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[MUA] My difficult right knee replacement surgery!<

Discussion in 'Knee Replacement Recovery Area' started by eaflorida, Jan 6, 2019.

  1. eaflorida

    eaflorida junior member
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    I had my right knee replacement surgery back on December 5th, 2018. I am a 61 years old living in Northeast Florida. I am nearing my 5th week post op on this coming Wednesday. To say its been difficult is an understatement. My first issue after spending only 1 night in the hospital after the surgery, was the fact that my Oxycontin RX did not help relieve the pain. So, I contacted my pain management Doctor and was told that I would have to physically come in to have my pain meds changed. I can tell you that getting in and out of the car at 1 week post op was a living hell. I literally cried for 20 minutes after getting my pain meds adjusted.

    I literally started Physical Therapy in home, only 2 days after my surgery. The therapists that came into my home, were compassionate and did not push me into painful situations.However, during the 2nd week of in home PT, my ROM measurements were like 30 degrees. The therapist had to leave a message for my surgeon. Upon my surgeon hearing about my limited ROM, she immediately referred me to outpatient physical therapy. That is where my living hell started. My outpatient physical therapists push me VERY hardwiring my sessions. I would end my sessions usually in tears as they forcibly bent my knee back for ROM, and my pain level would sky rocket to 9 or 10. So, I am now just short of 5 weeks post op. Unfortunately, even with very aggressive PT and pushing and bending, I was only able to get my ROM up to 77 degree bend. In fact, my last PT was only 65 degree bend, as I had a setback.

    So I saw my surgeon last week, and she had seen the difficulty I was having getting a bend over 77 degrees more than 4 weeks post op, and she has ordered me to have a manipulation to break up my scar tissue. I am scared to death as I wait for the manipulation to be scheduled. Thank God in the interim, I have not been to outpatient PT in several days. Because I have not been to PT in several days, my knee pain has lessened, as there has been no pushing it back in agony. I have simply been doing a few stretches and walking. My dilemma is that the Surgeon says I need to go to outpatient PT for 10 days in a row following the day of my manipulation. I can only surmise that those 10 days of consecutive PT are going to be a living hell as the therapists push me hard and bend my knee back.

    The other aspect of this whole process is that every time I goto PT, I see other patients literally 4+ weeks post op like me, but they are bending 120 degrees and able to walk without a walker and are so much more ahead of me in my recovery that it is depressing to me.

    So, my biggest worry right now is simply dealing with PT for 10 days after my manipulation. Any advice would be helpful. Thank you!
     
  2. Bismitmom1

    Bismitmom1 junior member

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    @eaflorida, don't stress too much over your manipulation! The therapy afterwards wasn't as painful for me after mine since my knee could actually bend! For me, it was a good thing to have done!


    I should add that I have since done things the Bonesmart way, and I have way less more pain and way more range of motion now that I'm done with PT. I have an appointment with my OS in two weeks and I am confident that he will be pleased!
     
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    Last edited: Jan 6, 2019
  3. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Hi and Welcome to Bonesmart!

    I am going to tag @Josephine
    our forum administrator and nurse director to address your concerns.

    Aggressive therapy is not necessary as many of us on here have had excellent recoveries by treating the knee very gently.

    Many of us here have NOT achieved 120 at 4 weeks post op. We are all different and heal at different rates.

    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: 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
    5. Here is a week-by-week guide for

    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.
     
  4. Larryhg3

    Larryhg3 senior

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    @eaflorida welcome to Bonesmart.

    I am very sorry to hear how much you have been through with your poor knee. I am in no way a medical professional but have gone through this process twice last year. It sounds like you pushed really really hard very early on and your knee is having none of it.

    In the early weeks our knees need to rest and recover from the surgery. It is not just the joint but the soft tissues surrounding it that needs to recover. We advocate for ice, elevate, rest and pain management in early recovery to allow this process to take place. The fact that our society is so opioid sensitive that a doctor forces someone in the first week of recovery from knee replacement to get into a car drive to their office to change a medication is ludicrous.

    PT is not supposed to be painful. Not Ever. If you have pain after PT or in the 24 hours following PT you have done more than your knee can handle. It will react by swelling and getting even more stiffness than was already there. That is how our knees “talk” to us. Some here never took PT and recovered very well without it. Many of us do take PT but with very strict rules for them.

    I am in the group that takes PT. My rules are very simple but if they are ever broken I am out the door. For now it sounds like what you need is to ice, elevate, rest and control your pain. If you can manage them some gentle stretches are acceptable but only if they don’t cause pain. By definition you will have discomfort (they did chop your knee out and replace it with metal and plastic) but pain should slowly go away.

    It is a very bad idea to compare your progress with anyone else’s. Every person is different, every knee is different and they all heal differently. Good luck in your journey please come here and post as often as you like. There is always someone here to cheer you on, hold you up, or even just tell you that you aren’t alone.
     
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  5. eaflorida

    eaflorida junior member
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    @eaflorida thank you for your kind words of encouragement!
    eaflorida
     
  6. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @eaflorida I would say no to the MUA and quit the PT. Are you icing your knee throughout the day? Elevating as well? Five weeks out is still very early days. You have already seen results after not having PT. Give that new knee a break and let it heal. Plenty of time for exercise when your knee has recovered from all the trauma.
     
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  7. CAB

    CAB junior member

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    :hi:
    5 weeks is very early and everything is still very painful. Keep up your meds.
    Go slowly...we are all in a hurry.
    Be careful.
    Don't lose what bend you have...so keep doing things slowly and gently.
    Its a tough time.
    My promise is that as time goes by, ever so slowly you wil begin to feel better and wonded where those weeks went.
     
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  8. Spex10

    Spex10 post-grad

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    Dump the PT. Ice, elevate and keep moving.
     
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  9. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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    @eaflorida, whether you proceed with your MUA or not is a tough decision. Regardless of the direction you take, I would strongly recommend you have a serious discussion with your OS regarding plan for following pt. Your issues with lack of ROM are most likely due to excessive swelling from over aggressive pt. You have the right to say NO and to dictate what you expect to get from pt. I was lucky I found BS within a week after my PKR. My surgeon did not require pt until after my first two weeks and only outpatient. Before I went I had the above conversation with him about my expectations. Surprisingly, he was in agreement and very supportive. Have the same conversation with your OS, you might be surprised.
     
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  10. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    To the best of my (limited and not medically qualified) knowledge, it is simply not possible in just 4 weeks for scar tissue to build to a level requiring MUA.

    There is something going on wrong here. You don't need hard work or aggression or pain. Imagine 'working hard' to recover a broken leg or a sprained muscle; you can't, and walking on a broken leg or exercising a sprained muscle are counter-productive, obviously. It's much the same with TKR, you have damage needing healing, not unfitness needing training.

    All you need is to help retain mobility (not fitness or strength) until healing is complete. This is done with gentle stretching exercises, without pain. No pain, MORE gain.

    And in any case she does not ORDER you to do anything, arrogant so-and-so.
     
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  11. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    @eaflorida
    You are still very early in this year long+ recovery. Your soft tissues need time to heal, for the swelling to go down, then your ROM that has been there all along will be revealed. It is swelling blocking your ROM, all the pushing and shoving has increased your swelling, further blocking your ROM as evident by your recent "set back".
    ROM: it's never too late to get more ROM!
    ROM (range of motion) information
    The only activities you need right now are these two gentle exercises.
    Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

    The PT's work for you, saying no to any treatment is your right, Saying no to therapy - am I allowed to?
    You can also say NO to your surgeon and postpone the MUA, giving your poor knee some time to heal.

    Suggest you stop PT and give your knee a chance to heal, giving your knee a rest has already made a difference in your pain levels.
    Be sure to read the articles Jockette left you about elevation and ice to help get your pain and swelling down, revealing your ROM.

    Keep us posted on how you are doing.
     
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  12. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I can only echo what everyone else has said
    You surgeon shows a degree of ignorance and lack of knowledge of the legal requirements that is nothing short of astonishing! To even imagine that a knee can build up 'scar tissue' at 4 weeks out is ridiculous. The story you relate regarding your treatment at the hands of the PTs is quite sufficient to result in the swelling and stiffness that would have blocked your ROM. And no MUA is going to undo that. Quite the opposite, it will cause more swelling and thus more hindrance of the ROM.

    I agree with Jaycey, decline the MUA and any further PT and don't do any exercises at home. Do also remember that this is a matter of consent and no-one can order or require you to have any medical procedure that you are not willing to have. You must read this to fully understand the process of consent. Saying no to therapy - am I allowed to? and CONSENT: what it means and how it can be used.


    Finally, I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
     
  13. Whome08

    Whome08 junior member

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    I am so sorry you are going thru this. I had my right knee TKR on 10/17 I had limited ROM. I realized that the aggressive PT was not helping and just making me more inflammed and uncomfortable. I did have an MUA, my circumstances were a bit different. I am now almost three months out and am starting to see more improvement. It probably sounds repetitive, listen to your body and your knee. Do what you can and feel like doing. Rest and elevate and ice. I know it's hard not to compare, I still do it. Everyone's recovery is different and definitely can't be rushed. I finally was honest with my PT and to what I would do and wouldn't do. Hang in there. It does get better. Trust me, we have all shed many a tear during our own recovery. You are not alone.
     
  14. eaflorida

    eaflorida junior member
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    Josephine, thank you and yes you are absolutely welcome to reach out to me and ask some additional questions. Thanks! Eaflorida (Scott).
     
  15. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    @eaflorida, you don't need to quote a whole post to answer it. Just go down to the bottom and start typing. If you want to call attention to a certain person at a @ right before their user name like I did you. If it turns blue, like yours is, then you know you've done it correctly.
     
  16. eaflorida

    eaflorida junior member
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    @Josephine . Please let me know what additional questions you wanted to ask me. Thankyou!
     
  17. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Here y'go then!

    It would be very helpful if you would answer each one individually - numbered as I have done - 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 forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

    2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

    3. how swollen is your leg compared to these?
    ai63.tinypic.com_eta39s.jpg

    4. what is your ROM - that's flexion (bend) and extension (straightness)

    5. are you icing your knee at all? If so, how often and for how long?

    6. are you elevating your leg. If so how often and for how long?

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

    8. are you doing any exercises at home? If so what and how often?
    This is the most crucial question so please help me by using the format I have left as an example
    (which means please make a list and not an essay!)

    Exercises done at home
    - how many sessions you do each day
    - enter exercise by name then number of repetitions of each
    etc., etc.

    Anything done at PT
    - how many times a week
    - enter exercise by name then number of repetitions of each
    etc., etc.
     
  18. eaflorida

    eaflorida junior member
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    @Josephine

    1) Pain level are currently between 6 & 7. In addition to knee pain, also experiencing lower back pain from swelling. Had 2 level back fusion surgery in mid 2017, and the swelling from my knee surgery is actually effecting my lower back pain.

    2) I am taking Nucynta 50 mg Extended Release in the morning and at bedtime. Also taking 75mg Nucynta anywhere between every 4 and 8 hours.

    3) Knee swelling appears to be moderate. It had swelled to over 4 inches more than my non operated knee right after surgery, but thankfully has recovered to some degree.

    4) My most recent ROM was 75 degrees when taken at PT last Thursday. Sorry but unsure of straightness.

    5) Typically ice my knees around 4 - 5 times per day, and generally for 15 minutes at a time.

    6) I am practically living on my Lazy Boy Recliner for most of the day. I can recline it all the way back, and place 2 pillows on it, to additionally elevate my knee.

    7) Activity level is very low. I get up to walk, goto the bathroom, shower, every day. my walks are indoors and brief., but several times per day. Still have back issues, so I do not really do much in the way of cooking, cleaning, etc.

    8) Exercises done at home:
    I get on my bed and let my knee hang over the edge of the bed for 5 minutes at a time, 3 times per day.
    I climb up a stair, and do some light bending 5 minutes at a time, 3 times per day.
    I do some light squats for 5 minutes at a time, 3 times per day.

    PT Regimen: Please note my last PT session was last Thursday, and I have not been back since. Here is what is was typically done at PT:
    I get on the recumbent bike and pedal halfway forward and halfway backward for about 10 minutes.
    I do 10 minutes of heel slides/knee bends on the table.
    I tighten my knees and try to push down on the table.
    I hang over the table and typically do 25-30 leg kicks.
    I put my knee on the 2nd stair and bend forward for typically 25 - 30 times.
    They put some heat on my knee for 10 minutes, then they measure my ROM and push my knee back. VERY PAINFUL. This lasts for about 5 minutes or so.

    THANK YOU!

    Scott
     
  19. Denny39

    Denny39 member

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    Hi @eaflorida
    Very sorry to hear of all the pain and suffering you have gone through. I am 4 weeks post-op today. I, like just about everyone else had no idea what this journey would really be like. I was fortunate enough to (1) have found the Bonesmart forum early on, and (2) have a very good surgical and post-op recovery team. But, it still is pretty tough sledding. I was one who did achieve 120 degrees in 4 weeks, but I think it was partly because I caught on to something soon after I got home.

    I will share it with you, and you can try it if you wish. Basically, I began a routine of extra heel slides. I did this because when I first did them as one of my first PT exercises, I could barely move my heel 2 inches. But I noticed that as I progressed through the set of 10, I had gotten up to about 8 inches, with no increase in pain. By the third day, it had occurred to me to put a piece of wax paper under my heel so it could slide more easily, and I began doing extra sets. I NEVER pushed it to the point of pain, just well into the manageable discomfort zone. Progress with flexion (I only managed about 75 degrees on my first few tries) was slow but steady, and even the start-up pain began to diminish. Consistency is very important in the total recovery process.

    Another thing I found useful while using my walker was to stand still, raise my foot 1 or 2 inches from the floor, and swing it gently back and forth a few times.

    We’re all different, and what worked very well for me may (hopefully) help you as well. But the Bonesmart philosophy does not embrace forced, unnecessary pain for a good reason. It’d counterproductive. Without going into detail, I’ll just say that I proved that pretty conclusively, and it set me back a few days.

    I hope your recovery gets on a good, solid course very soon. Stay current on this forum. There is much help, encouragement, and support at your fingertips.
     
  20. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Is this on your back or your face?
     

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