Bilateral TKR MUA required?

[Mom's girl]

Hi guys

I am new to this forum,was looking for some advise.
My mother underwent bilateral TKR on the 19th Oct. While she has been progressing well in PT, she is complaining of constant stiffness in her right knee. This is also causing a limp when she walks. When we met our surgeon recently for a follow up, he asked us to see him again after 6 weeks and expressed the possibile requirement of an MUA.
This has really scared us. While our PT is very confident that this is not required and that some stiffness is very normal at this stage, the surgeon seems to think otherwise.

Since I see that a lot of you here have had experience in this surgery, seeking your support to understand of stiffness is normal post TKR.

Would really appreciate your guidance

 

[Jockette]

Hi and Welcome to Bonesmart!

Yes, stiffness is very normal. Here’s one explanation:

“Many members think PT is needed to alleviate tightness. Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.”

I really wish surgeons would have more patience and understanding for us in recovery, instead of expecting “instant” healing and requirements of a ROM number by a certain date. We all recover differently and at different timeframes. And, there is no “window of opportunity.” You’ll find an article about that non existent window in our Recovery Guidelines.

MUAs are useful if someone has a true adhesion, but they are not helpful if the stiffness is caused by normal, general swelling.


I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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 to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Jockette]

Read through those articles, especially number 4, about PT. Too often our PT is more aggressive than our new knee is ready for and it can cause more pain and swelling.


Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[Mom's girl]

Dear Jockette,

Thank you so much for your responses. This helps me a lot!
My mother will complete 2 months after surgesry on 19th December. When we were going in for the surgery, we were told that she would be up and running in 2 months and will be thankful she had the surgery.
But we don't seem even close to that. On the contrary, the stiffness has caused her movement to now be very limited.

Her left knee has beautifully recovered but she complains of constant stiffness in the right. In fact, her ROM is pretty good, the PT is also happy with her progress.

After our last meeting with the surgeon where he spoke about MUA, we were very disheartened. But I really want to thank Bonesmart. You guys have given us renewed positivity and I now know that all she needs is time.

I keep reading about adhesions though. Is there any way to find out if she has adhesions at this stage? I just want to be sure the stiffness will pass.

Thank you for being so patient and supportive in this difficult journey

 

[Celle]

My mother will complete 2 months after surgesry on 19th December. When we were going in for the surgery, we were told that she would be up and running in 2 months and will be thankful she had the surgery.
But we don't seem even close to that

Whoever told you both that was being either wildly optimistic, or untruthful.

The truth is that complete recovery from a knee replacement takes a full year.

It isn't at all unusual for a knee to still feel stiff at 2 months post-op. If your mother's PT is happy with her progress and her knee's ROM is good, she can't have adhesions and an MUA would be pointless.

Even when someone has both knees replaced on the same day, the knees never seem to progress at the same rate. Maybe that's because one knee needed more work done on it during surgery.

At this stage, I recommend giving that slower knee more time and treating it gently.
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 let your mother's PT talk her into working harder at exercises on that knee, because that often has the reverse affect.
At this stage, there is till plenty of time for improvement. The stiffness can take several more months to go away, but it will do so eventually.

 

[Mom's girl]

Dear Celle

Thank you so much for the detailed response. We are slowly coming to terms with the idea that this recovery will take a long long time. Thanks to you guys, I am now less worried also.
I have 2 more questions:

1) my mother does physio 3 times a week. She complains of more stiffness the day after the physio. She is now thinking that since it has been 2 months she should stop physio completely.
Is there a defined duration for which physio should be continued after a bilateral TKR?

2) the PT is talking about hip discrepancy due to all the limping before the surgery. She is saying that this is causing some limping now as well and will need to be corrected. Are there exercises that can correct this issue?

At this stage, I am looking for a lot of guidance and relying only on you guys to help me ensure we are taking all the right steps to help my mother recover

Thanks so much

 

[sistersinhim]

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 formal PT. But, I didn't just sit around and do nothing. I used my knee as it was intended to be used by walking around to take care of my daily needs. As I healed I was able to do more. Icing and elevation was a huge part of my recovery.

Listen to her knee. It will tell you if she's doing too much by increased pain and swelling. When that happens, I found that resting, icing and elevating helped.

 

[kneeper]

Dear Celle

Thank you so much for the detailed response. We are slowly coming to terms with the idea that this recovery will take a long long time. Thanks to you guys, I am now less worried also.
I have 2 more questions:

1) my mother does physio 3 times a week. She complains of more stiffness the day after the physio. She is now thinking that since it has been 2 months she should stop physio completely.
Is there a defined duration for which physio should be continued after a bilateral TKR?

2) the PT is talking about hip discrepancy due to all the limping before the surgery. She is saying that this is causing some limping now as well and will need to be corrected. Are there exercises that can correct this issue?

At this stage, I am looking for a lot of guidance and relying only on you guys to help me ensure we are taking all the right steps to help my mother recover

Thanks so much

1--At two months I'd be inclined to think she can do her knee "exercises" at home just fine. For me, it really was just a matter of bending the knee through its range several times a day. For example, say you're sitting in a chair watching tv or something. Just pull your foot back as far as you can (without intense pain) and hold it for a second or two. Do a couple of repetitions like that a few times a day. Take short walks (10 minutes?) as able--with a cane if she's still using one.

2--gait is definitely a challenge for many of us after years of compensating for the bad knee(s). The PT may be able to teach her some exercises for the leg muscles/ groups, to get things back on track, but a lot is just practice walking--and that happens fairly naturally as you heal. In my case, my PT showed me that some of my muscles were weak and gave me things like side leg raises to do. But those are a bit of a strain on a healing knee. Walking sideways was a bit better. So my guess is most of the leg muscle exercises a PT would show your mom could be a bit more than she's up for at 2 months.
But let her knee(s) be her guide.

2 months is definitely still in the healing stage. And feeling a bit stiff lasts a long time. Improvement is gradual, but it should come.