MUA It's been a nightmare

2hips1knee

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I had my right knee replaced March 7th 2022, and it's been a nightmare. Four weeks after having the operation, I had a bowel movement that was black. After going to the nearest hospital to find out the cause, I had tests done, and there was blood in my stool. The medication I was taking for inflammation ( Mobic ) and for blood clots ( Buffered Aspirin ) was the cause. They did a colonoscopy and an endoscopy, and determined I had a duodenal ulcer, which is a tear or perforation in my duodenum. Three clips were needed to close the perforation. I also had to have three blood transfusions because my hemoglobin was down to 7.7, which should be 12 or 13. Needless to say, it didn't help with my recovery from the knee replacement, only able to do some of the exercises. Spent the following week worried about getting my hemoglobin number back to where it should be, it was almost two weeks of inactivity. So, when it was time to see the Dr. who did the surgery, and my flexion not being where he thought it should be, an MUA was scheduled, and I had it done. My knee felt looser the next few days, but I had a PT who believed in the " no pain no gain " thinking, and now my knee feels like before the MUA. I stopped going to see the PT and decided to do my exercises at home. I can now dress myself, even putting my socks on and tying my shoes, and I'm making progress on the stationary bike, that I could only do recently.
 
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Jockette

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I’m so sorry to hear of your rough start, and ulcer. I hope at this point you are healing and feeling better from that.

”No pain, no gain” is never appropriate after a TKR, but it is especially not appropriate after all your additional physical distress. You body has much more to heal than those of us who only had a knee replacement.

Trust that in time your knee will heal and your ROM will return. Time and gentle treatment is all it needs.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

5. At week 4 and after you should follow this

6. Access to these pages on the website

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Jockette

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Please also give us the dates of your hip replacements and we’ll add that to your signature. :flwrysmile:
 

hawk2go

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That's one rough recovery month @2hips1knee. I hope the anemia and bowel issues are well resolved so that you can get back to your TKR recovery. Your plan seems sound and those small victories are to be celebrated. Work a little, rest/ice a lot as you are pretty early in your year long recovery.

Did you have your hips replaced as well? If so, let us know the date and we'll create a complete signature for you.

Looks like Jockette left you the recovery guidelines. The links are priceless and certainly did a lot to ease my mind during recovery as I wondered: was I doing too much? was I doing too little? would my knee ever look normal? why am I crying so much? when will that numb spot fade? etc. etc.

If you have questions, ask them. If you have them, it's likely someone else has or will have them, too.
 

sistersinhim

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Don't worry about not going taking formal PT. Every step and movement your knee makes is PT. You don't have to take PT. Aggressive PT causes setbacks, not healing. I'm one of those who never took formal PT. I've had 12 knee surgeries, 2 of them kneecap removals, and 1 tkr. Even after those I never took formal PT. But, I didn't just sit around and do nothing, I am not a lazy person! I used my knee as it was intended to be used by walking around to take care of my daily needs along with the necessary house and yard work. As I healed I was able to do more. Icing and elevation were a huge part of my recovery.

Listen to your knee. It will tell you if you're doing too much by increased pain and swelling. When that happened to me, I found that resting, icing, and elevating helped. Your knee knows how to rehab itself without being told what to do.
 
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2hips1knee

2hips1knee

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I'm not sure of the exact dates of my hip replacements, but I had my left hip done August of 2004 and my right hip done August of 2018. I found this site after my right hip replacement in 2018, looking to see if there were others out there going through what I was. It gives you peace of mind, knowing others are dealing with some of the same issues.
 
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2hips1knee

2hips1knee

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Saw the surgeon yesterday, that did the MUA two weeks ago. I told him, well this MUA helped me get flexion for a few days afterwards, but the knee is limited in bending again. Didn't think he was going to be satisfied with the progress I was making, until I stood up and did a squat, that he seemed impressed with. After that, he told me, we'll see you in 3 months and see how thing are going then. He also agreed that there is still quite a bit of swelling, some due to the MUA, that needs to be reduced, to get more flexion.
 

Roy Gardiner

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I stopped going to see the PT
:thumb: No pain no gain is the opposite of the BoneSmart view, as you now know.
I'm making progress on the stationary bike, that I could only do recently
Using a bike to gain ROM is pretty simple:
  • Set the bike to zero resistance
  • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
  • Gently turn the pedals, through discomfort but without pain.
  • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
Here is a bit more chat and some pix and how 'healing' and 'training' are different
 

Jockette

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Yes, you still have a lot of healing to do. It will happen. Complete recovery does take an average of a year.
Please give us the date of the MUA, and we’ll add that to your signature. :flwrysmile:
 

sistersinhim

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Thank you for the date of your MUA. I added it to your signature for you.

You should see a big improvement once that swelling goes down.
 
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2hips1knee

2hips1knee

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Going to take it easy with the basic exercises for the next several days, until that swelling does go down more. Finding out the hard way, that more is not better when it comes to getting this knee healed and back to somewhat normal.
 

sistersinhim

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It will probably take more than several days for the swelling to come down. More like several weeks. Remember, impatience is counterproductive to a joint replacement.
 
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2hips1knee

2hips1knee

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I know, there is that thinking, if I do more, I'll get to where I want to be sooner. I imagine, there are several on here that know someone that had a similar procedure done, and their recovery time was quicker then what they are going through. So, your thinking is, maybe I'm not doing enough to get there. But, then you start doing some research, and find out, there is no set time frame for you to heal from this. Even though there are PT's out there, that tell you, push it, and you'll get there faster. It was one of the reasons I stopped going to outside physical therapy. I tried that route for 20 sessions, and I wasn't getting there any faster. So now, I've accepted that for me, it will come with time.
 
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2hips1knee

2hips1knee

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An MUA may be the answer for some, but for me, it didn't give me the results I was hoping for. I thought when I had the MUA done, that it would put me on my way to better flexion, and it was something that was needed, to get me on to recovery. But, the extra flexion didn't last long, and I think it set me back with the internal bleeding it caused, and the extra swelling. So, it makes you wonder, was it really needed, and would I have been farther along in my recovery than I am now? Would I do it again, probably not.
 

InkedMarie

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So sorry @2hips1knee . It seems like it’s a coin toss on whether an MUA works or not. What do you do now? Is flexion improving at all?

Marie
 
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2hips1knee

2hips1knee

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I think the flexion will come, when the swelling goes down. The main reason I got this surgery, was to get rid of the pain I was having in my knee. So, after all this healing is done, if I no longer have pain in my knee, then I've accomplished what I set out to do with the tkr, and the flexion will be the least of my concerns. There seems to be this thinking that, if you don't get that flexion by a certain time, you won't get it. I remember my PT telling me, "you're a little behind", like there is a time frame for this recovery. The MUA's are a knee jerk reaction, no pun intended. lol There was nothing my doctor did, to determine if I had adhesions, which is what the MUA is for. So, they go with the MUA when your flexion isn't what THEY think it should be at that stage of your recovery.
 
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sistersinhim

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The scar tissue (which is more correctly called adhesions) is very, very rare, and one of the easiest ways to develop it is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions.

This article explains the difference between scar tissue and adhesions:
MUA (Manipulation under Anaesthetic) and Adhesions

You need normal scar tissue. That's what holds your incision together, and it's part of the normal healing process. Without it, you'd always have an open wound. Most MUAs are done unnecessarily. Most of the time the only thing needed is more time for that swelling to go down. When the swelling goes down the bend improves. Time is the best healer and rehab, not excess exercises or MUAs.
 

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