TKR Dreaded MUA?

[Josephine]

I am at 8 weeks post surgery and I am only at 75 ROM! My PT is hinting that I may have to have an MUA and I don't want to have to have the dreaded MUA!

Then don't have it. You have the right to choose and if you would prefer to give it more time, then just tell them so. Besides which, your PT's opinion may not be shared by your surgeon, remember that.

I have been working very hard to try and stretch and get my numbers up

I think you need less activity rather than more because all you're doing is making your leg swell more which is most likely why your ROM is low in the first place. Plus at only 8 weeks it's not at all uncommon to have low ROM caused by swelling. Read this Swollen and stiff knee: what causes it?

I wanted to know if anyone who has had the procedure and how it has worked for them?

If you go into the recovery forum, you will find some threads have a prefix label like this

Click on the prefix and you will get a list of all similar threads old and new.



I'm also going to ask you some questions and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

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!

) Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

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 ROM - that's flexion (bend) and extension (straightness)

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

7. what kind of PT exercises and exercises at home are you doing? How much and how often? (and detailed details would be appreciated, please! **Reps, sets and sessions** and all that)

** If you're not familiar with this, it goes like so:
1 lift of your leg = 1 rep (repetition)
5 reps and then a brief rest = 1 set
5 sets and finishing = 1 session.

 

[kneeper]

It is a fine balance between doing your exercises and *overdoing* them. I know I got kind of stalled for a while due to swelling. When it came down, I started gaining bend again.

But if you do wind up doing the MUA it isn't the end of the world. We've had people who it worked out well for. I don't know why PT's try to scare us and make it like a "threat." :(

 

[referee54]

But if you do wind up doing the MUA it isn't the end of the world. We've had people who it worked out well for. I don't know why PT's try to scare us and make it like a "threat." :(

:iagree:
It just may be something that you need to have done---not yet---but wait and see.

If it does come to pass that you need an MUA, it is just a procedure to get you on your way.

There are quite a few of our members who had MUA's and it was a big boost to them.
It is not an act of failure.

 

[numbzee]

Thank you Josephine
1. Iam doing pretty well in regards to pain levels. When resting I have no pain. I would say the pain doesn't get above 3 or 4 unless my PT is pushing my ROM then it will go to 8 or 9 ! Still have stiffness and swelling .
2. My doctor had prescribed Oxycodone 7.5/325 after surgery one to two at a time as needed for pain. In the first two weeks I took mostly one every four hours around the clock. As of today 8 week I am only taking one Oxycodone 5. /325 before bedtime. Dr.lowered my dose two weeks ago. During the day I take 1,000 mg of Tylenol two to three times a day if needed. There are times when my knee feels like the bone is aching but not enough for heavy Pain medicine. Sometimes have shocking pains without warning. Guess it's the nerves trying to heal?

3. I ice my knee two to three times a day
4. I elevate whenever I am sitting or lying down
5. My ROM is 75 with help with PT. Extension is 0 no problem there.
6.Light housework, laundry, vacuum, cooking doing dishes. Taking care of my two dogs
7. Exercises, leg lifts 3x10, hamstring stretches 3 for 30 seconds, heel slides 5 for 30 seconds each, toe raises 3x10 slowly. Step ups on 4 inch step 3x10.

 

[referee54]

Sometimes have shocking pains without warning.

Yes---I used to call those, "zingers." The nerves are now knitting together.

 

[Minnie's knees]

:iagree:
If it does come to pass that you need an MUA, it is just a procedure to get you on your way.
It is not an act of failure.

I am having an MUA tomorrow. I am 9 weeks and stuck at 86. My OS gave me the option to wait another 4-8 weeks and maybe not need it or have it now. He told me exactly what @referee54 said that it will just get me there a little faster and before I go back to work in 2 weeks. He also told me it's nothing I did, I have RA, diabetes and issues with my liver so pain meds are limited to 1x day. This all contributed to the slower recovery. I can't afford to be off work again and as of Jan 1st I will have to pay $4000 deductible and out of pocket expenses. So I chose to do it now. You will know if and when it is right for you.

Hang in there and keep doing what you are doing!

 

[Celle]

Best wishes for your MUA. I hope it helps you.
Don't forget that the MUA does cause some soft tissue damage, so be prepared to rest, ice, elevate again for a bit longer than you have been doing.

 

[Minnie's knees]

@Celle thank you!

 

[numbzee]

Hi Minnie's Knee! Thank you for your reply. That was considerate of your OS to let you make the choice and not force the procedure on you. I understand your wanting to have this done today since you have to go back to work soon and the medical deductible for next year coming up . I would have done the same thing if I were you. I am thinking about you today and hope it all goes well. I am retired so no pressure to get back to work! Lucky me. Please let me know how everything went today. Take care

 

[Minnie's knees]

@numbzee I love my OS because he is always that way. He never pushes. He gives the facts and/or options and lets his patients make their decision. I posted an update about my MUA on my thread. I wish I could retire but it will be a few more years so I need a functional knee that I can be happy with. You are fortunate to be retired and be able to be patient. Good luck with your continued recovery.

 

[Josephine]

1. Iam doing pretty well in regards to pain levels. When resting I have no pain. I would say the pain doesn't get above 3 or 4 unless my PT is pushing my ROM then it will go to 8 or 9 ! Still have stiffness and swelling .

Well, you have to stop that! No exercise should ever hurt AT ALL. Remember the mantra: if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you. You don't need to argue, just say NO in a very firm voice and tell her that of she does that again, you will report her for abuse. When you say no, she is no longer allowed to touch you as you have withdrawn your consent and all us medical carers are required to have the patient's consent to do anything, even washed their face!

2. My doctor had prescribed Oxycodone 7.5/325 after surgery 1-2 at a time as needed for pain. In the first two weeks I took mostly one every four hours around the clock. As of today 8 week I am only taking one Oxycodone 5/325 before bedtime. Dr lowered my dose two weeks ago. During the day I take 1,000 mg of Tylenol two to three times a day if needed. There are times when my knee feels like the bone is aching but not enough for heavy pain medicine. Sometimes have shocking pains without warning. Guess it's the nerves trying to heal?

People say that but I have no evidence to suggest it to be so. I rather think it's just muscle spasms from inadequate pain management. So on that note, take your Tylenol as much as you can whilst not forgetting to add in the 325mg in the oxycodone, of course.

3. I ice my knee two to three times a day
4. I elevate whenever I am sitting or lying down

You never answered my questions ...for how long o you ice or elevate? This is important.

5. My ROM is 75 with help with PT. Extension is 0 no problem there.

75 isn't great but neither is it awful for 8 weeks considering the abuse your knee has had. Were it not for the ministrations of your PT, you would be much further ahead by now.

6.Light housework, laundry, vacuum, cooking doing dishes. Taking care of my two dogs

Okay.


Your exercises - my comments in bold
How many sessions do you do a day? You only need to do one session
leg lifts 3x10 - do 5 in the morning and once you can do them, forget about them
hamstring stretches 3 for 30 seconds - okay
heel slides 5 for 30 seconds each - you need to be careful with heel slides. Read this Heel slides and how to do them.
toe raises 3x10 slowly - toes raises are both extremely punishing to the knee and largely unnecessary
step ups on 4 inch step 3x10 - too much. 1 set of 10 is quite sufficient

 

[numbzee]

Sorry I forgot to tell you that I ice my knee for 30 minutes and keep elevating for an hour. Today at PT I got to 77 with a lot of work. Probably too much work. I see that you said I should not be doing the toe lifts! Also not to do so many step Ups. Only do 1set of 10. Thank you Josephine!

 

[Josephine]

I ice my knee for 30 minutes and keep elevating for an hour.

You accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day. Same with elevating.

Today at PT I got to 77 with a lot of work.

No, no - do not ever do 'hard work'! That's what makes excessive swelling and swelling is what is blocking your ROM.

 

[numbzee]

Thank you Josephine. I am now icing and elevating for an hour! I know it is impossible but I wished I could take you to PT so you could tell them what they can and cannot do to my knee. I am a wuss and am afraid to speak up! I know it is my knee but being assertive is hard for me so now I am paying the price ! I better learn soon or find a PT who thinks like you.

 

[Minnie's knees]

@numbzee maybe you can approach PT by telling them how much it hurt after your last session and ask them to go easy. Explain you are willing to work at it but hurting afterwards makes it hard. Hopefully they will respond accordingly.

 

[numbzee]

Thank you for the advise Minnie's Knees. Hope you are doing better today.

 

[kneeper]

Yes, you can explain how much it continued to hurt and can PT be less intense this time. Also practice saying "that's as much as I can do today" or something like that.

 

[Minnie's knees]

@numbzee Thank you, I feel like I am doing better. I am 4 days post mua, swelling is not as bad and I was able to drive again a short distance yesterday. I am back to PT tomorrow. When do you go back to PT? Hope it goes better this time and please speak up even if you just say "Ouch, that hurt!" And as @kneeper said don't be afraid to tell them when it is enough. You don't have to be confrontational just let them know it hurts.

 

[numbzee]

Hi Kathy, so pleased how well you are doing only 4 days post! I can't wait to hear what the PT says about your improvement tomorrow. So happy fir you. Still very hard work I know but now you can progress much faster. I have been doing more stretching exercises and got up to 85 ROM on my own! Ha ha! Will see how it goes tomorrow. Take care.

 

[Celle]

Still very hard work I know

PT should never be hard work. You do need to exercise, but the exercise should be gentle.

Have you seen this interesting article?
TKR: work “smarter” and not “harder”