MUA Knee is worse after TKR

[SuzeB]

Starting to regret my surgery. Had TKR in Aug 2019. Didnt have a lot of knee pain, but occasionally my knee would give out whilst standing still. Had mild pain in knee which would go up my thigh and cause muscle weakness on outside of my thigh and cause me to drag my leg and struggle to walk. Told surgeon I was not sure if my knee was causing thigh/hip pain or vice versa?

MRI showed no intact ACL, meniscus damage, arthritis etc and ITBS. Advised to have TKR and immediately struggled with intense pain and limited movement.

6 weeks on and no better so end up having MUA and fluid removed. Completed 4 months of rehab and still going to pool myself and carrying out what I had learned.

Knee stiffenes up within 4-5 mins of inactivity and after a few hours of sleeping, I can barely walk unaided. Knee still buckles occasionally and is numb, sore and stiff.

For past 6 weeks I have constant cramp like pain at top of my calf. Still unsteady on my feet, can't ride my bike or walk my dogs as I trip too easily.

At my wits end and not due to see the surgeon until August. Just can't bend my knee and seems to be getting worse, not better. Manipulation did help back in October, should I look at getting this done again, get 2nd opinion. At 59, I am feeling down and very frustrated.

 

[Roy Gardiner]

to BoneSmart


IMO failure to recover is usually caused by overdoing things, so that the knee cannot heal. It's difficult to tell from your description if that's your problem, but it wouldn't surprise me.

I'd say you need to see your doctor at once, not in several months.


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​

6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Care In Hospital​

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.

 

[Randi]

I’m not sure we should immediately blame the person for overdoing. Sometimes there are soft tissue issues that need to be sorted out. I know this is a bad time to see doctors but when things settle I would suggest you call the surgeons office and see him/ her ASAP. If they tell you that mechanically everything is ok, ask about soft tissue issues. I have a long story that doesn’t matter here but after great frustration I finally got to a wonderful pain clinic that is truly holistic , physical and emotional support, etc and finally am being heard. I have had several types of treatment that are non invasive and I have had great, though not perfect results. Advocate for yourself. If you feel things are not right keep talking to people until you find the ones that listen. Surgeons are amazing mechanics and I had the best, but they are not necessarily great at dealing with other knee related issues. Good luck and I hope you find relief soon.

 

[Jockette]

Completed 4 months of rehab and still going to pool myself and carrying out what I had learned.

This statement leads me to agree with Roy when he said:

IMO failure to recover is usually caused by overdoing things, so that the knee cannot heal.

It seems too often we are given too much to do in PT and for some of us it hinders our healing process. Not all PTs are created equal, and too many honestly don’t understand this recovery from the traumatic assault it is on our body.

I would suggest cutting way back on your exercises and just go about your day doing your daily activities as you are able. Give your knee a rest from working on recovery and let it progress naturally.

 

[Tykey]

We can only comment in general, because we don't have all the info.
But for what it's worth, I agree your knee needs a good long rest from trying to batter it into submission.
Pool aerobics sounds a good thing to do, but isn't, I'd give this rest, stay at home, potter about and your knee might be forever grateful
Time for my Dr Phil quote:

How is all your physical therapy working for you?

 

[SuzeB]

I did actually say to the physio at rehab that certain exercises seemed to make matters worse and aggravate my knee, but they would encourage me to keep it up and that it would slowly improve.

 

[Jockette]

Unless you have really exceptional circumstances, 4 months of PT seems excessive to me. I was discharged by 8 weeks.

As with many things, moderation is key. I found with my PT, if I could do 10 reps, they wanted me to try 20. If I could do that, they told me 30. Before we are healed, more is not better. Yes, our knee needs movement, but it also needs gentle treatment and time to heal. Time being the biggest factor. Painful PT is not helpful, instead it keeps the knee upset. Too many PTs don’t get this.

 

[SuzeB]

Thank you for your response. Immediately after surgery I had physio at home. After 8 weeks, I started rehab twice a week for next 4 months which consisted of 45 mins each physio, exercise physiology and hydro. I was slowly getting better but Rom was still limited. In last 6 weeks my knee has slowly gotten worse and this has been since pulling back on exercise. Now my knee is sore in 3 places to touch and hurts every step. I still have a large area of numbness and it feels as though as the numbness is slowly lessening, the pain is increasing. Stiffness is still roughly around 50% of what it was in the first weeks following surgery.

 

[Jockette]

Give your knee a rest. It will take a while to improve, upset as it is, but just give it time to recover. It’s been through a lot in these last months.

This recovery takes an average of a year, in the best of circumstances, so you are about 1/3 through. But if it’s been overworked, it could take longer.

It is not your fault. You did what you were told to do. Unfortunately, the recovery approach your PTs had you do didn’t work for you. (My PTs approach didn’t work for me, either.)

But there are other approaches. Bonesmart’s approach is gentle, yet effective. Give it a try. But you have to be patient, and that’s hard. But time and patience will get you through and you’ll heal.

 

[marieltha]

Very gentle water walking at an easy pace, every other day at first, wearing supportive, tie-style water shoes, and an Aquajogger water flotation belt to walk mostly in deep water worked for me. Still does. Not water aerobics. And I was told to very, very gradually increase my duration: 10% a week! It has helped my soft tissues as well as the joints . Good luck.

 

[Celle]

Had TKR in Aug 2019.

@SuzeB -
Please will you tell us the full dates of your knee replacement and MUA, and which knee it is, so we can make a signature for you? Knowing the exact date will help us to advise you appropriately in the future.
Thank you.

 

[SuzeB]

Hello, yes I had a total knee replacement on my right knee on 14/08/2019. At just after 6 weeks on 5/10/2019, I went in for a manipulation and removal of fluid for testing which showed no infections etc. Since posting this last week, my knee has worsened and I can barely walk unaided. I rang the surgeon's rooms and tried to make an appt but was told he is only doing phone consults for the time being. Hence I am speaking to him tomorrow some time, however, I am not holding out much hope as I feel he needs to see how bad it is and how I am struggling to walk. Will have to wait and see what he says.

 

[Sara61]

Crikey you did have a hard time at PT that sounds like a normal gym session for an active person not someone recovering from a TKR I only had PT at almost 2 weeks after my surgery and then it
Was for 15-20 mins of gentle movements, I think this stopped at about 3 months as the PT medic said I could just carry on with DLA and the odd walk or two. I was advised against pool therapy and told this would cause too much force on the knee and only to do this after a year.
Try resting your knee for a few days and stop exercises, stick to gentle house movements, for stiffness I use a moisturiser not only does it make my skin soft the movement eases my knee too, for that swelling plenty of ice and elevate as much as you can.
Hopefully your doctor can give you some reassurance tomorrow and sensible advice.
Stay safe - sending a virtual hug to you xxx

 

[Tykey]

I'm 6 months post tkr.
I've been laid up with the flu for 3 or 4 weeks.
My recovery was already progressing very well, with ADL being my only therapy.
I'm now upright at last, and my knee is EVEN better, less stiffness, even less discomfort etc etc.
So you shouldn't be trying to batter your joint into submission.
Time for Dr Phil

"You are in your own way"

 

[SuzeB]

Thanks for all the advice, it is very helpful. Had a phone consult with the surgeon Monday, due to the virus. Had bloods taken today, having xrays, CT and bone scan with spect tomorrow so will see if anything shows up. Turning over in bed last night I hurt my knee quite badly, very sore and stiff today and my husband said I let out an almighty scream when it happened. Didn't need that, but that's how sensitive and vulnerable my knee feels right now. At least it is being investigated now with these tests

 

[Jockette]

I’m sorry that you are in even more pain now.

I’m glad that tests have been ordered. I hope they provide and answer for you.

 

[sistersinhim]

Turning over in bed last night I hurt my knee quite badly, very sore and stiff today

Oh my, don't you just hate that. I believe when we wake up with more pain than usual, that we have done something wrong in our sleep. It happened to me quite a few times.

I suggest you try icing more than normal to try and get that pain back down. Elevation should help, too.

 

[SuzeB]

Thank you