelling in the 24-48 hours afterwards. There is no hurry to get through recovery. You want to do this right....not fast.

You indicate you want to get off your pain meds. Have you tried using 1000mg doses of Extra Strength Tylenol on a schedule every 6 hours? You can also ask your doctor for a prescription for Tramadol to use with the Tylenol if needed. It works well for many people. Just be sure if you go on a Tylenol regimen that you do not exceed 4,000mg in any 24-hour period. You also need to count other medications with acetaminophen in them like cold, flu and allergy meds.

 

[Jockette]

There is no rush to regain ROM, mine continued to improve well after my second year anniversary.

 

[Celle]

If you follow the BoneSmart approach, it would suggest that an MUA is the epitome of ‘making matters worse’ for many people. So, it’s a hard choice.The research shows, if I understand correctly, that in the long run, you won’t be any better off with an MUA, but in the short run, it can feel successful in a high percent of people.

@Helizabug, I think you have misunderstood what we say on BoneSmart.
What we say is that an MUA is seldom justified at 6 weeks, when pain and swelling are still present. At that stage, it is much more likely to be pain and swelling, and not scar tissue/adhesions, that are preventing a knee from bending further.

Unfortunately, some surgeons and PTs are impatient and they are not prepared to let the knee recover at its own pace. Some of them believe in the mythical "window of opportunity" and think that "It's now or never" for the knee to achieve full ROM. In fact, ROM can continue to increase for a year, or even much longer, after a knee replacement.

There is a proper time and place for doing an MUA and, when done at the right time, for the right reason, an MUA can be effective and helpful. The right time is later in recovery, when swelling has decreased and the knee has had time to heal more, but still cannot bend to 90 degrees or more. At that time, the surgeon or PT will be able to feel a "hard stop" when attempting to bend the knee - it feels as if there is something like a hard brick wall preventing the knee from bending further.

Far from not being any better off after an MUA, a person can receive a lot of short-term and long-term benefit from the procedure, if it is done at the appropriate time, for the correct reasons, which I have just described, above.

 

[Didot]

I support what has been said above. I needed a MUA on both knees (done 8 months apart), which my surgeon claimed was unusual. Neither knee got anywhere near 90 degrees. He said I needed to wait for a full 12 weeks before he would consider it, as the adhesions (if that was the problem) were only able to be properly broken then. No point in doing it before then, he said.
Once done - at 12 weeks - I never looked back. I'm still way from perfect and cannot get the bend he did in theatre, but I truly believe that slowly but surely it improves more and more over time. I had my first knee done in January last year and it's still far from fully recovered.... but getting there. Hopefully.

 

[Minnie77]

So I had bi lateral total knees done in October. I had the manipulation done at 5 weeks. I think it helped me a ton but everyone is different. I couldn't bend my right knee more than 55 by then and I couldn't straighten my left knee barely at all. I went under for probably 15 minutes was all. Woke up and he put me at cpm machines for 2 weeks for 23 hours a day. I'm not a sitter so I wasn't in them for 23 hours a day. I only slept with them a few nights. I'm not sure if they actually helped at all! But after the manipulation I was bending at 100 and just about straight. There really wasn't too much added pain. As for sleeping I think finally in the last week or 2 I'm able to sleep at a 5 hour stretch. I was also waking every 2 hours. I did a whole lot of icing too! But again everyone and every knee is different in recovery! Good luck to you and I hope you see improvement a little everyday!