MUA Manipulation and stiff knee after TKR

[maryo52]

Forgot to mention the small risk of infection that cannot be ignored, which would devastate a prosthetic knee.

 

[hhilltop]

I think my OS was thinking this, but not wanting to tell me. I had the MUA at 2 months. At my 3 mo visit my overall ROM hadn't improved - it shifted - I gained flexion, but lost extension of about the same amount. I was asking what my options were. Things were mentioned, but no explanations given - a second MUA, scar tissue removal, and dynasplint. I opted for dynasplint. Thoughts of surgery to remove scar tissue was/is scarey - what were the chances I'd just have scarring issues repeat after the procedure? Then the very next day, after a painful day, I suddenly had 15 degrees more. Now I suspect some big band broke loose at the time I didn't know what to think of it. Yes, sudden gains can happen, but slow gains are more the norm. I made slow gains from there, but have been stuck at the same measure for a long while now. It removed thoughts of the other options - or as it seems now - delayed them. I'm back to wondering.

 

[maryo52]

Martha in Vermont, extension can be harder to improve than flexion. I'm assuming you got 15 degrees more flexion. Yeah, it sounds as if something let go.

I don't know for sure, but I believe scar tissue removal in the back of the knee requires an open procedure because arthroscopy doesn't have the capacity to get in back there.

I found my flexion improved before my extension did. And was more painful. Dynasplint is supposed to be most effective on extension efforts. How is your extension now?

 

[Josephine]

My OS wanted my MUA done by 8 weeks. He said the research showed the best results at that point.

Actually, I would disagree with that. There have been one or two papers favouring early MUA but the cohort of patients in them were rather small. On the other hand, there have been numerous large studies opining the opposite.

 

[hhilltop]

I'd like to read those articles. At 1 month out when he told me this, I wasn't at all equipped to question him. I was at a hospital with a good reputation with a surgeon who knows his profession.

 

[Suziepi]

Hi all,

Well it was Physio today and my ROM has dropped back to below 80. I'm in more pain than usual as I have reduced the strength of morphine in the pain killers I'm taking. I could tell my Physio was frustrated and she worked on the knee to get more ROM. It budged a little but it also added more pain.

On a good note a friend told me about this excellent Physio that she has be going to. Luckily I got an appointment with her today after seeing my current one.
I was amazed with her help she is the first professional here ( including the OS) that has told me things that make sense. We worked out that a fall I had two years ago has caused a pitched nerve condition in my back. Which in turn is causing issues in my knee. She identified that the muscles in my operated knee have deteriorated. Which I know they have. Her solution is to manipulate my lower back in her room so that the bones are straight. She also wants me to drop my current Physio and stay with her whilst she is treating me.

So here is hoping that I am on the right track. Something has to work eventually to get this poor knee working. It's telling me it's had enough.
Suzie

 

[hhilltop]

Hey, I have to tell someone - guess you all are elected. FINALLY - in today's PT the measurement has shown movement gained since Thanksgiving. It was (-5,110) without pushing and 120 with pushing. I've been doing both Graston technique and Red Cord PT for the past month both once each week. I plan to scale back to alternating them once each week since I have to travel an hour to get to either of them, but it definitely helps tip the scales towards waiting to decide if I need scar tissue removal. I'm still not comfortable doing stairs. I can go up, but it still hurts. Going down is pretty wobbly without handrails on 6 inch stairs. But, I'm starting to feel like there could be light at the end of this long dark tunnel. Hallelujah!

 

[Suziepi]

Hi hhilltop,
Congratulations! Getting an ROM to 120 would be like heaven to me. So using these two techniques are working for you. You will most likely get more improvements in there near future. I should see if these techniques are offered around were I live.

It is definitely rewarding to look and find out other options that are available to get any improvement with a stiff knee. I am now on my fourth Physio and this one seems to be on the ball with respect to my situation. This week she worked on straightening my back so things stay in alignment. I do feel that my knee is working better for me, but it is still early days yet. She wants to settle my knee down as it still reacting to the TKR and MuA.
Have a great day
Suzie

 

[hhilltop]

I started a thread for both of these techniques. I posted the Graston website, which includes a tool to help locate one of their PT's. I'm told the RedCord is working towards having a similar tool, but isn't there, yet. I like someone's earlier comment about a good lymphatic massage. My mother had great gains with the help of someone who gave them. I'm still a bit swollen even at 8 months out. I met up with someone 12 years out who still complained that she looked a bit swollen.

 

[Suziepi]

Hi Martha,
Thank you again for your information.
The Graston technique looks promising. At present I can only see that there is a practice in Perth that uses that technique (which is a about 3 thousand kilometers away). But I will ask around maybe some other local physio's may know .
I have had a few lymphatic massages in the last few months and they have helped reduce the swelling.
Suzie

 

[Suziepi]

Hi all,
Well I have just made it to 94 ROM! Two weeks ago my previous Physio was trying to get 80 with no luck. Since my TKR in October I have never gain a ROM of more than 90 (besides the 120 whilst under anaesthetic during the MUA). I was always slipping backwards.

Not bad, it just goes to show that if things aren't working then its time to find out why. Luckily, at last i have found a Physio who was prepared to look at the whole body and dig a little deeper. She found that my back was out, which I turn impacted a nerve at the side of the knee. Every time something was done to the knee I ended up in more pain and less ROM.
After one session of her manipulation my back was aligned and the knee is allowing more ROM, although it is still stiff and often in pain from the exercises I am doing.
This new Physio has taken me on so that I can do a 6 week rehab program as an outpatient. I feel very lucky. Even if my knee doesn't gain much more ROM I am glad the problem has be identified so I can move on.

Suzie

 

[hhilltop]

Yes, it is time to celebrate! I know there's more to be gained, but when you've been stuck and something finally breaks loose - Hallelujah! I just made gains after my PT had me doing exercises to align other parts of my body, too. I'm not savvy enough to understand it, but maybe we are on to something. Keep up the good work. Like you, I am glad there's PT's that will hang in there with us that are on the slow track to recovery.

 

[Suziepi]

Hi Martha,
It is good news for you too. I wish I was savvy enough to understand the whole body and how each part impacts the rest.
Sometimes though I wish the medical profession was a little more open with their patients and provide them with more details. After all, it is the patient that has follow through with rehab, to keep the pain under control, to RICE and to monitor the progress of the TKR. Yes, I did get an information session before the operation. But I am finding there is a lack of support post TKR, especially if things are not progressing to what is considered normal.

I have learnt that there is a lot of politics amongst the doctors and Physio's, I noticed this last appointment I had with my new Physio. She rang my OS during the session to get a referral for the 6 weeks program. During this conversation she left the room as though she needed to keep something from me. Mind you I had previously requested from my OS that I would be put on the rehab session and to see this Physio, but he had rejected it. Lucky for me this Physio saw patients without the OS approval although I had to pay a nice fee for it.

Well it is our knees. So I will go where I need so that this knee settles down and doesn't keep me up at night.

Good luck and have a nice day

Suzie

 

[KathyH]

Well done, Suzie with your ROM progress. A lot of us on here have learnt that we just take baby steps, but the progress does come. Happy for you

 

[Suziepi]

Hi KathyH,
Thank you for your encouragement it is nice to be able to celebrate with fellow BoneSmart members each baby step.
I am so glad of this forum as I don't feel alone getting the slow progress. I often get down especially when my the ROM goes backward. Although now I am more positive. I just have to think of the time before the operation when my knee was so painful. It was so hard just to walk a couple of blocks. Now even though the ROM isn't perfect, I can walk the couple of blocks without the pain. I am learning to be grateful for what ever improvement I get.
Have a great day
Suzie

 

[juniper]

Suzie, I get it, slow, slow, very slow. I love that you are taking control, getting the PT you need even though your OS won't approve it. Any way to argue that with him? If your ROM is stuck, what does he care if you are intent on taking care of it? He should be glad; proud that you are ready to invest the time and energy to move forward. You shouldn't have to invest more money. This kind of thing makes me crazy. I'm fourteen months from my TKR and still having stiffness and some swelling. Things are better since I've been seeing this amazing woman for massage. But, like you, I shouldn't have to be paying for this when I pay plenty for health insurance. Keep letting us know what's happening. I had to learn not to focus so much on my knee and on my pain, just kind of to plow through it. And I am. And it is actually making a difference. But I am much farther along than you are. Keep on.

 

[KathyH]

This site and our BS friends have been a God send to us all. I don't like to think about how we would have coped if it wasn't for everyone on here.

Yes Suzie, we do learn to be grateful for even the slightest improvement - wonderful, isn't it?

 

[Suziepi]

Thanks Juniper and KathyH,

One thing I've learnt that doctors are only human. Silly me, in the past i would put them up on a pedestal. Most do their job well as they see that they should do it.
A few doctors disappoint us and only do just enough without thinking too much about each case they handle. In a lot of cases this may be sufficient but in quite a few cases it's to the patients detriment. I'm am definitely aware of this now and wish to be strong enough to stand up for myself and those I care for.
Suzie

 

[SadKnee]

Susie so glad things are moving forward for you! I am having issues with my ROM so your posts are very helpful and appreciated!! I am glad you found a good PT!

 

[Suziepi]

Hi SadKnee,
Good luck with your health issues and in Improving your ROM. I hope it doesn't take you too long for your knee to be functional.

It is taking a long time for me to improve my ROM and I may have to accept that it might not improve much above 100, 120 would be like heaven. I won't give up on looking at options.

This baby knee is so time consuming. It's been over 5 months of pain and worry. Time enough I say, I want to move on although its difficult. I am now going to focus on improving my strength, reducing the pain so I don't need to be on strong pain killers and relaxing. I guess I just want to have some fun.
Take care
Suzie