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[TKR] Knee Manipulation

Discussion in 'Knee Replacement Recovery Area' started by Kb208, Jul 13, 2019 at 11:45 AM.

  1. Kb208

    Kb208 new member
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    So I am almost 5 months out from TKR, initially pt was going great ROM was improving was easily able to straighten leg completely. And then started having issues with my hip on the same side as the TKR and ROM regressed, now doctor is discussing manipulation. He has some concerns that it is to late. I am at 90 bent and am now unable to straighten with out pt forcing it and extreme pain. In addition to not being able to work (I have a job that requires me to lift 100 lbs and to stand for 12 at a time) the $30 a visit for pt is getting harder and harder to cover. So I have 2 questions, first is 5 months out to late for a manipulation? And 2nd would it hurt to cut back or even stop pt visits?
     
  2. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @Kb208 Welcome to BoneSmart!
    Not at all - in fact it is far too early! You don't need MUA. Just some reduction in the post op swelling will aid your ROM. Please do not feel pressured to go this route.
    You will probably benefit from stopping all PT and going it alone on this recovery. Any pushing to achieve ROM is counter-productive. Let that knee heal. Ice and elevation will really help ease the swelling that is limiting your ROM.

    Here is some reading for you:
    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

    5. At week 4 and after you should follow this Activity progression for TKRs

    6. Access 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 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.
     
  3. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Hi and Welcome to Bonesmart!
    It is my understanding that manipulations can be done almost any time, even well past 5 months.
    No, it will not hurt you to stop going to PT.

    Many of us were discharged long before 5 months. I was at 8 weeks. Was I totally healed and back to normal? No, that takes a while. As long as a full year, on average, to heal completely, and some of us take longer than that. But before you agree to a manipulation, please carefully read our recovery articles.
    This tells me that your “therapy” was actually not appropriate for a knee replacement. It tells me that most likely it was too aggressive and your knee was never allowed to settle down and heal. I’m so sorry if this is truly the case. Unfortunately, too many of our members have had this experience

    Stopping PT at this point will most likely be in your best interest. Many have followed BoneSmart’s gentle approach to recovery with excellent results. The activities you do in the course of your day will be plenty of exercise for your healing knee.

    I’m going to tag @Josephine to come and talk to you. She is our nurse administrator and has many years working with joint replacement patients. She’s the best!

    When you read the recovery guidelines that Jaycey posted, take special note of the section on PT, and see how yours compares.
     
  4. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Hello @Kb208 - and :welome:

    Please will you tell us the full date of your knee replacement and which knee it is, so we can make a signature for you? Thank you.:flwrysmile:

    To answer your questions:
    No, it's not too late to have a manipulation, although I don't think it would help much.
    And yes, I think it would be an excellent idea to stop going to PT.

    In my opinion, the main reason why your knee is neither bending nor straightening properly is the aggressive way it has been treated by your physical therapists. It's not "scar tissue" (adhesions) that is preventing better development of Range of Motion (ROM) , it's swelling and angry, inflamed soft tissues, caused by abuse at PT.
    PT should never hurt, and forcing a knee to bend or straighten is a recipe for problems.

    Instead of formal exercises, spend time resting, icing and elevating your knee, to try and reduce its swelling and inflammation. For exercise, just take gentle walks around the house. It will take quire a while for your knee to calm down, so don't expect fast results.

    However, there's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
    Myth busting: the "window of opportunity" in TKR
     
  5. Kb208

    Kb208 new member
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    I had my left knee replaced on 2/28/19, I had to fight for the replacement due to my age. I am only 47, I had 95% cartilage lost under my knee cap and the medial side. My knee had been swollen and frozen for 5 months prior to surgery.
     
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  6. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Thank you for your surgery date. I've put it in your signature.
    I'm sorry you had to fight to have your knee replacement. Surgeons should look at the state of your knee and the effect it has on your quality of life before they look at your birth date.

    The idea that you have to wait until you're "old enough" for a replacement is rather old-fashioned. With knee replacements nowadays expected to last for 30+ years, the chances of needing a revision later have decreased.
     
  7. Kb208

    Kb208 new member
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    I agree as did my insurance, unfortunately it took my going to a new surgeon and doing pt for 3 months with no relief and then insisting that I needed the surgery and was willing to accept I may need a revision surgery in the future due to my age. Even with the rom issues I am having, I am happy with the TKR. I obviously still have swelling and some pain but it is much better then prior to surgery.


    Sent from my iPhone using Tapatalk
     
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  8. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control. This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

    All you have to do is use it in your daily living. Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new. You have to be patient, though, it doesn't happen quickly. ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there:yes:.
     

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