Bilateral TKR MUA suggested 8 weeks out -please advise

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and Celebrex. i noticed swelling seems to be more of a problem especially in my feet . Could be the meds?
YES YES YES. When I took Celebrex years ago, my legs swelled up horribly. Within 3 days I had gained 10 pounds. Stopped the med and it all went away. Same thing happened with Viox (sp? now I believe it has been pulled) and then Bextra. It appears to have been some kind of reaction to NSAIDS, as now high or prolonged doses of ibuprophen does the same thing. Our bodies all react differently to meds. Proceed with caution.
 
Hello,
I had BTKR on may23rd,2013. I also developed a severe case of Ileus which set me back with PT about 3 weeks. So far my experience has been a very depressing and painful journey. Now after 8 weeks out an MUA is recommended. Can someone please share their experience with MUA with me.
One of the concerns I have is that I did develop Ileus last time and if I go under again it could come back. Is the MUA needed for excess scar tissue? Im so depressed about this and really don't what to do. My left knee is at 80 and my right 90 after 8 weeks. Please weigh in on this.

Thank You
Ray
 
Hi Ray,

I have no experience with ileus so can't comment on it. Did you have general anesthesia or spinal for the btkr? Can you discuss with the OS or internist if there is anything you can do to avoid a recurrence?

How is your swelling, what are you taking for pain meds and what is your extension? Is it just flexion that is a problem?

I had MUA at 3 months because of issues with extension. I was concerned about the procedure but in my case, it was no big deal. You are out for a very short time, and they bend your legs to break up scar tissue.

I would suggest you wait another month at least. I would see if you can get in a pool, warm water preferred for therapy. I would try massage to see if that can help with breaking up adhesions.

I will tag someone who had MUA with success as they may be able to shed some light on this, KathyH.

Good luck and please keep us posted. I know how frustrating it is. You are never alone with this group!

Be well,

Dawn
 
Hi Ray, I can appreciate your concern and am hoping some wise bonesmart folks
can help us both. My physician recommends a MUA for me as well - I am also at 8 weeks
With a surgery date of May 28 for a RTK. My flexion is 100 on my own
With 105 with pushing by the PT. I know how difficult it is for you to ask for more time but that's
What I did and he gave me two weeks to meet His goal of 115. I'm not sure I can get there.
From what I've read here we can continue to gain ROM after 8,10,12 weeks and beyond. I just
Don't know when it's time to say "okay" do it. If your primary concern is a return of your
Ileus I think that would be unlikely as the procedure is very short. Good luck to you I think we will get more
Info from one if the moderators. So sorry about your additional struggle it's hard enough to recover without
Additional problems. Hang in there you are at the right place!
Josie
 
Josie, your ROM is fine. Considering buying some time, giving yourself until 4 months, which is the outside date orthos will generally do a MUA. Continue the soft approach. You'll be pleasantly surprised. You are at an acceptable ROM that will probably improve faster if you don't push your knee. For crying out loud, it's your knee. If you get to 110 by the outside date he'll do MUA, that should be just fine. I gave up self-PT at 110 and it increased to 130 by one year.

Ray, my ortho said in the old days they did manipulation in the office. Gave a sedative and bent the knee. It sounds forceful but once you're under anesthesia, not much force is (or should be) used. My ortho said they grasp the top of the lower leg, just below the knee, and gently bend. When mine was manipulated, he felt three small pops and one big pop, which is the adhesions breaking. Look in the library for Josephine's article on MUA.

An ideal time to have MUA is when the swelling is well under control. They can do a spinal for this. So if ileus is an issue, is there a reason you couldn't have a spinal? Make sure you have gone over a list of questions with your ortho.

MUA is not a quick fix. It breaks adhesions but it also re-injures the leg. Very often, you are pushed in PT to "keep your gains." Don't fall for it. The gentle approach is the only way to go: range of motion efforts to the point of discomfort but not pain. I used a CPM to increase time spent on range of motion without inflaming my knee. You'll be told they got xx degrees on the table (meaning, under sedation), and there will be a 2+ week backlash of swelling that will severely limit your ROM. Plan on practicing lots of faith then.
 
Ray, I'm going to tag Josephine so she can comment on your particular situation.
 
I had MUA at 3 months because of issues with extension
Josephine, whilst you're here... :)

My understanding and experience is that the tendons at the back of the knee are almost completely unaffected by TKR. This would mean that scar tissue would not affect extension, only flexion. How does MUA help extension?
 
Kneed, please stick with this one thread for your recovery questions and posts. That way you don't have to keep repeating yourself and I don't have to keep looking all over for you other posts to see what's gone before!

Now after 8 weeks out an MUA is recommended. Is the MUA needed for excess scar tissue? My left knee is at 80 and my right 90
That's what an MUA is usually done for - as you can read in this article MUA (Manipulation under Anaesthetic) and Adhesions. However, I would be a little leery about having this so early out. and 8 weeks is extremely early. Your ROM's not that bad and it's most likely excess swelling that is causing the problems. Read this Swollen and stiff knee: what causes it?

Also this article MUA: the ineffectiveness of early MUA (JBJS).

How are you managing with your PT now? And your pain control? I notice you did answer my questions but very sparsely. I really need more detail if I can be of any help.

Let me repeat a couple here
2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
3. how often are you icing your knee and for how long?
4. how high are you elevating your leg, how often and for how long?

Swelling management really is the key to this.
One of the concerns I have is that I did develop Ileus last time and if I go under again it could come back
You have been told this by a doctor? Because my understanding is that it's a one-off occurrence and unlikely to repeat itself.
 
Kneed, please stick with this one thread for your recovery questions and posts. That way you don't have to keep repeating yourself and I don't have to keep looking all over for you other posts to see what's gone before!

That's what an MUA is usually done for - as you can read in this article MUA (Manipulation under Anaesthetic) and Adhesions. However, I would be a little leery about having this so early out. and 8 weeks is extremely early. Your ROM's not that bad and it's most likely excess swelling that is causing the problems. Read this Swollen and stiff knee: what causes it?

Also this article MUA: the ineffectiveness of early MUA (JBJS).

How are you managing with your PT now? And your pain control? I notice you did answer my questions but very sparsely. I really need more detail if I can be of any help.


Let me repeat a couple here
2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
3. how often are you icing your knee and for how long?
4. how high are you elevating your leg, how often and for how long?

Swelling management really is the key to this.
You have been told this by a doctor? Because my understanding is that it's a one-off occurrence and unlikely to repeat itself.

**** (I am stuck at 90 for the past 3 weeks at PT, I am currently taking oxycontin 10 mg 2x daily with Norco 7.5/325 every 4 hours and I Celebrex daily.)
****8 As icing goes every 2hours 20 minute duration
**** I elevate my both legs at least 5 hours per day
**** Yes my doctor said that rather than anesthesia he will sedate me for the manipulation to reduce any Ileus concerns.
I hope this helps you sorry I wasn't more informatitive In my last post. :angel:
 
**** (I am stuck at 90 for the past 3 weeks at PT, I am currently taking oxycontin 10 mg 2x daily with Norco 7.5/325 every 4 hours and I Celebrex daily.)
****8 As icing goes every 2hours 20 minute duration
**** I elevate my both legs at least 5 hours per day
**** Yes my doctor said that rather than anesthesia he will sedate me for the manipulation to reduce any Ileus concerns.
I hope this helps you sorry I wasn't more informatitive In my last post. :angel:
Since i had developed Ileus from my last surgery they are suggesting Heavy sedation to do the manipulation. What is the difference between sedation and anesthesia? thank you
Ray
 
Obviously your ileus was a nightmare you don't want to repeat. Probably the best thing for you to do is to call up the anesthesia department of your hospital and ask to have one of the anesthesiologists/anesthetists address your concerns.
 
Just catching up on your thread. Sorry you've been having such troubles. I don't have much to offer except to say maybe try icing a bit more. something like 20 minutes on, 10 minutes off & repeat, over the course of an hour. (((KfS)))
 
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