MUA MUA recommendations?

[Minstrel]

@Jamie . . . If it weren't for the pain that I feel beneath my knee cap, I would say that my recovery has been going well. The pain is not debilitating, it's more annoying.

It has now been just over 9 months since my surgery and I have walked as far as 8 kms and biked about 18 kms over a 3 hour period, in both cases with intermittent rest periods. I also swim every day I can; covering a minimum of 1000 metres with my 12 inch scuba flippers on.

Today I called my surgeon's clinic to enquire about this pain and was told that I could make an appointment to see the doctor to discuss the possibility of a procedure whereby my knee would be opened up again and the back of the patella could be "scraped". I was told that there would be a risk of fracture and also of infection, and together with no guarantee of any improvement, it might not be worth it. In fact, the gal I spoke with recommended that I just learn to live with the pain.

Another recommendation is to return to active physio treatments with an emphasis on patella-femoral exercises, which I will follow up with tomorrow.

This was dismal news. I don't want to live with this constant, low-grade pain. I know each of my knees is different even though they are both mine; at this point in my recovery after my first TKR, I was back at a job that required that I walk for 5 hours a day, day after day. I could not walk for 5 hours at a time now; I can only walk for half that.

Too, this afternoon a couple of things mentioned over the course of our conversation were news to me:

1) No knee replacement ever results in the absolute absence of pain; some pain with use will persist.
2) 25% of knee replacement patients are unhappy with their outcomes (1 in 4!).

Honestly, through 2 procedures now, I don't ever remember learning of either comment.

What has your experience revealed about other cases similar to mine? Any feedback you can offer would be appreciated.

 

[Jamie]

@Minstrel ... I apologize for not responding sooner. For some reason I didn't receive an alert for your tag.

You are going to have to be the person to judge whether the pain or discomfort you're feeling is enough to warrant having a patellar button put in. I'm assuming that's what your surgeon is referring to when he says he would scrape the patella. The tracking of that button is very important, so if you opt for this procedure, be sure it's something your surgeon has done successfully many times. The knee ligaments must be perfectly balanced for smooth and pain-free movement. There are risks that this procedure would not resolve all your pain or that it could be worse afterwards because the alignment is so critical.

I don't agree with your surgeon's statement that all knee replacements have pain afterwards. My two do not and that's not what I hear from the surgeon's I talk with or most of our BoneSmarties over the years. It's really difficult to attach numbers to the people who may not be satisfied with their replacement knees. "Unhappy" is a very subjective measurement. So, I'm not sure I'd put much stock in that 1-in-4 statement either.

I think you're wise to start with the therapy first and see how that goes for a couple of months. The fact that you are able to walk, bicycle and swim at these levels is very promising. You must decide if that's adequate for your life going forward.

 

[Minstrel]

@Jamie - My turn to apologize for the late response. We were enjoying the last of our summer camping trips and then work-related responsibilities consumed my days.

To be clear, the comments about scraping my knee and learning to live with my pain were made not by my surgeon, but by a physiotherapist who returned my call that day.

I have viewed several animated videos online of knee replacement surgery and it seems that every one describes how the patella is shaved of any bone decomposition prior to having a new part attached to its surface. Surely my surgeon would have done this to the extent necessary; I am confident with his competence. What am I not doing to make the last of this pain go away?

The next time I am scheduled to see my surgeon will be in about 5 weeks when my 1 year anniversary occurs. I will raise the issue of my patellar pain and possible remedies with him at that time.

I did go to the same physiotherapist I have been seeing locally for this knee back on August 13 and truly, I got the impression that he really does not know how to help me any more. The appointment consisted of pretty much the same exercises as ever followed by a measurement: -11 extension and 111 flexion. Still only 100 degrees of ROM - the same that I had back in mid-May with measurements of -6 and 106.

My swimming increased to 2000 metres daily during the days we were home and I was able to use the local outdoor pool which has now closed for the season. However, I have not been back on my bike since mid-July and I have yet to return to the habit of a daily walk, which was usually 3-4 kms. The focus this summer was on kayaking which I was able to enjoy.

Stairs continue to be my biggest concern. Every step down is a reminder that I still cannot descend without hesitation. More than the ROM numbers, function is important to me and I face stairs many, many times daily in my home.

We'll see what my surgeon says when I see him. My "litmus test" for a successful outcome has always been my ability to downhill ski, which is my most favourite outdoor activity. To think that I may have skied my last run is very distressing - I am not ready to hang up my skis.

 

[Jaycey]

think that I may have skied my last run is very distressing - I am not ready to hang up my skis.

No reason to think you can't ski again. In fact one of our members who has had both knees replaced is a ski instructor. I'll tag her so she can come and chat here. @skigirl

 

[skigirl]

I had some pain with my patella two years after my ltka, which turned out to be adhesions which had scarred down the patella. Other than that, my knees have given me very little pain. My left was in 2009 and my right in 2010. I skied 100 days a year for many of those years. When I asked my supervisor if he noticed a difference in my skiing, he said---Yes it is much better!"

After I had surgery to remove the adhesions in my knee, my pt insisted on going very slowly in recovery. I felt very much the way you do but I was willing to try his way. Scott felt that if you exercises a hot, swollen knee you caused adhesions to form. So, for the first 8 weeks, we did only non weight bearing exercises---clam shells, leg lifts,adduction, etc.l At eight weeks we slowly began to up the exercises. I never spent any time with anyone stretching and bending my knee---that is a great way to irritate your knee expecially if you are trying to force it to bend more.

My time spent with the slow recovery was frustrating, but it was well worth the time spent, I have not had any pain with that knee since it healed and I have skied every year since then.

It is hard not to spend every minute thinking of your knee during recovery, but I feel strongly that having someone else bend your knee is not productive and will cause knee pain.

I think gentle exercise until the knee is not hot or inflamed. After that, work on the muscle tone. If you are having problems going down stairs, that sounds like quads and hamstrings are not strong---but your pt is a better guide than I am about muscle unbalance.

Most of all, I don't think you have to give anything up for life--- but, allowing your knee to heal makes sense. I did a lot of work in the pool myself. I did water aerobics and put on a boyancy belt and "ran" in the deep end of the pool. That was effortless on my knee and did help with muscle tone.

sometimes, we have to step back from our focus on physical prowess and maybe read more Jane Austen. Not for life---but just for a few months to give our bodies time to heal. I discovered that I loved reading and still read quite a bit more than I used to read!!

 

[Minstrel]

@skigirl

To read that you have enjoyed skiing for years post-TKRs is reassuring. I want that badly for myself.

Please tell me more about the surgery you had to remove adhesions from your knee (2 years after your replacement surgery?). How was it determined that it was adhesions? I've already had an MUA; wouldn't that have broken up any adhesions in my joint, including beneath my patella?

I agree that muscle tone is an issue. Short of anything in the pool, what exercises can I do that will not further irritate my knee? Should I be cycling more? Truthfully, cycling is awkward and somewhat painful as I still don't have great flexion. What else can I do to improve muscle tone that is not weight-bearing?

Otherwise, I walk every day I can about 3.5 kms/45 minutes - similar route each time. I walk with poles and focus on planting my heel and rolling off the ball of my foot. If feels like my leg is extending properly and I want to walk further, if only to benefit my frame of mind.

Also, I am just 27 days shy of my 1 year anniversary for my right TKR. My knee is still quite a bit warmer than my left knee. And it's never far from mind because I still feel pain all the time. It's not debilitating but it is annoying, and frankly, it's scaring me because I am worried about what I still cannot do.