MUA My difficult right knee replacement surgery!<

1) Pain level are currently between 6 & 7.
That's high!
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.
Okay
3) Knee swelling appears to be moderate.
Okay
4) My most recent ROM was 75 degrees when taken at PT last Thursday. Sorry but unsure of straightness.
Not bad.
You can assess your extension yourself using this technique
1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee
a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's +0
d) if you can't get your fingers under at all, it's -5 or more​

Here's a graphic to explain the degrees involved
knee-rom-small-jpg.50489

5) Typically ice my knees around 4 - 5 times per day, and generally for 15 minutes at a time.
You accomplish little or nothing in 15 minutes. Ice for at least 40-60mins and more than 4 times a day.
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.
Ice when you elevate!
7) Activity level is very low. I get up to walk, go to the bathroom, shower, every day. My walks are indoors and brief but several times per day.
Good


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 - okay
I climb up a stair, and do some light bending 5 minutes at a time, 3 times per day - okay but not the 'light bending'
I do some light squats for 5 minutes at a time, 3 times per day - quit the squats

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: good
recumbent bike and pedal forward and halfway backward for about 10 minutes - good
I do 10 minutes of heel slides/knee bends on the table - no good
I tighten my knees and try to push down on the table - no good
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 - these are lunges, don't do them
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 - if it's painful then it shouldn't have been done
 
@Josephine

This would be sitting upright on the bed, with my feet hanging over the bed towards the floor.

Thanks,
Scott
 
My heart goes out to you my first TKR recovery sounds slot like yours. I refused the offer of MUA at 6 weeks, as I didn't have 90 degrees. It eventually came over time, I think part of the problem was my PT was too aggressive. I had my second TKR 4 weeks ago, have had very gentle PT at home and am doing much better. Hang in there!
I too, live in north Florida , Lake City. Where are you?
 
@Josephine quick question for you. What are your thoughts on support stockings? Do you believe they add any benefit as to reducing swelling after TKR? Is there any particular brand or measurements that are recommended for support hose?
I appreciate you taking the time to help me out and so much more clearly give me expert advice.

Many thanks!


@Dolly Girl I live in the extreme Northeast corner of Florida about 10 miles south of the Georgia border, and maybe 7-10 miles from the Atlantic Ocean in Yulee. Thank you for your kind words.
 
Hi @eaflorida Just thought I'd say that if you do have to have an MUA don't worry about the PT afterwards. I had an MUA and was terrified, when I woke up and realised I could actually bend my knee I was the happiest person ever! My ROM before the MUA (at 7 weeks post TKR) was only 40, straight after the MUA it was 95 and it's improving all the time. I'm so glad I had the MUA.
 
@hopalong61
Thanks for your input. So your ROM increased dramatically after you had your MUA. May I ask what you did for PT after the MUA? How many weeks are you now, since your MUA. Did you take things slow and easy after the procedure.
 
How many weeks are you now, since your MUA
Just a little tip, members’ surgery and procedure dates are in a signature below what they write. It’s very helpful when we have a question like yours. You can see your date in your posts, and mine was March 13, 2017, as you can see you in my signature.

Also, Josephine is going to be offline for a day or so, but she’ll be back soon to answer your questions.
 
Hi @eaflorida,
My MUA was in March last year. For PT afterwards I did what was recommended by my consultant, heel slides, leg raises, etc, nothing too strenuous, just enough to put my mind at rest that my knee wasn't going to go back to what it was before the MUA. I didn't take it slow and easy but I knew when to stop ! The best advice is to listen to your knee, it will tell you when it's unhappy. If I've done a lot of walking, even now, the next day I really suffer.

My physio recently told me that I should allow 2 years for recovery, as i'm now at 12 months and my knee is still not 100% I think she's probably right ! My TKR and MUA haven't stopped me from doing anything though, I've still been able to go back to work full time, go on holiday abroad and live my normal life so i'm happy that one day i'll say "OK, i'm ready for the next one now !" Probably later this year I think.
 
May I ask what you did for PT after the MUA?
@eaflorida I think hopalong had already answered your question!
I'd say that if you do have to have an MUA don't worry about the PT afterwards

What are your thoughts on support stockings?
My thoughts are mixed. Basically I don't think they are very effective and that opinion is supported by this article TEDs Negative Research: Lancet 27th May 2009.
 
Well, I saw my surgeon late last week. My last measured ROM was 65 and that quite painful. I had major issues bending my knee, and my quad muscle was not firing.

So this morning I am having my MUA. I have PT scheduled later this afternoon. I will report back as to how I am doing.

I do want to thank everyone for their kind words and encouragement.

Scott
 
Best of luck today - will be thinking about you.
 
I'm so sorry you have to go through this. I pray for a successful outcome! Remember that after your MUA your knee will be set back almost to the time of your surgery, so very gentle movements are all you should be doing for the next few weeks until your pain and swelling settles down.
 
Hoping for a great outcome for you. I too had an MU I was at the 7 or 8 week mark. No PT was ordered afterwards. Matter of fact I was told to be down with ice & elevation until I felt I could begin ADL's. Its a new baby knee again, just without an incision.
 
Out of recovery and getting ready to go home. Dr actually lifted my knee up and let it fall on its own weight, no pushing. He was able to get my ROM to 110 degrees. In my last PT, we barely got above 70 degrees.

The most important thing though is I need to be sure and bend my knee.
 
Be very gentle with your exercises. All you need to do is move your knee gently. It will be newly-wounded after the MUA, so don't overwork it.
 
I am home now, from the MUA. It was about a 35 minute drive home. I decided to sit in the passengers side front seat. I was unable to do that after knee replacement surgery and before the manipulation. I always slid in the back seat before, and sat sideways with my right knee laying on the back seat and slightly elevated.

So everyone was pretty spot on as to this procedure setting me back. My ability to walk now is very slow and difficult and VERY PAINFUL. I had to have my spouse help me sit in my reclining chair. Then I just had a good 5 minute cry, because the reality of the situation is starting to sink in. I am going to my physical therapy appointment in about 30 minutes. Of course my spouse is driving me. I am going to put my foot down with my PT people. If they push me too far or do anything unreasonable and painful to me, this will be my last PT session. I can barely walk right now!

It was interesting that all the staff in the hospital that I just had the manipulation done, kept telling me that i need to avoid elevating my knee. For Christ's sake, I could barely get out of the car and into the house and that was only after my leg was being on the floor for the 30 minute drive home.

I am going to do the knee sliding exercises that are outlines in bonesmart.org. That would mean, sitting in a chair and bringing my knee slowly back and forth. It also includes lying flat on my bed and gently bringing (bending) my right knee. And maybe a little bit of exercise for a few minutes on my recumbent bike.

Again, thank you all for your empathy and compassion and of course all the useful information from this blog. I will let everyone know how I am progressing. But, I think that slow and steady is what I need to do in combination with icing and elevating. Boy I am telling you this knee thing is simply the worst. I have had several surgeries and procedures, and this TKR is simply the most difficult by far.

Scott
 
We are all thinking of you, we understand.

I had a partial, supposed to be a quick recovery. It hasn’t been. I know better, now, but it’s been really tough.
 
What did they have you do?
 
A few minutes on the bike pedaling 1/2 way forward and backwards. A few heel slides bending my knee while I was flat on the table. Also a little massaging in my knee area. My quads are like on fire. I think he calmed them down. And it was more about starting the whole process over. I can only say that if they make me do something extremely difficult or they hurt me, that will be my last PT. Guaranteed. It’s weird but I actually feel a little bit less sore after today’s PT.
 

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