TKR MUA scheduled for Monday

[Jennarella]

I'm posting on behalf of my Dad, who had a TKR 4 weeks ago today. Recovery has been unexpectedly difficult. My Dad is 76 years old and was very active until last November, when his knee pain became unbearable. In hindsight, we know that he should've pushed harder to have his TKR sooner, but that's hindsight...
Dad ended up in a wheelchair for about 6 - 8 weeks preceding surgery.

From the time he woke up from surgery, it seemed like something was wrong. my Dad is the toughest guy I know, but pain management was...well, hard to manage. They ended up giving him 5 different pain killers, including morphine, in the hours following surgery.
Dad was in the hospital for 6 days following surgery due to pain and a lack of mobility. He was doing everything he was told - doing PT, using the machine thing to bend his knee, etc.

We were told today, by the surgeon, that he plans to do an MUA on Monday and then PT 5 days a week for 2 weeks thereafter. My Dad likes his surgeon, but how do we know if the surgeon is doing the right thing? The last thing I want to do is add any stress to my Dad, but should I suggest he get a second opinion? Dad is reluctant to go to a rehab facility, but are his recovery options better if he does?

Thanks in advance for your time and feedback.

 

[Tykey]

Hi, sorry to hear your dad is struggling.

A bit more info would be helpful, particularly what is his ROM figure. Has he any info as to why the surgeon is proposing an MUA plus lots of PT. That is likely to increase and lengthen his pain

 

[Jennarella]

Thanks for your reply.
He was able to max out the machine, which went to 105.
In spite of this, he has continued to have significant pain and stiffness and that seems to be driving the surgeons recommendation.

Just based on your initial response, it sounds like it would be good to get a second opinion.

 

[Jockette]

Hi and Welcome!

To be honest, it is extremely early in this recovery to do an MUA. Your dad’s knee/leg has barely had a chance to begin to heal in this year long (on average) recovery. He's had excessive pain which was (still is?) difficult to control. Does he have a lot of swelling? I would think he does, which is very normal for 4-5 weeks, and swelling is another form of pain

What you should be concentrating on right now is getting that swelling down. It is most likely the reason he’s having a low ROM. I’ll give you our recovery guidelines where you can read about icing and elevating, 2 very important components of this recovery.

The main purpose of an MUA is to break up any adhesions. Adhesions don’t form this quickly, and yet it seems too many surgeons are too quick to want to do an MUA.

Since you are unsure of having this procedure, and I agree with you, your dad can tell the surgeon he wants to wait. The surgeon can advise, but as patients, we don’t have to agree. He can’t do the MUA unless you sign the consent form.

Saying no to therapy - am I allowed to?

There is no time limit to do an MUA, though many surgeons believe there is. We just had a member have one 7 years later!

There is also no “window of opportunity” to regain ROM. Mine continued to improve in my second year post op, and even more, in my third! So don’t let them bully your dad about the ROM.

What has dad’s PT been like? If it’s very painful, that is adding to his problem, not helping it.

I’ll leave the guidelines n my next post.

 

[Jockette]

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.

Also pay special attention to number 4, post op therapy.

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]

And, you won’t be able to get a second opinion this early in recovery. Another surgeon won’t see him for quite a while, because many problems do resolve themselves within the first year, so it’s way too early to attempt that route.

 

[Jockette]

Also, please tell us the date of your dad’s surgery and we’ll make a signature for you.

 

[Tykey]

Those CPM machines are old fashioned, and I thought they had all been recycled into washing machines. If he manages to max out the limits of the machines, how much more will he get without it?
Besides that 105 isn't bad at all at 4 weeks.

If his wish to do an MUA is to reduce pain and swelling, the logic of that seems flawed, because its likely to make them worse.

So I wouldn't be rushed into anything like an MUA or intensive PT. Take recovery in an easy gentle manner, like the vast majority in this place.

 

[Roy Gardiner]

The BoneSmart view is that 4 weeks is far to soon for MUA.

MUA is to break up 'adhesions', that is, where soft tissues swell, dry out and stick together. It's unlikely that this happens in such a short time.

Adhesions are often caused by overdoing exercise, which causes swelling. The key to exercise, as the Guidelines give in detail, is that they must not be painful or cause swelling, but be done only to the point of discomfort, not more.

 

[Helizabug]

Listen to Jockette and the others (who posted while I was composing this ) At four or five weeks and with 105 degrees of flexion, what is the MUA supposed to do for someone, especially if he has been dealing with a high level of pain? I would ask that question.

I just had an MUA about three weeks ago because my flexion seemed stuck in the 80s. My pain was really very manageable before the MUA, and now, three weeks later, I can see the benefit of the procedure, BUT I had two weeks of acutely increased pain and swelling after the MUA.

I would push for more information about why they want to do an MUA. Maybe it’s the right call, of course, but, as a patient, I think it sounds like a weird way to relieve pain and swelling.

 

[sistersinhim]

We were told today, by the surgeon, that he plans to do an MUA on Monday and then PT 5 days a week for 2 weeks thereafter. My Dad likes his surgeon, but how do we know if the surgeon is doing the right thing? The last thing I want to do is add any stress to my Dad, but should I suggest he get a second opinion? Dad is reluctant to go to a rehab facility, but are his recovery options better if he does?

Your father's soft tissues are just beginning to knit back together after this traumatic surgery. If he has a MUA now, it will pull those tissues back apart, setting his recovery back to almost the time of his tkr. It is obvious that the knee will bend to 105 on the CPM, so there's no need for a MUA. What is stopping his bend is swelling and pain. His knee does not need PT or a MUA. It needs time and gentle movements.

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 your knee. It will tell you if you're doing too much by increased pain and swelling. When that happens, I found that resting, icing and elevating helped.

 

[sistersinhim]

Please tell us the date of your dad's surgery and which knee it was. We will add it to your signature making it easier to advise you.

 

[Tykey]

The question being asked by everybody, is "what is the purpose of the MUA in this case?"

The answer continues to escape me.

 

[Julia1911]

I was 4 weeks out (1/27/20) just this past Monday. 67 years old. Left leg almost debilitated for 3 months prior to surgery (regular doc said I should have been using a walker and not cane it was so bad).

At PT yesterday, new PT (prior 2 weeks was floater PT for this one who had been on leave--new PT has a very gentle but proactive approach--said I had 90 degrees ROM and was right "on track" with where I should be at 4 weeks post op. She was not concerned and said I was making progress and hitting all the "marks" for where I was post surgery.

This is in US where PTs seem to be more aggressive.

 

[Jennarella]

Also, please tell us the date of your dad’s surgery and we’ll make a signature for you.

Dad’s surgery was Jan 28th.

 

[Jennarella]

The question being asked by everybody, is "what is the purpose of the MUA in this case?"

The answer continues to escape me.

The surgeon has said that it is to reduce stiffness.

 

[Jennarella]

I can’t thank you all for your speedy replies! We feel less alone already! I appreciate all the tips and advice. Thanks!

 

[Jockette]

In this recovery stiffness can last for many months. Part of that is swelling.

Here is another aspect of stiffness:
“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.”

 

[sistersinhim]

The surgeon has said that it is to reduce stiffness.

Actually, stiffness is caused by swelling. A MUA will just cause more swelling, thus more stiffness. Think of filling up a garden hose full of water and leaving the nozzle cut off. Would you be able to easily bend that hose? The knee joint is the same way. When it's full of fluid it can't bend as well. Get that fluid out and the bending will come easier. Most of us are stiff for 3 of 4 months or more, so your dad's stiffness isn't anything unusual.

His knee is way to injured still too undergo another traumatic procedure.

 

[Jamie]

If your father was in a wheelchair for 6-8 weeks prior to surgery, it is highly likely that the muscles in his leg atrophied somewhat unless he was actively working them in some way each day. This can mean that his recovery may take a little longer and it probably should be a lot less aggressive than whatever he's been doing. Those muscles have to get stretched out gradually.

Another point....sometimes the measurements you see on a CPM machine do not translate 1 to 1 for ROM. If he measured 105 on the machine, it is likely that his flexion is somewhat less than that number. Next time he's with a therapist, you could as that it be measured to give you an idea where he is. He's really fairly new out of his surgery and he shouldn't be too worried about where his numbers are. He has plenty of time to gain ROM. The important thing is to work on any pain and swelling. That's normally done by backing off the exercise and activity, icing and elevating, and taking something for any pain on a regular schedule until things improve. Then he could gradually start adding back in more exercise and activity as long as it didn't result in more swelling or pain. As has been mentioned, the stiffness can just be a fact of life for a while in recovery.

Probably the best thing for him during recovery will be to use a stationary bicycle if he has one available. It is gentle on the knee and allows the patient a lot of control over any movement. If he doesn't have one, you might check second hand stores or other resale outlets to find once at a reasonable price.