MUA Getting Back in the Saddle

[HorseyLady]

Got a call from my OS secretary this morning. I will be having my MUA and arthroscopy to excise scar tissue on Friday 23rd August. I will be 10 weeks post TKR. Not long to wait thank goodness - this is very quick for the NHS

Josephine - I know you don't agree entirely with early MUA's but my surgeon, based on my past history with MUA and scar tissue, feels he needs to do something quickly. As you know, I made no progress with ROM despite following the mantra - measured at 49 (but 66 on CPM)! The plan is to get me on the CPM immediately after surgery. Have you any experience of this? MUA and arthroscopy together? Or any advice for post MUA? There seems to be a mixed view as to whether lots of PT helps or whether I should treat this as the start of recovery again and do ice, elevate and gentle stretching?

Thanks for your help

 

[new knee in June]

Hello Allison,
I'm happy you have a date I hope Josephine has some great wisdom for you. We will have to
Wait until she answers. Do you still do gentle stretches ?
Please keep posting, I look forward to hearing from you
You have a lot of time to spend with your horses....I know how happy that makes you
Talk soon....take care,
Diana.....June sunbeams riding into the sunset

 

[Josephine]

I know you don't agree entirely with early MUA

That's a bit of a misquote. My 'opinion' is that the evidence doesn't support the value of early MUA and more, that it is actually counter-productive as stated here MUA: the ineffectiveness of early MUA (JBJS).

There seems to be a mixed view as to whether lots of PT helps

My opinion and the evidence is that lots of PT doesn't help anything and is also counter-productive. It's not rocket science: if you twist your ankle and persist in walking on it regardless, it's going to swell, which will restrict movement, and hurt for an awful lot longer than if you'd rested it and done a sensible amount of gentle exercising. But if you want to go along with your surgeon, that's fine too. It's a free world we live in and I for one would be delighted if it achieves the desired goals. It must be said, however, I will also be extremely and happily surprised!

 

[new knee in June]

Good morning Allison,
How are you ? Good I hope what did your doc. Tell you to do until your m.u.a ? Rest, ice, stretch.
I am almost done with o.p therapy....1 more week if they want to add on more app.
I will say "no" I will do pt in my normal life, just walking & gentle exercises.
I am going to try & move my sept.5th app. Up. I would like to go back to work August 19, I need my os letter
To go back. I am so bored..icing & elevating
I only work nights ( 7-11 ) p.t, by myself.
I assume you will have to follow the advice of your doctor...for the best results after mua.
Have a relaxing day
Talk soon,
Diana. June sunbeams praying for great results....

 

[maryo52]

Hi, just catching up with your thread. I had MUA separately from arthroscopy. I think MUA + arthroscopy is a great idea. What a feeling afterward (especially with the lovely anesthesia drugs lingering) to have one's knee freed of all those internal adhesions! Just to warn you, your knee will not bend well in the weeks afterward, or at least mine didn't. I had mine at 3 months. It really was a month before I hit 90 degrees. Your initial month requires a lot of faith and it requires resisting the temptation to push your knee. I did ONLY gentle stretches, 2-3 times a day, 10 slow slow holding stretches each time. I also hung out in the CPM quite a bit. I figured adhesions would have a hard time re-establishing themselves if my knee was a moving target! It worked and I'm at 130 and would have more ROM but my joint capsule is fibrotic from the arthrofibrosis and I have an effusion. Not wonderful but certainly just fine and much better than trying to live with a knee that doesn't like to bend. Please tag me if you want me to chime in on your progress as things go along.

 

[HorseyLady]

Hi maryo52 Thank you so much for your advice. I haven't been able to find anyone who had them together but I did find a recent paper via Google that suggested it gets better results than a MUA alone. I guess it makes sense really - I always wondered with a MUA what happened to the broken adhesions - do they go off and stick somewhere else Sounds like you got great results from yours, I would love to have 130 at the end of all this.

The CPM is a great idea too, I think my OS was planning to put me on it straight after the operation but it would be great to continue that at home. How was your pain afterwards? Did you need to take anything extra?

Living with a knee that doesn't bend is horrible - I have started to get hip and lower back pain and I know it is because of my gait. I just don't have enough bend to bring my leg through properly so I swing it out, I can feel myself doing it. Everything is difficult - chairs, stairs, even sitting at a table because it is stuck out and my family keep accidentally kicking it! Lol - the "hard end block" is that solid I can rest the leg in suspension

Thank you for your offer to help, I will certainly be tagging you in afterwards

 

[maryo52]

Each time I or my PT tried to get my knee to bend, my hip would hitch. That adds up and takes its toll.

I don't know, but I think some people have adhesions that hold them back, and others develop arthrofibrosis, which is along the same lines but more aggressive and far reaching. I forgot to mention my ortho got only 95 on the table. While I was in recovery, he swung in to report on the procedure and was rather off-putting. He said I'd be lucky if I kept 90. I realized later that he didn't deal well either with the whole thing. I think it was at 2 months followup that we kind of high-fived my getting to 110 at that point.

I have very long legs. So I couldn't sit in a theater, or even a car. I had to ride in the back with my leg up over the front passenger seat laid flat. Everywhere I went I felt as if I was a human obstruction!!

 

[HorseyLady]

Hi new knee in June my fellow June Sunbeam
Until my MUA I have to continue with my cpm machine and doing my exercises. Also icing and elevating. I have my pre op assessment on Thursday - yet more blood, tests and questions - even though nothing has changed with me since my TKR

Can't believe you're finishing op therapy already - well done you! And as for going back to work on August 19th - you must be feeling great. What work do you do? Glad it is only part time so you can rest in the day if you need to.

You get bored? I don't - I am really enjoying not working I love spending time with my horses, reading lots of books, sitting in the garden etc. Mind you, a lot of my day is spent exercising and cpm but I don't mind that as I enjoy listening to music while doing it. Just wish I could play my cello but I need to be able to bend my knee for that :rolleyes: I can't walk my dog yet either

Hope you have a lovely and relaxing weekend xx

 

[puffin]

Slow recovery is tough so I hope that you get great results from your MUA - it is annoying to have to go through the full preop again when it is just a few weeks since the first.

I am due to start water therapy next week to get the mobility and stamina back again - at the moment I can only walk a few hundred metres with difficulty so I cannot imagine going back to work yet - I doubt I could even get from the disabled parking to my office without help

 

[HorseyLady]

Oh dear, I've gone backwards. Yesterday I went to sit down in my armchair and I usually bend my good leg while lifting the bad leg up onto the stool and pillows. Somehow my toes of my bad leg got caught under the stool and my leg was forced into a bend. I screamed and it was absolutely excruciating so I rolled around clutching my leg until the pain wore off. Things then seemed to calm down after 5 mins so I elevated and iced.
Today my leg is swollen and painful and is bending even less than is usual for me! Had a quiet day icing and elevating then tried the cpm this evening but could only get to 52 - thats a 14 degree loss from the day before.
Really made me realise how painful this MUA will be - just hope they give plenty of anaesthetic!

It could only happen to me

 

[puffin]

Ouch! What a horrible thing to happen to your knee!! It is not surprising that your knee is refusing to bend very far with all that new swelling making it extra stiff - keep icing, elevating and taking the pain killers

I hope that things improve soon

 

[new knee in June]

Dear Allison,
Oh my,that sounds painful I would skip the c.p.m machine & only ice & elevate ( constantly )
Hopefully the swelling will go down I haven't had my first mishap yet, but it is always in the back of
My mind.
Do you still have pain meds ?
Best wishes coming your way, please be careful
Diana

 

[puffin]

How are you doing today Alison? Hope that the swelling is going down

 

[HorseyLady]

Thank you for asking after me Swelling down a bit today and I have stopped the cpm machine for a day or two. I have been taking the Tramadol again to get me over this little setback so I am feeling a lot better.

 

[new knee in June]

Good morning Allison,
How is your knee today ? Better I hope I go back to work in 3 more nights I work for the
School dept. in my town. I'm not a teacher. I work nights shredding important documents ( s.s.numbers, addresses,
Home phone numbers, doc. Information) I also set up for school committee meetings & job interviews, teachers meetings.
Mostly I am by myself & can sit & ice & have a cup of tea. ( don't tell my bosses ) my husband works at the
High school, across from my building...if I need help carrying anything heavy he is right there to help.
I hope you are relaxing before your procedure, visiting with your horses & enjoying your garden
I am thinking of you always,
Diana.....June sunbeams .....enjoying the little things in life......

 

[maryo52]

If you are having your adhesions addressed on the 23rd, there is really no point to any PT or CPM in my opinion. Personally, I enjoyed my "week off" from PT before the procedure. I didn't take time off from stretching/CPM again until three months after the procedure.

 

[puffin]

Hi Alison
Glad that you are feeling a little better and that the pain killers are helping you. I hope that the pain is not too bad. I would not worry about being "setback" by the accident as the procedure next week will hopefully set you on the path to recovery and so in the long run it will probably make little difference

Take care

 

[KathyH]

Alison, I just had the MUA at three and a half months. Prior to that I couldn't get past 70 degrees ROM. The procedure itself was a doddle, with GA. My consultant bent my knee to 90. I was put on the CPM not long after. Stayed in hospital overnight and chose to have the CPM going all night. Found it quite soothing actually and even managed some sleep with it going. I went home the next afternoon. There was a fair bit of stiffness for a few days after. This was only a week before Christmas, but it didn't stop me preparing for the houseful of family staying until New Year's Day.

Am now at 105 ROM, which I have been for some time. Hoping I can slowly improve on this number, although I'm not restricted to do anything with this flexion.

Would I do it all over again? The TKR and the MUA? You bet I would. Hope this helps you.

 

[HorseyLady]

Yay I have permission from my Bonesmart friends to ditch PT and the CPM in the run up to next Friday. You see, I am that dedicated that it hadn't crossed my mind to stop my exercises. But you're totally right, I should be enjoying my time off and relaxing in the run up to the MUA and its aftermath which I know will be uncomfortable, if not downright painful and also require lots of dedication afterwards.

KathyH Sounds like you have done really well since your MUA. I will be very happy with 105 as like you say, this doesn't restrict you. At the moment I can't get beyond 60 and my kneecap (which I know is in my knee somewhere) is well and truly stuck down in some hard mass. I think my Consultant plans to cut out scar tissue via arthroscopy, do the MUA then put me on CPM overnight. I am just hoping my pain is controlled on the CPM? What I would really like is nerve block

new knee in June I think your job sounds perfect and how lovely to have your husband close by to help you. I am sure you will be fine as you have lots of support and also the daytime for pampering your knee with ice and elevation if you need to. My horses are fine and I have been to see them today, even managing to groom them both WITHOUT a walking aid. Yes I lurch terribly as you can imagine with a non bending leg, but it was not painful and the horses don't care if I am gimpy even if my hip and lower back like to complain!

 

[new knee in June]

Dear Allison,
I have never heard such happiness from anyone who was told, don't do exercises or c.p.m machine
I had to when I read your post. It's nice Mary & Kathy are letting you know what to expect during your
Procedure ( bone smarties are the best ).
I'm glad your were with your beloved horses & with no pain.
Have a wonderful weekend my friend
I will keep you in my prayers..
Diana....June sunbeams relaxing in the sun !!!!