TKR MUA

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PiperMike

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I've had a LTKR done 10 weeks ago and have only achieved 85' of bend with lots of physio and home exercises. My surgeon has scheduled me for MUA in 2 weeks. My concern is the follow up after the procedure. I've been reading throughout this site about TKRs and the MUA and have gained more information in the past hour than I had learned in the previous year!
Following an MUA, what would be an average timeline for pain reduction to be able to walk normally for short distances? At this point, I've been told to use a cane when I walk to assist with the muscles as they heal.
Thanks in advance!!
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Tykey

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Hi and welcome. It's worthwhile first having a bit of a think about why you only have 85deg.

Very often we see problems like this because of trying too hard to force it to bend, and all this can do is create internal swelling and hence lack of bend. Most of us have little problem because we do very little (more often than not, no PT)

What have you and your PT being doing so far?
 

bottomshollow

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@PiperMike, so pleased that you have joined us here on the forum. Here are links to a couple of articles in our Library regarding MUA: MUA (Manipulation under Anaesthetic) and Adhesions
MUA: the ineffectiveness of early MUA (JBJS)

You may have noted that I have moved your thread from the Forum Rules & Stafff forum into the Knee Replacement Recovery forum. Your questions and concerns will get the attention they deserve here.

We are here to help in any way we can: answering questions and concerns; supporting and encouraging you from start to finish; giving you a place to vent, whine, complain if you need to; sharing experiences with one another; and having fun and some laughs along the way.

Take care and keep us posted. We care.
 

Roy Gardiner

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:iagree:


Hi Mike, welcome to BoneSmart.

lots of physio and home exercises
If you have maybe overdone it and your knee has been painful and/or swollen all the time, then it won't achieve good bend whether or not you have the kind of adhesions that MUA will break.

If you don't have adhesions, MUA won't help.
 
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PiperMike

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Thank you for the warm welcome and also for the links Bottomshollow, they were very informative and part of the reason why I will regularly monitoring this site!
Tykey and Roy: I started PT a week after my TKR with mild stretching and bending. My exercises at home consisted of sitting on a bosu ball and rocking back and forth to the threshold of pain but trying not to cross it. I also would plant my heel and try to push back while sitting on the ball against a wall. The 3rd part was to regularly stretch my hamstrings. I would do these exercises 2-3 times a day followed by icing with a cryo-cuff for 45 min to an hour. For the past 2 months that made up my day!
When I went back to see my surgeon 2 weeks post-op, he was already concerned about the lack of bend in my knee. 6 weeks post surgery we started talking about the MUA. At the 9 week point, we scheduled a date for 2 weeks from now.
Most of my pain when bending is felt behind my knee. It's almost like I've rolled up a large towel and am trying to bend my knee around it. I also have pain in the front just on the top of my knee, but this isn't as painful as behind.
I spoke with one of the nurses who has assisted in these surgeries and procedures. He said the best thing I could do is to take my drugs as prescribed for the pain and just keep working with it. I believe he goes with the philosophy of bending it as much as you can to recover.
That's my story to this point. Any advice or guidance is greatly appreciated. I guess what I'm most curious about at this point is after the MUA, the best way to control the pain in conjunction with the drugs and how long people have taken to get back to some normality of movement or mobility.
Thank you in advance and I look forward to reading more!
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Mutley

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Hi pm,
Just a quick note from me. I had an MUA at 9 weeks post op as ROM was around 80 and really couldn't make any gain. So desperate was I to see some results I went ahead...OMG :-( For me, at this point it was a BIG MISTAKE. Basically my big, swollen, angry knee was 'forced to bend' so became an even bigger, swollen angry knee. I was in more pain than after the actual TKR. It set me back both physically & mentally for many, many months. I have no doubt that I did require an MUA, just NOT at that point. To top it all, my surgeon could only achieve a ROM of 120 due to previous knee trauma, scaring, etc and today 18 months post op I'm left with a bend of anything between 100-110. My advice would be give it a bit more time. Let the knee calm down & just investigate any gentle exercises that could make a difference. If at some point later you feel no progress has been made then yes, I would say go ahead with the MUA but quite frankly, this insistence by surgeons to perform this procedure so quickly after the original op is not necessarily the right one.....
I wish you luck for your continued recovery!
 

Roy Gardiner

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Hmm I can keep saying 'as far as I know' but sometimes you need the boss @Josephine

As far as I know :) adhesions (the things that MUA break) take time to form, so that if your ROM is unchanged from the first day, it's not likely to be adhesions causing it, so MUA might not be the correct approach. I'm with Mutley on this, it might make things worse.
 

Josephine

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I've had a LTKR done 10 weeks ago and have only achieved 85' of bend with lots of physio and home exercises.
What's your actual surgery date?
Given what you described before this comment, I can tell you exactly why your ROM is so low. You're doing too much!
When I went back to see my surgeon 2 weeks post-op, he was already concerned about the lack of bend in my knee.
I am not in the least surprised - did I already say you were doing too much?
My surgeon has scheduled me for MUA in 2 weeks
I strongly advise you NOT to have this done yet. 10 weeks out is still very early and most of the problem is nothing to do with adhesions but with swelling and pain. Read this Swollen and stiff knee: what causes it?
Most of my pain when bending is felt behind my knee. It's almost like I've rolled up a large towel and am trying to bend my knee around it.
Exactly so. Just what I've been saying.
Following an MUA, what would be an average timeline for pain reduction to be able to walk normally for short distances?
Well, IF you have it - and I pray you don't - You can walk out of hospital the same day. It's not a disabling procedure.
I spoke with one of the nurses who has assisted in these surgeries and procedures. He said the best thing I could do is to take my drugs as prescribed for the pain and just keep working with it. I believe he goes with the philosophy of bending it as much as you can to recover.
I know from experience that OR nurse know squat about recovery or rehab. I know because I was one for 40+ years and my learning about it did begin until I started doing Occupational Health, then working on BoneSmart and then having a TKR myself! I agree with him 100% about taking the pain meds but not at all in regard to the rest. That is exactly what you shouldn't do!

So I'm going to ask you some questions and it would be very helpful if you would answer each one individually in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!
aflagsforworship.co.uk_jo_pic_images_nonofisss.gif
)


2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often? A time table of it would be best

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

6. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)
 

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Nearly forgot - you need to read these as well

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM
 

maryo52

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I've had a LTKR done 10 weeks ago and have only achieved 85' of bend with lots of physio and home exercises. My surgeon has scheduled me for MUA in 2 weeks. My concern is the follow up after the procedure.
MUA is a walk in the park compared to TKR. I had a few days of higher doses of narcotic, that's all.

A knee in this situation is not a happy knee. The MUA knee has undergone "lots of physio and home exercises" and therefore tends to have more inflammation, swelling and pain. The inflammation is exactly the climate where adhesions develop. So all this activity actually promotes adhesions, which in turn keep the knee from bending.

This is a three part article explaining the proper rehab of a knee with adhesions/scar tissue, which carries the medical term "arthrofibrosis." In short, you have to work smarter, not harder: encourage range of motion while minimizing inflammation. http://www.kneeguru.co.uk/KNEEnotes/courses/arthrofibrosis-rehab-tutorials-dirk-kokmeyer-pt-scs-comt/principles-arthrofibrosis.

I had to have another intervention after MUA because what happened is that PT pushed me even harder after MUA and my knee's arthrofibrosis went from bad to worse. I don't recommend this course of action!!
 
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