TKR MUA at 3 weeks post op?

Rsmach1

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Hello, and sorry for the long winded post/question. I'm a 54 year old male at almost 3 weeks TKR post op. I went in on a Tuesday and was released home on Friday. After surgery I had a very limited ROM as noted by my Dr 1 week later (although he never actually checked it with a gauge). Week 2 I had my 1st home therapy visit and was found to be at 52° flex. All of the home therapist I've seen so far (except 1) have been the "No pain no gain variety" and have worked me to the point of major swelling, and pain for day's after. 14 day's post op I had the staples removed and my Dr said I am in desperate need of an MUA and was putting the request in to my ins Co. (still without actually measuring). Today I was finally able to go to the Dr's therapy center and had a much better session. Upon completion the therapist measured my flex and I was at 65° (a 13° increase in basically a week).
Is my Dr being overly aggressive in pressuring me to have an MUA this soon? Especially since now that I'm out of the intense pain caused by the overly aggressive home therapist. Everything I've read seems to point to having an MUA after 8 or more weeks post op. Thank you for your time and any help/opinions.
 
Hi @Rsmach1
:welome:

Wow that is a rapid call for mua already!!!
I hovered at 55-65 for almost a mnth due to the extreme swelling from my knee history. After 2 mnths I’ve now been on anti inflammatory meds for 9 days and it’s changed everything. Suddenly I can move my knee and my pt is commenting every appt on the progress.

The rom is not an issue right now. Your body is rebelling against the intrusion by swelling and trying to naturally bubble wrap itself.

I’m sure you are going to get a LOT of feedback on the mua here as it’s such a controversial procedure.

Is there any way to change your pt for another approach or opinion and see how you do?

I look forward to seeing your posts and how things play out for you. Come say hi or ask anything - you are surrounded by some great support on here now
 
@Rsmach1 I think you need to tell your Dr you are backing off all PT and giving your knee time to rest so the inflammation and swelling can go down. A swollen knee WILL NOT bend!!! You have been done a HUGE disservice by having such an overly aggressive PT torture you these first few weeks. :hissy:I read the other day that many Orthopedic surgeons doing knee replacement are still using the rehab protocols of 20 yrs ago, instead of new ideas/studies proving there's a better and less painful way.

Others will chime in and might send you some links to read, but know that you DO have the right to say no to therapy, and you are allowed to tell therapists what you WILL put up with and what you won't--such as forcing the knee to bend.

My surgeon says no one is EVER allowed to force your knee to bend, as that creates more swelling/inflammation, causing the knee to not bend for 1-3 days afterward. All it does is set you back.:hairpulling:

You will find many here who did no formal PT and got all of their bend back in time---some sooner and some later, but they get it back without the "no pain, no gain" rant that many PTs push upon us (especially in the United States).

As for MUAs, I had one back in 2016 due to a totally different knee recovery (not a TKR), and from all of the reading I did then and even recently, patients are often given at least 6-8 wks post-op, if not closer to 10-12 wks post-op before making the final decision. The thing about TKRs though is that you can continue to gain more bend in the year after your surgery and sometimes longer. I think your surgeon is definitely jumping the gun on this.

I wish you the best of luck.
 
I can't imagine why he's scheduling MUA so soon, unless it's an easy way for him to get money from your insurance. 'Normal' post-op swelling has nowhere near healed, he can't possibly tell yet whether MUA is needed.

I would strongly challenge him on the need for this; he needs to tell you something new, something not covered by normal recovery, for this to be needed

All the above IMO as a non-qualified person, just one who's been around this a bit.

Take a look at all the info in our standard guidelines:

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. Here is a week-by-week guide for 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.
 
You’ve gotten good info and are hearing a consensus: Don’t do it. Not this soon. It really is too early to know for certain if you need the procedure. In fact, the PT protocol you’ve been subjected to has probably increased your swelling! No wonder your poor knee can’t bend. :sorry:

If you can back off PT, do so. You can always, at any time, start back up again. Give your knee some rest, elevation, and icing as described in the links Roy left for you. It might take a few weeks for your knee to settle down, but you will almost certainly notice more flexion when it does.

Some people are slower to regain flexion, but they do get there! Here is Bertschb's record of his ROM over the full year of his recovery.

~~~~~~~~~

I'm 12 months out from my surgery and have some advice based on my experience:
1. Stop going to PT - all it will do is make your knee swell and reduce ROM
2. Don't worry about your ROM
3. Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months!

Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.

~~~~~~~~~~~
 
Hello @Rsmach1 - 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:

The others are right - it's far too early for an MUA. At this very early stage, it is swelling that is preventing your knee from bending. As your knee heals and the swelling goes down, your knee will naturally bend more easily.

Most surgeons don't expect 90 degrees until about 6 weeks post-op.

In any case, 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

Don't get persuaded into the "no pain, no gain" mentality. PT should never hurt. If it does, it's doing more harm than good. Myth busting: no pain, no gain

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

Instead of doing lots of exercises, concentrate on trying to reduce your knee's swelling, with lots of rest, ice and elevation.
 
Thank you all so much for your replies and feedback! I can't begin to tell you all how much it's appreciated. I would have replied sooner but I was waiting for an email notification telling me there was activity on my thread that never came.

Celle, my surgery date was October 30th, 2018, and it's my right knee.
Previous history ;
1985 OPEN lateral meniscectomy, 85% of my meniscus removed.
2000, 2001, 2014, 2015 orthoscopic surgeries to repair recurring medial tears, all right knee.


Everything you've all said has made perfect sense to me. I've questioned the PT's on more than one occasion regarding trying to bend a swollen joint, all but one said "You just have to push thru it".
At approximately 10 days post op pre PT, I was actually starting to feel better. I had the swelling down, and was able to walk just guiding my walker and not using it for support, being able to bear full weight on my tkr leg.
Since then it's been a very dark time, the last aggressive pt home visit was this past Saturday, and finally today (Wednesday) I have been able to get the swelling down to a manageable level, although I still can't walk as well as I did pre PT.

Sussie, thank you for your input. My Dr, and the PT's have all said I need to get as much ROM by week 13 as possible because I won't get more after that. I'm so glad to see you've proved them wrong.

So today as a birthday present to myself (and my knee lol) I've canceled all further home visits from the Pain and torture gang that have done me no good whatsoever, and have told the Dr I do not want to schedule the MUA. I have made appts for pt at the Dr's office but will only do what I feel my knee can take.

Thank you all again, Randy.
 
I agree with everyone who feels it’s far too early. My tkr was Oct 04, and I still have limited bend.
I think the suggestion that it’s another way to get an insurance billing is spot on.Why else would your doctor have already submitted the request before discussing it with you, ka-ching, ka-ching. $$$$
 
Agreed, that and the fact this Workers Comp based I believe is the driving factor to the overly aggressive post op treatment along with the $$$
 
I’m another one who’s ROM increased later on. It’s better now at 20 months post op than it was even at my one year check up!

13 weeks and that’s it? :doh:Where do surgeons get this info? Surely at one year checkups they have patients with better ROM than they had at 3 months. I’m not even going to discuss PTs.
 
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Thank you for your surgery dates. I've put them in your signature.

Here are a couple of other examples from people who continued to gain ROM long after 23 weeks:

This is what Campervan wrote about the slow development of her ROM. As you can see, her flexion continued to improve for a long time - even 6 years.

"I had a slow recovery. Here's my flex measurements at various points:
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months
128 – 6 years "

And here is one from bertschb:

I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.
 
I've questioned the PT's on more than one occasion regarding trying to bend a swollen joint, all but one said "You just have to push thru it".
Pushing through the pain is always the wrong thing to do after a knee replacement. All it does is increase pain and swelling.
At approximately 10 days post op pre PT, I was actually starting to feel better. I had the swelling down, and was able to walk just guiding my walker and not using it for support, being able to bear full weight on my tkr leg.
Since then it's been a very dark time, the last aggressive pt home visit was this past Saturday, and finally today (Wednesday) I have been able to get the swelling down to a manageable level, although I still can't walk as well as I did pre PT.
You've found out for yourself that aggressive PT is counter-productive.
All your knee needs is to be kept moving gently.

So today as a birthday present to myself (and my knee lol) I've canceled all further home visits from the Pain and torture gang that have done me no good whatsoever, and have told the Dr I do not want to schedule the MUA. I have made appts for pt at the Dr's office but will only do what I feel my knee can take.
I'm so glad you've done that. You can give you knee all the exercise it needs with your activities of daily living. Later, start increasing the amount of walking you do. Walking is the best exercise of all for rehabbing a new knee.

It's your knee and you are the only one with the right to say what happens to it. You may be interested in these articles:
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used
 
Pain and torture is so perfect a description. With so many other modalities, such as TENS, laser therapy, acupuncture, massage, etc, the physical abuse of physio seems absolutely medieval. I think a lot of PTs have a pain fetish, and this is a job where they can express themselves.
Good for you @Rsmach1 , for taking control.:friends:
 
So tomorrow will be 4 weeks since my tkr, unfortunately I feel like I'm at 2 weeks post op because of the problems caused by the PT's during the home visits. It's taken a solid week to reduce the swelling and pain they caused, and for the first time I finally have been able to get my knee to feel "relaxed".
Also for the first time I am able to sit on the couch with my foot on the floor without discomfort, although I'm still far from 90° flex. I actually went for a short walk outside yesterday but found I had over did it, and today have a very sore/tight calf. I'm just going to restart and exercise as if I was 2 weeks post op due to the time lost to recouping from PT.
Tomorrow I see the Dr and have no doubt he'll want me to schedule the MUA because I'm not at 90° flex at 4 weeks, but so long as I see progress (as little as it may be) I will not have it done.

I only wish I had found this site sooner, I truly believe I'd be doing much better then I currently am.
 
Tomorrow I see the Dr and have no doubt he'll want me to schedule the MUA because I'm not at 90° flex at 4 weeks, but so long as I see progress (as little as it may be) I will not have it done.
Good!
expecting 90 degrees by 4 weeks is a bit ambitious. Most surgeons don't expect 90 degrees until about 6 weeks.

If he suggests doing an MUA just tell your surgeon that you feel you are making progress and you would like to wait for a while before considering an MUA. He can't force you to have one.
 
So I saw the Dr today and he was somewhat supprised at the ROM I've gained (unmeasured prolly at 75-80 flex now, all thanks to the Bone Smart way) since I last seen him 2 weeks ago. He proclaimed I'd have even more had I had the MUA he recommended, but I seriously doubt it as someone in the waiting room who was at 12 weeks P.O. and had the MUA was just barely at 90.
What I found very surprising is the Dr offered it to me again for this Friday, and stated it was now or never! Because of my progress I declined but asked him, I thought MUA's were normally done later, like 12 weeks or more post op. He said he won't do them much past 4 weeks. Now I'm really confused, I thought MUA's were done to break scar tissue and adhesions, and those take 8 weeks or more to develop?
 
I'm glad your OS isn't my OS. I'm glad you refused the MUA. Your ROM is improving and will continue to do so. It sounds like your doctor is looking for some easy money!

Yes, the number-obsessed PTs and OSs will rattle on about it as if the big, bad "scar tissue" is just sitting there, waiting to pounce if you don't do enough exercise.

Actually, it's quite the reverse. The infamous scar tissue (which is more correctly called adhesions) is 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.
 
So I'm 5 week's post op today. I saw the Dr's pt yesterday and had a good session, as she listened to my concerns and didn't try to force anything. Externally my knee is looking better and pain is very manageable, although I do have some concerns and questions.
First is my ROM, the pt measured it at 70. I know you've all said not to worry it will come, but I can't help it as I seem to be stuck at the moment. Also like I said externally the swelling has gotten much better, but it still feels very tight inside. The pt tried to say that the tightness I'm feeling is scar tissue forming, but I think it's just still swollen in there from the surgery. Am I right?
At this point how often should I be icing and elevating?
When I try to work on my ROM I have what I assume is the normal tightness at the top of the knee and quad area, but I also am dealing with a sharper pain on the lower inside of the knee, and that's what's holding me back. Do I just need more time after the earlier setbacks from the PT's that caused problems?
Thanks for your time and input, it's greatly appreciated!
Randy.

PS. I'm able to walk around the house now without a cane, except in the mornings as I'm pretty stiff for the 1st hour.
 
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Yup. Sounds right. I have the same thing. The internal tightness is swelling and takes time to abate. A lot of us talk about it it’s that common.

I have the same medial patella pain that reminds me its there when I activate my quads or bend my knee too frequently. It eases when I do the ice elevate routine. Again others have mentioned it too and I was told it was some bursitis as everything’s just irritated.

It does get better - I’m going through it myself. Hang in there
 

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