MUA My difficult right knee replacement surgery!<

[Jockette]

Your poor knee has been constantly traumatized your entire recovery. It is very upset. That’s why there is so much swelling and so little bend. Rest it, ice it, elevate it. Move it gently. Very gently.

I understand being nervous about going to PT. I am the same way, I had some aggressive things done to me in the name of therapy that have affected me very strongly emotionally.

The Bonesmart approach to recovery works. It really does. If either of your doctors have a different approach, then they are entitled to their opinion. You are also entitled to your opinion and have the right to chose the approach you want to take.

Try to relax. If you take things slower and easier, you will see improvement.

Because:
Keep in mind, it’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[Celle]

I try not to worry with what is wrong with my knee, and my inability to bend it is a major concern. The manipulation actually created a new type of knee pain for me. My abductor muscles on the side of my knee going up to my thigh, are big time bruised and jacked. When trying to bend, these areas give off more initial pain the the knee by itself. But again, honesty trying to bend my knee is almost impossible for now. Should I be worried?

No, you shouldn't be worried.
Don't let anyone else worry you, either. Tell them that, for the next month, you don't want to hear anything about ROM numbers. All this obsessive measuring of ROM just upsets and worries people, quite unnecessarily.

Your poor knee has been through major surgery and then an MUA. It's doubly wounded. The poor thing needs rest, gentle treatment, and time to heal. Give it a break, and stop worrying about ROM.

ROM will come as your knee heals and all its swelling goes down. That will happen when your knee is ready for it
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

We've had people here on BoneSmart whose ROM increased slowly, but it didn't stop increasing. By a year post-op, their ROM was just as good as that of people who gained ROM quickly.
Here are a couple of examples:

First, from Campervan:
"I had a slow recovery. Here's my flex measurements at various points:
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months
128 – 6 years "

Then, from bertschb:
"I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM."

 

[sistersinhim]

The MUA set your recovery back to almost the beginning of your tkr. You have all these layers of tissues that are trying to knit together. The MUA pulled at those very fragile tissues and probably tearing some of them apart.
https://bonesmart.org/forum/threads/closing-surgical-wounds-how-is-it-done.4286/#post-90691

 

[eaflorida]

Thank you everyone. I appreciate your insight. I had my PT today, and it went very well. The Therapist actually spent most of the hour giving me lymphatic massage and massage all over my knee and leg. She was amazed at how tight everything was and assured me that all that area will eventually relax and calm down. I have to tell you though that some of the massage was painful but my leg/knee need it.

She also assured me that even though my Rom is not terrific right now that the good news is that it does appear that all my new knee hardware is doing well. The best piece of advice she gave me is simply that my soft tissue around my knee and going up to my thigh is highly traumatized but again in time it will calm down.

Tomorrow should be interesting in that I see the AR/NP at the drs office that did the MUA. It will be interesting to hear what she says. But, irrespective of what she thinks I am forever grateful for bonesmart.org and the valuable information and tips they have provided to me. Honestly, I would probably be even a worse wreck without the tips and the empathy that you provide me!

 

[Celle]

The best piece of advice she gave me is simply that my soft tissue around my knee and going up to my thigh is highly traumatized but again in time it will calm down.

That's what we say, too.
Give it time and everything will work out OK.

 

[eaflorida]

Another great PT today. Mostly elevating my knee, lymphatic massage, and massage of my knee cap. Some very very light bending. It was amazing.

Earlier today I saw my Manipulation Drs AR/NP. While she was not elated about my continuing bending difficulty, she did seem rather empathetic about my situation of excessive swelling and bruising. She indicated that I don’t need to see my surgeon until February 5th. She also said my knee looked well enough that I could get into my jacuzzi. So tonight my wife helped me get into our 102 degree hot tub. While it was a little challenging to figure out how to get in and out, it really felt great on my badly swollen knee and leg. As a matter of fact, as soon as I got out my knee hurt less and I did some gentle stretches.

So finally after 7 weeks since my TKR I am happy to report that things are looking up a little. And I think the PT massages and lack of extreme pushing and bending are helping my poor traumatized knee.

Amen!

 

[donnag1108]

Sounds like you had a good day and those are valuable for sure. So glad you got to enjoy that hot tub. It really lifts my spirits to do normal things and I get extra satisfaction when I now do something pain free that hurt before surgery. Good for you. Keep on going!

 

[eaflorida]

So by now, I have been to the new PT people for 4 sessions. I can not get over the fact that they don’t have me doing exercises like the first PT company I went to for the first 6 weeks. Just very gentle movement of my knee. They truly do get it!

So I am 7 weeks post op, but can still barely get my Rom to 55 degrees. Of course I had my Manipulation just under 2 weeks ago. As many have said, the swelling and bruising and pain from the MUA are not good. It really adds several more weeks for things to calm down. And, just like before the MUA, I still have so much difficulty bending now. Sometimes I wonder if it is my low pain tolerance?

Thanks to bonesmart.org, I am not freaked out about my poor ROM. Bottom line is that my knee is currently in no position right now, for aggressive PT. And I am thankful that my current PT understands this. I will keep going to PT because the stretching they do to me indeed has been beneficial. But in the back of my mind I am a little nervous as to how my Surgeon is going to react when I see her on February 5th, if my low ROM is still present.

 

[Dolly Girl]

Hang in there, this is a tough, tough recovery for us all.

 

[sistersinhim]

I am a little nervous as to how my Surgeon is going to react when I see her on February 5th

Don't worry about how he will react. You are the only one you have to please. You are doing the best you can for your knee. That's what counts.

 

[eaflorida]

So today is 8 weeks from the date of my TKR surgery. It’s just over 2 weeks since my MUA.

Today was the first time at PT where I Did not feel pain while doing some gentle bends. What I mean is that I had pressure but not pain. I hope I am beginning to turn the corner. I still have a lot of swelling and bruising, but I am getting some bend without feeling like death.

I am also trying to ditch the walker and use the Cane more.

I never in a million years thought that I would need 8 weeks before I began to feel noticeably better, but things are definitely improving. Mind you I still have a long way to go to get anywhere near a 120 Rom, but finally I am starting to feel better.

Scott

 

[eaflorida]

So tomorrow I go see my Doctor (surgeon). Am a little bit nervous as I am not quite sure of what to expect. I did get my Rom to 65 on Friday at PT. Today marks 3 weeks since my manipulation procedure. Thankfully some heavy f the trauma and swelling has decreased, although there is lots more bruising and swelling that is still there.

I do have a question though. Is that it imperative that I keep my knee slightly bent while spending most of my time on the recliner? I tend to have it mostly elevated and fairly straight with pillows under my calves.

Thank you everyone. Like I said last week, the serious pain of the first nearly 9 weeks seems to be significantly reduced. Still lots of aches and pains but no 9/10 or 10/10 pain wise.

 

[Jockette]

I do have a question though. Is that it imperative that I keep my knee slightly bent while spending most of my time on the recliner? I tend to have it mostly elevated and fairly straight with pillows under my calves.

I’m not sure I understand your question. Most of us are told to keep our leg totally straight, but that can be painful, so a slight bend is fine, it’s more comfortable and won’t cause the harm we are told it will.

Was your question MUST you keep a slight bend? I don’t think you must, do what makes you comfortable.

 

[bumneej]

A gentle PT makes a big difference. I also had to change and found a great one who sounds like yours. She has gotten both my extension and bend to where it needs to be without the stretching and pulling of my knee and leg. But I need to do my at home exercises to keep it that way. I am 8 weeks tomorrow and still have constant pain but not as intense. It is slowly getting better. I no longer even use a cane and walk pretty normal. Hang in there, you will get there! I was so afraid and worried about my ROM at first but my new PT does not focus on that and helped me not to and it is improving on its own. So try to relax and know that eventually you will also get to that point. I do try to straighten my leg a lot because my extension is what I have had the most trouble with. But I don't keep it extended continually. I think once your pain level is better and the swelling is down you will find it easier to do the exercises for your ROM. Time and patience is what I heard a lot and that is so true!

 

[eaflorida]

So I just had my appointment with my surgeon. My Dr was not a happy that I only had a 65 degree bend at PT last Friday. She wanted to schedule my 2nd Manipulation next week. She said I will be like this for the rest of my life if we do not do the manipulation now. Not good. I am very seriously considering dropping her as my Dr.

 

[eaflorida]

So if anyone out there has turned down a first or second manipulation due to poor Rom, please let me know how long it took you to progress and fully get your ROM back.

I am not very happy about my surgeon and her threats that I could be at a 65 degree bend for the rest the of my life. I am finally starting to feel better in PT with decreased pain, and she has to **** on me. I told her to give me more time to get more ROM and she said we can’t wait.

Any input would help.

 

[Jockette]

I’m so sorry you are going through this.

I don’t understand how she honestly feels that continuing to force your leg to bend is going to help you. It’s already been beat up enough.

Your leg needs to calm down and heal. I guess we never know for sure what our outcome will be, but you are so early in recovery and have had a very aggressive beginning, and you need to give your leg/knee time to recover this early onslaught. It is WAY too early to say your leg will stay this way.

 

[Pumpkin]

@eaflorida ,

I am very seriously considering dropping her as my Dr.

I think this is a good idea, the challenge will be finding another OS who will see you this soon after surgery.
IMO the manipulation on January 14th, caused increased swelling and inflammation, which in turn has limited your ROM.
I would suggest you wait and let your knee heal.
Myth busting: the "window of opportunity" in TKR

 

[eaflorida]

@Jockette

Thanks Jockette! I was pleading with my Doc to give me some more time to heal. She thinks that if I wait longer for the swelling to go down that this might only equate to maybe another 5 degrees of ROM. And she took a dig at me switching my PT from JOI to Heartland. She thinks my PT I switched to is not pushing me hard enough. She also felt that the pain meds I am taking are not strong enough for the pain I am enduring through PT.

My wife was with me at the appointment this morning (I still can’t drive but I am getting closer). She was just as adamant as I was that there is no way were scheduling this 2nd Manipulation in the very near future.

It took me about 8 weeks post op, to finally start feeling better about my new knee and the reduction in pain. From an emotional standpoint, a manipulation right now would 100% put me back into a very negative mental state.

 

[Pumpkin]

It took me about 8 weeks post op, to finally start feeling better about my new knee and the reduction in pain.

Sounds like you are on the right track, feeling better, less pain.

A MUA will only set you back to day one at this point. You had one very recently and need to recover from that trauma.
CONSENT: what it means and how it can be used
TKR: Pushing to gain ROM - don't do it - have patience!
TKR: work “smarter” and not “harder”
Myth busting: no pain, no gain