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[MUA] My difficult right knee replacement surgery!<

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

  1. Celle

    Celle FORUM ADVISOR Forum Advisor

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    It's only 2 months since your TKR and already she's done one MUA and she wants to do another. The lady is really rushing you. When is she going to allow your poor, wounded knee time to heal?

    I'm so sorry she's pushing you. She's wrong and there's no need for it. Your leg won't set and never improve. She's been taught an old myth that should have died long ago - the window of opportunity.

    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

    The first MUA did no good and it set back your recovery, because it damaged wounded tissues that are still trying to heal. A second MUA will work no better than the first one did and it will set back your recovery again.

    You did the right thing in telling her that you want to wait for more time and see what happens. Stay firm about that. She can't physically force you to have another MUA and she can't do anything without your permission.

    You feel as if you're starting to make some progress at PT, so carry on going there, as long as the therapy is gentle and not painful. Discomfort is OK, but pain is not.

    Also, make sure that you are spending plenty of time resting, and icing and elevating your knee, to try and reduce swelling. It really only takes a little bit of internal swelling to inhibit ROM.

    Go easy on the exercises. 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.
     
  2. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Just to encourage you, here are a couple of posts from people whose ROM developed slowly, but was satisfactory eventually.

    This is what Campervan wrote. As you can see, her flexion continued to improve for a long time.

    "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 "

    And here's one 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.
     
  3. Celle

    Celle FORUM ADVISOR Forum Advisor

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    It's your knee and you are the only one who has the right to say what will happen to it. You shouldn't have to plead with your surgeon. You should tell her what you want. You are allowed to have your wishes honoured.
    Saying no to therapy - am I allowed to?
    CONSENT: what it means and how it can be used

    Your PT should not be pushing you at all. It's aggressive PT therapy that increases knee swelling and hinders ROM development.
    PT should not hurt, ever. If it hurts, it's doing more harm than good.
    Remember this:
    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.

    Different surgeons have different approaches to recovery from a TKR.
    For example, my surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
    After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
    His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.
     
  4. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    So many US surgeons have this idiotic notion. I have never, ever known anyone to get a fixed flexion in such circumstances.
    I think you will do yourself a big, big favour if you do that. However, you might have difficulty in getting a new one.
     
  5. bumneej

    bumneej junior member

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    Listen to the people here on BoneSmart. I went through painful aggressive PT. It did set me back every time I went. I finally listened to people here and left that facility. I took over a week off to rest my knee. I did some light stretching exercises and iced and elevated. I found someone who has really helped me with a gentle approach and I am now where I should be. Since my surgeon was not happy with my bend of 100 at 4 weeks post op I decided if he ever mentioned doing an MUA I would refuse to have it done. I was prepared for him to suggest it and I was ready for a fight. It is your knee, you have the right to say NO. Give it time to heal and work on getting the swelling down. It is very hard to work on your ROM with pain and swelling going on. Doctors don't know everything.
     
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  6. Lindylee

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    I hope you don't mind me butting in, but I'd hate to see you regress now after all you've been through. Make sure you have plenty of stops on your long journey. I was told to avoid long journeys for 6 weeks, but, if it was inevitable, to stop every hour and have a little walk round. I hope you'll be able to move around in the venue easily too and that you and your wife enjoy your celebration. I'm sure it will be good for your emotional health to have a break. Happy Anniversary!
     
  7. eaflorida

    eaflorida junior member
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    So today is 10 weeks since my RTKR. Wish that I could be overly positive, but I am still having a very tough go at it. At PT last week, my ROM was only 66. Knee still gets hot from time to time. My surgeon actually called my home yesterday as she really wants to do a 2nd MUA. She reads all her threats and tells me that my knee is going to be like this for the rest of my life, if I don’t get that 2nd MUA now. She says the effectiveness of that 2nd MUA will go down significantly if I wait any longer to get it done.

    Going out of the home for even a few hours without Constant elevation and icing just causes my knee to swell up more with an increase in pain.

    So I read all the bonesmart forums and really don’t see anyone that is still stuck on a 66 degree ROM at 10 weeks. I guess that my bend has been challenging since the beginning.

    I am leaning at blowing off my surgeon and her pathetic threats. But nonetheless really need to see some improvement to cheer me up.

    Thanks
    Scott
     
  8. Celle

    Celle FORUM ADVISOR Forum Advisor

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    I think it would help your knee a lot if you stopped going to PT and, instead, spent more time resting, icing and elevating it.
    It's the swelling that is preventing it from bending. get rid of teh swelling and your knee will start to bend more easily.

    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.

    All too often, people make the understandable mistake of thinking that working harder at PT will bring good ROM results, but really the opposite is true. Working hard at exercises keeps your knee swollen and stiff.
    Knee recovery - Lose the Work Ethic!!
    TKR: work “smarter” and not “harder”
    TKR: Pushing to gain ROM - don't do it - have patience!

    Your surgeon is wrong. Please don't agree to a second MUA - it will only aggravate the swelling and delay your recovery.
    And, no matter what she thinks, there is no deadline on when an MUA can be done.

    It makes sense to wait.
     
  9. traceys

    traceys graduate

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    Oh @eaflorida you are breaking my heart. :console2:

    I was EXACTLY where you are in measurement, mentality, emotion, even my anniversary at 7wks post op.
    I totally get your thought process and I don’t want to sound like a broken record repeating everyone else on here.
    BUT - I let my pt beat my leg up 3-4x a week for 3 months and cried every night about the swelling and pain and lack of rom. I was of the mindset that the more I did the quicker it would heal. Then I realized if I kept doing the same thing and was unhappy why did I keep doing it?

    Your dr has her own agenda for whatever reason. Your pt aren’t matching your needs, they are fulfilling their clinic’s requirements.

    I have documented my journey up and down this recovery and read back thru it periodically and kick myself (with my one good knee) on why I waited so long to put a stop to things.
    Trust your instincts
     
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  10. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    You still have SO much swelling. That is preventing your ROM from improving.
     
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  11. eaflorida

    eaflorida junior member
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    @traceys
    I read your whole thread today. Boy, I thought I had it tough until I read your stories. Wow. Congrats to you and your long difficult journey. You are very inspiring.

    As you figured out, the information and recommendations of those on bonesmart.com are so important because of the rubbish our surgeons and therapists constantly throw at us.

    I am just over 10 weeks post op. And I am happily telling my surgeon to go take a flying leap?! When it comes to giving me a 2nd MUA anytime soon.

    Again, thank you for your inspirational story through this very trying TKR recovery.

    Scott
     
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  12. traceys

    traceys graduate

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    @eaflorida
    I’m so glad you found your voice! That’s great. Can’t wait to see how you do now with the stress off. Anytime you need to vent or ask there are a lot of people on here with great info and big hearts to help. You have a ton of support now.

    I look at my case as such that it can always be worse. I wake up in my warm bed and look out my window, then I have a nice breaky and put on my comfy sweats and wait for my hubby to come home at the end of the day. So I’m not fighting a terminal illness, homelessness, loneliness, poverty - ya I’m blessed in the big picture. It’s been a long journey with this knee but its been an incredible life and I’m getting thru it. And if being honest and posting what I do helps anyone then I’m gratified.
     
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  13. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    What wonderful news! It sounds like following the Bonesmart way is working out really well for you.
     
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  14. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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    @traceys, you have such a wonderful positive perspective, please be sure to reflect on the support and encouragement you give to others when you are having your own dark days! It will help to remind you of your own advice.
     
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  15. eaflorida

    eaflorida junior member
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    Its been awhile since I have checked in. Just wanted to give a little update as to how I am doing:

    I am still struggling with my ROM. Yesterday only measured 67. It's been about 3-4 weeks + and my ROM seems stuck around 65-67. I still goto PT twice a week, and have made what I think is a huge improvement in what I can do. For instance, I am now able to do multiple revolutions on the recumbent bike. Its not pretty and sometimes I need a little help with the pedal to go all the way around, but I can actually go all the way around without screaming in pain. I can also sit in the passenger seat in the front of my car, without being uncomfortable or in pain. These are things I could not do 2 or 3 weeks ago. So my dilemma is simply I am seeing better flexibility and less pain in my knee, but none of this translates in a better measured ROM. It has me concerned as I would have thought being able to do these things would translate to better ROM.

    I guess I could use some words of encouragement to reassure me that I need to stop worrying about my ROM and instead focus on the things I am able to do now, that I could not do before.

    Thank you Bonesmart!

    Scott
     
  16. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    If you need a “little help” you are still doing more than your knee is ready for. Stop helping it, however that is happening, and just rock the pedals.

    Even though you are no longer wanting to scream in pain, I take that to mean you still have a fair amount of discomfort trying to do a rotation.

    After all you’ve been through this may not be the best course of action for you. Yet. I used a bike at PT 3 times and each time it did me more harm than good. My ROM eventually improved just fine even though I never used a bike again after I was 4 weeks post op.
    This is a much better gage of accomplishment! :happydance:

    Your particular knee is going to need lots of patience and tender loving care so it can heal.
     
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  17. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    One of our members, Bertschb, kept a record of his ROM process. He agreed for us to post it for those of you that are afraid you're stuck. The key is to have patience! Bertschb says:
    “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.”
     
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  18. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Surprisingly enough, we have members who have significantly increased their ROM over time simply by walking. Short walks at first and gradually increase time and distance as you are able.
     
  19. Celle

    Celle FORUM ADVISOR Forum Advisor

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    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.

    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
     
  20. grandma chris

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    @eaflorida I had my TKR on 20 November. I followed BoneSmart way of doing things quite religiously as I really really didn't want pain!

    So anyway, I went to pt a few times - only once a week, for about four weeks - and when I went I would do the bicycle and walk around the perimeter of the room.
    Once or twice I did very mild stretching exercises but in general I was a very non-compliant patient!

    Once I got clearance to go in the water, I went to the warm pool at the rehab centre and there was also non-compliant. I did the water cycling and some up and down the very low stair they had in the pool but mostly refused to do squats and lunges. The rehab technician was very worried about me, but I stuck to my guns.

    As soon as my doctor told me I was doing fine (without measuring me - just eyeballing) and to only see him again if I developed a problem, I stopped going to pt. My ROM at that time was very limited. The last time I was measured, the very inexperienced therapist measured me at 100 and when I whooped with joy she measured me again and said it was 85. So I really don't know what it was!

    Now I go twice a week to my local Y and do aqua fitness in the warmer water wave pool. I do the aerobics part and about three weeks ago started doing squats and lunges.

    I still don't know what my range of motion is, it has not been measured since the 85 - 100 incident. But I do know that I can go up and down stairs foot over foot with no pain, I don't really need a cane anymore but I do use it because it's icy out there! I can get in and out of my rather deep bathtub without help the way I did before my surgery.

    There is a gym upstairs from the pool and when I'm wearing shorts again, I will go upstairs and ask one of the fitness people to measure my ROM. I really don't care what the number is - I have the functionality I need.

    I don't have any pain and I still get stiff sometimes, so then I elevate and ice.

    On Monday I leave to go overseas and that involves three flights, one of them 10 hours long! I am bringing some instant cold packs, the kind you fold over and they ice up. I don't actually really think I'll need them but oh well, I bought them!

    At my last appointment, my doctor told me that my ROM would continue improving for a year or more. He's right. I'm only past three months out and every week it's better.

    I wish you great good luck!
     
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