MUA Good Strong Knee - No Bend<

[Josephine]

I can extend painlessly to about 15

Extension usually comes with a plus + or a minus - Which is this? A +15 means you cannot get your leg straight.

in preparation to see the surgeon.

When do you see him and is he aware of the issues you are experiencing?

I seem to have symptoms of arthrofibrosis

How do you know what the symptoms of arthrofibrosis are?


I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Gel-girl]

@Josephine

its a 15 plus extension

Seeing surgeon on 19 October and no I’m guessing he doesn’t know as when I rang the hospital the e-referral my GP was sending was nowhere in their system. A really helpful guy in patient appointments talked to the orthopaedic secretary and got me the appointment.

I googled symptoms of Arthrofibrosis after reading about adhesions on here and looking into my symptoms further online. I’ve probably got it wrong but I wanted to be as informed as possible going into the consultation - about all the possibilities and next steps.

Would really appreciate some structured advice so ask away.

 

[Josephine]

Thanks for that.

Here y'go then!

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 forget to factor in 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 swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

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

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Gel-girl]

1. Generally 1-2 When I bend, as soon as I bend beyond uncomfortable it’s 7

2. 50 mg Amatriptyline before bed - normal day
60 mg Amatriptyline before bed on an active (done too much) day
1 paracetamol as I wake
On occasions 1 paracetamol if my knee aches at night

3. Medium - it has always been swollen and is always swollen day or night since the tkr, it swells more as the day goes on.

4. No true idea but guessing from info on BS +15 and 90
In the evening it can be +15 and 60

5. I ice once a day after my morning walk for an hour with 3 large gel pads from the freezer.

6. Generally I elevate while icing and whenever I’m sat (apart from when I’m at my sewing machine)

7. Our bungalow is small so not much housework and cleaning and dh does his fair share. I batch cook once a month I use a stool to prep so I’m not on my feet all the time. Shop twice a week local, round the corner I only carry least heavy bag! I work from home, mostly in the evening using a laptop - maybe a couple of nights a week.

8. Walk once a day, half an hour at about 4 mph with a coffee stop in between. Gait good considering bent leg and I don’t limp.
Static cycle once every 2 weeks rocking for 5 mins - rotation extremely painful so I’ve stopped doing that.
Heel slides laid down with toes up 2-3 a day.
No PT - I did 3 knee classes starting at 5 weeks post op. I always ended up in tears at 15 mins into class. At third class instructor referred me to a pain clinic which I attended end of June. He gave me Amatriptyline and suggested I see surgeon. GP referred me end of July.

 

[Josephine]

1. Generally 1-2 When I bend, as soon as I bend beyond uncomfortable it’s 7

A SEVEN? At one year out? My gosh!

2. 50 mg amitriptyline before bed
normal day 60 mg amitriptyline before bed on an active (done too much) day
1 paracetamol as I wake
On occasions 1 paracetamol if my knee aches at night

Well, you know that amitriptyline is NOT a painkiller!. It just alters the way nerves send messages to the brain. Very often it's used for depression.

But WHY only ONE paracetamol and only once a day? You should take two 3-4 times a day at 6hrly intervals.

3. Medium - it has always been swollen and is always swollen day or night since the TKR, it swells more as the day goes on.

That's a worry.

4. No true idea but guessing from info on BS +15 and 90
In the evening it can be +15 and 60

I can measure it for you if you like. You just need to send me a photo like one of these, in short shorts and bare feet, including the hip and ankle in shot

As for extension, you can assess that yourself using this advice

1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee

a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's +0
d) if you can't get your fingers under at all, it's -5 or more​

Here's a graphic to explain the degrees involved

5. I ice once a day after my morning walk for an hour with 3 large gel pads from the freezer.

Okay .....

6. Generally I elevate while icing and whenever I’m seated

But do you elevate correctly? It needs to be like one of these - remembering the axiom "toes above nose"!

7. Our bungalow is small so not much housework and cleaning and dh does his fair share. I batch cook once a month I use a stool to prep so I’m not on my feet all the time. Shop twice a week local, round the corner I only carry least heavy bag! I work from home, mostly in the evening using a laptop - maybe a couple of nights a week.

Good.

8. Walk once a day, half an hour at about 4 mph with a coffee stop in between.
Gait good considering bent leg and I don’t limp.
Static cycle once every 2 weeks rocking for 5 mins - rotation extremely painful so I’ve stopped doing that.
Heel slides laid down with toes up 2-3 a day.

How do you know you walk at 4mp? Are you using an app on your phone?
Given that just rocking on your bike is painful, I suggest you stop all exercises and physio for the time being. It's a worry your ROM is so poor - if it IS poor.

No PT - I did 3 knee classes starting at 5 weeks post op. I always ended up in tears at 15 mins into class. At third class instructor referred me to a pain clinic which I attended end of June. He gave me Amatriptyline and suggested I see surgeon. GP referred me end of July.

And you don't yet have an appointment?

 

[Josephine]

Heel slides laid down with toes up 2-3 a day.

I did ask you to tell me how many of these you do at a time.

 

[Gel-girl]

Once a day - 2 to 3 no more it’s too painful!

 

[Josephine]

Oh, I thought you mean to do sets 3 or 4 times a day!

 

[Gel-girl]

No way too painful!

On a different note. Long story short. We are up in Preston up North visiting Mum n Dad. Two nights ago Sunday night/Monday morning dad fell/went light headed. He ended up in hospital by the by. I got up quick rushed in to see and went queasy. Moved away and fainted for split second and went down landing on my tkr side. Big bruise on arm and boy did that knee/whole leg hurt next day. My leg very bent and I limped all day. It’s a bit better today! Icing at the moment before off to see Dad. We are staying on till tomorrow dad being so well looked after, he’s very bruised and in CCU at the moment.

 

[Jockette]

I’m so sorry about both your dad and your fall!

 

[Gel-girl]

Just read your previous comments @Josephine! Only saw the one about heel slides.

Yep pain is 7 when I bend! If it was bent all the time I reckon it would be a 10 -yea I’d scream!

Yes I know about amotriptoline. It seems it’s being used as a pain/muscle relaxer and it’s helping people sleep. It certainly helps me sleep although with knee having a jolt 2 days ago I’m waking with aching at night at the water. I take one paracetamol at a time incase I need another in 2 hours. It generally gets me through the ache as I get up. I then have no pain during the day just when I have been in bed at night. One paracetamol eases my ache at night to help me back to sleep. I’ve been taking 8 paracetamol in 24 hours for approximately 6 years. It’s my way of using less incase I need them. I have been taking 2 every 6 hours at the moment due to falling on Monday am.

Yep the swelling worries me too. It doesn’t get as warm/hot as it did.

Will measure extension and photograph flextion when I get home.

Always done toes above nose. I don’t elevate in bed at night anymore it was uncomfortable and aggravated my back.

I have a fit bit. I haven’t done ‘a walk’ since Friday - 5 days as hurting due to fall. I’ve still carried on doing about 2000 steps around parents home and hospital when visiting Dad. The pain is easing off. Walking does not hurt my knee or make it ache normally although I’m guessing it could be after it’s affecting my knee.

Yes I have an appointment at the original hospital but only after phoning twice and persevering till I got an answer. I got an appointment 19 October.

I’ll get those photos to you as soon as I can.

Thanks Josephine sorry I missed your posts.

 

[Gel-girl]

Moment not water

House not how me

 

[Josephine]

No worries!

 

[Gel-girl]

@Josephine
Photos
What is my extension if I can get 4 fingers under!?
Not sure I’ve got flexion photo right to be able to measure
This was 11am both verging on the edge of painful - about a 5/6 if it was constant.

 

[Josephine]

What is my extension if I can get 4 fingers under!?

It's in this article Extension: how to estimate it and ways to improve it
I was going to say "it was in your recovery guidelines" but having checked your thread all the way through, I see that nobody left them for you! I do apologise

3. slide your hand, palm down, under the back of your knee

a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's +0
d) if you can't get your fingers under at all, it's -5 or more​

I make your flexion 72 degrees

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​

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.

 

[Gel-girl]

Thanks @Josephine two of the photos are my extension with 4 fingers height under. My knee will just not physically go down any more than that. So that’s easily +10

72 means I have got worse!

Read the Knee Recovery guidelines many times thanks and have adhered to all of them for my nearly one year recovery. I was 50 weeks out last Thursday. I just expected to be further along the road than I am.

My appointment next Friday with the original OS will hopefully have the right outcome.

Thanks again

 

[Jockette]

I am always able to bend further when sitting on a chair than laying down. I know you’re not laying down in that picture but you’re not on a chair, either.

Pardon me if this is too much information, but I can bend my leg best in the bathroom. Between my toilet riser, and no chair legs in the way, I get furthest there.

Do you find you can bend better when sitting in a chair of some sort?

I’m sorry that at the one year point things have not gone better for you.

 

[Kazmeraz]

@Gel-girl so sorry to hear about your dad hope he’s on the mend. I’ve been reading your thread and I agree with Jockette the bend is better sat on a chair. My bend looks very much like yours and is only probs about 80 according to physio. I am not overly worried about the bend as I can do most things with that. It’s too painful to try bend further. I know I’m not as far along as you but tbh I don’t think there will be more improvement as it’s the same as it was when I first had it done. I certainly won’t put myself through any more surgery.
It’s the stiffness and swelling that are my problem. I hope you get the answers you are looking for from your surgeon appointment. I’ll be thinking of you and waiting your update. Best wishes.

 

[Gel-girl]

@Jockette Yes I know what you mean I think I can bend a fraction more when sat but I was trying to get the hip and ankle in shot. Thanks also for kind words and support it is much appreciated.

 

[Gel-girl]

@Kazmeraz Dad is on the mend thanks. I felt a bit the same at five months out - no more surgery but now I want a bit more from my knee than I’m getting. A lot of my thread is about my disappointment of not being able to ride my bike - I still feel this way but another is steps and stairs and still not being able to do them “normally”. It will be interesting to see what the OS says. Good luck with your recovery.