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MUA My difficult right knee replacement surgery!<

It’s been awhile since I have posted. I am still thankfully alive and kicking. I have been going to PT for 2 times per week for what seems like forever and am still having difficulty getting great ROM. The last time it was checked it was only 75 degrees. Probably not where I should be.

While my mobility has improved, I am still dealing with major swelling issues. It seems like I can’t even spend more than an hour or so with my leg not being elevated, or else it swells up big time. So it’s hard for me to believe that I am overdoing it this far out from my surgery?

Have not been to a doctor in more than a month because my previous surgeon was not happy I changed PT companies, was not happy with my Meds. I was taking, and literally scolded me that I needed a 2nd Manipulation ASAP. She actually indicated in her office visit notes that I was being non-compliant. So I decided to contact a very highly thought of other Orthopedic Surgeon in town. In order to make an appointment with him I needed to send him my Previous Surgeons notes, surgical report, X-rays before and after my TKR, and my PT notes. These were all sent and after he reviewed them, he decided he would not take me in as a new client. I believe that him reading about comments that were made as me being non compliant and somehow about changing my PT provider to an easier PT provider as per my previous surgeon whom is trigger happy with ordering multiple manipulations may not have helped my cause.

My brother is a Doctor but does not specialize in TKR’s thinks that an SCD machine with 3 compartments might be beneficial as to helping with my swelling issues, would be curious as to what others might think about my swelling problems.

Again, just trying to alleviate some of my concerns, especially when I have not seen a doctor for awhile.

Scott
 
@eaflorida
Hey. It’s almost like you are rewriting my story. I’m 6mnths out and have been stuck at the same rom for months now. My knee balloons up internally so easily and if I don’t use some form of compression wrap it swells to the point of not being able to wear pants. So I get where you are coming from completely.

All I can say is to hang in there. List what you can do and what you can’t in your current state and see if you can focus more on functionality.

Sending good vibes your way.
 
Did you have a MUA at all? My surgeon is against them. He reckons 2 years out, research shows that there is no benefit having had them. My ROM at 9 weeks is also below average, and he has assured me that time is the only solution.


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Still going to PT twice a week. It's only been three months - just two since your MUA. I think that partly is causing your swelling. Also, some of us stay swollen longer. My surgeon told me that the swelling (and improvements) could take a year or longer. Maybe if you did no PT, just walked...
 
@traceys

Am curious as to what your Rom is stuck at looking at nearly 6 months out. Is your Dr/surgeon still onboard with your slow recovery?

How often do you put on your compression wraps? Did you buy any special kind of wraps, and where did you get them?

Thanks for the information about your recovery. It helps to know that others are in a situation similar to mine. Good luck to you and your new knee.

Regards,

Scott
 
eaflorida said:
My brother is a Doctor but does not specialize in TKR’s thinks that an SCD machine with 3 compartments might be beneficial as to helping with my swelling issues, would be curious as to what others might think about my swelling problems.
Click to expand...
It's only 3 months since you had this major surgery - and complete recovery takes a long as a full year.
At only 3 months out, it's normal for you to still have swelling. I don't think a machine is necessary. A decrease in exercising and an increase in rest, ice and elevation would probably help just as much.

eaflorida said:
Have not been to a doctor in more than a month because my previous surgeon was not happy I changed PT companies, was not happy with my Meds. I was taking, and literally scolded me that I needed a 2nd Manipulation ASAP. She actually indicated in her office visit notes that I was being non-compliant. So I decided to contact a very highly thought of other Orthopedic Surgeon in town. In order to make an appointment with him I needed to send him my Previous Surgeons notes, surgical report, X-rays before and after my TKR, and my PT notes. These were all sent and after he reviewed them, he decided he would not take me in as a new client. I believe that him reading about comments that were made as me being non compliant and somehow about changing my PT provider to an easier PT provider as per my previous surgeon whom is trigger happy with ordering multiple manipulations may not have helped my cause.
Click to expand...
I think you were a bit hasty in trying to change surgeons so early.
Very few surgeons will take on another surgeon's patients before a year after the surgery. That's a courtesy thing, so they can't be accused of stealing someone else's patients.

You have a perfect right to change your PT supplier, or even to stop going to PT at all.
Saying no to therapy - am I allowed to?

Similarly, you have the right to say no to an MUA and ask for more time:
CONSENT: what it means and how it can be used
Your surgeon might not have liked that, but she would have had to lump it.

Your surgeon did sound rather hasty and keen to do MUAs. That's what she was taught, but it's not necessary.
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

And 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.
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.

You can't hasten this recovery, no matter how much you'd like to. Your knee is going to take it's own sweet time, because it has its own agenda, not anyone else's:
Where are you in recovery?? (TKR)

Try to be patient (I know it's hard) and give your knee the time it needs. If you can do that, it will serve you well.
 
Does your PT do any ice? I had quite a lot of swelling even at 4-5 weeks and when my PT put the "GameReady" on it (super cold and compression) the swelling measurably decreased. It wasn't permanent on that day, but it was clear to her that it was swelling that was impeding my bend.
I also found that "less was more" in terms of exercises. When you're swollen it doesn't take much to add to it or keep it swollen.
 
So I was finally able to see an Orthopedic PA yesterday about my knee. I have not seen any medical professionals since I was 2 months post op. They x-rayed my knee, read thru my operative report from my original surgeon, and looked at my pre and post op x-rays.

The good news is that my knee hardware is looking good. The bad news is that my knee is still swollen and very stiff. The PA actually felt around my knee and indicated that it does not appear that I have a lot of fluid build up on my knee. But the PA did say he has never seen such a stiff knee. He was surprised to find out that I was never given any anti-inflammatory meds right after the surgery. He thinks this may be a big reason for my stiffness. He also wants to run some bloodwork to rule out the possibility of an infection. I go back to see him next Wednesday. Hopefully they have a plan of action for me and my knee.
 
Your story is hits close to home for me (from 2010/11). Now having had two knee replacements on the same knee, I got adhesions the first time but not this time and I know my first surgery was not very good. But what my first surgeon did right was when the MUA didn't get me over the hump, he went in arthroscopically and took out the scar tissue, and the research I've read supports this practice, and perhaps it's a conversation to have with your OS. My surgeon said that my swelling (that never went away) was related to the adhesions, but use of an SCD device doesn't sound as if it would cause any problem and who knows, it might help. But it won't get you ROM.

I have to second what Kneeper said. No amount of PT will increase bend, especially when scar tissue is inhibiting things.
 
eaflorida said:
But the PA did say he has never seen such a stiff knee. He was surprised to find out that I was never given any anti-inflammatory meds right after the surgery. He thinks this may be a big reason for my stiffness.
Click to expand...
Lots of people recover successfully from a TKR without taking anti-inflammatories.
They're not essential and they have some inherent dangers. They increase the likelihood of bleeding, they shouldn't be combined with anticoagulants, and recent research has found that they increase the likelihood of your developing heart problems.
NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study
 
@Jockette
So today I had a followup appointment with my new Knee Surgeon this afternoon. So a brief summary of my situation is that from day one, I have had issues with pain, swelling, and ROM. It got so bad, that my initial surgeon said that I was being non-compliant. The original surgeon said that I was also a baby, because I switched PT Companies to an easier PT Company. The surgeon also said that I was not taking strong enough pain medication. And the initial surgeon was wanting to do a 2nd manipulation literally less than 3½ weeks from the 1st manipulation. Thank God that I decided to not have the 2nd manipulation and thank God I would never go back and see this surgeon again.

So getting back to today's appointment, the new surgeon diagnosed me with arthrofibrosis. In simple terms, my body did not like the new knee. So muscles and soft tissue had a very difficult time dealing with my new knee. My knee cap area and front of the knee are as hard as a rock. My current ROM is 85 degrees and my extension is 12 degrees. The surgeon says that my body is forming all this scar tissue and no amount of PT is going to fix my arthrofibrosis situation. Instead of trying to bend my knee, which I have been fighting to do since day one, he now wants me to try and keep my leg straight.

So, The Dr today says that as time goes by, the pain I am still feeling in my knee should go down. However, the swelling and stiffness in my knee is something that I will most likely continue for the rest of my life. When I mentioned to the Dr that my left knee is also bone on bone and that it needs to be replaced, he told me in no uncertain terms that I do not want that knee to ever be replaced as I would have the same issues on that knee as my operated on right knee has.

I asked him if revision surgery could help me, and he indicated that no it will not, because my arthrofibrosis will cause all the scar tissue to build back up again. I asked him if I should continue to go to PT and his response was if I felt it was helping me, I could keep going. He also wrote a prescription for a special kind of knee brace that could help with my walking, for the time being and asked me to come back for a followup in 2 months.

So this new knee of mine appears that I will be dealing with this for the rest of my life. Certainly not what I expected to happen but what can I do. I have been dealing with this hell for 4 months now since the surgery and honestly it's difficult to remember back to my life before my new knee. Now, The best that I can do is what I have been doing for the past 4+ months, spending 22 hours a day in my reclining sofa with my knee iced and elevated.

If anyone else out there is dealing with arthrofibrosis of the knee, I would love to read about what you are experiencing and how you are dealing with it.

Thanks
Scott
 
Hi, Scott, I’m so sorry this has been such a nightmare for you.

If it was me, I would just “lay low” for a while. I would just do what daily activities I could, I wouldn’t bother with any PT or exercises, and see what time yields.

Down the road a while I would seek another opinion. Personally I would not accept this latest verdict. There are many surgeons out there and it’s shocking how their opinions vary. I think sometimes they tell us things like this because they just don’t want to take on the case.

When I was ready, I would go to a big city for another second opinion. The bigger the population the more situations they see.

Best of the best wishes to you.
 
@eaflorida.....Jockette is right. Unfortunately your body did not like all that rough treatment from day one after your surgery. All the activity and pushing likely kept your knee "hot" and inflamed, which can lead to the formation of a lot of scar tissue - arthrofibrisis.

There is no treatment short of surgery that improves arthrofibrisis. However, you can keep things from getting worse by making sure that you don't push yourself or let anyone else do it either. So I'll second Jockette's advice to just stay cool until you're at least 6-9 months out from surgery. At that point you need to see a surgeon who has lots of experience with arthrofibrosis. The best place to go in the country for this is one of the Steadman Clinics. The closest one to you is in Greenville, SC. if you would be willing to drive there for a consultation.

Just as MaryO told you, having arthrofibrosis now doesn't doom you to always have it after a surgery. It is possible that you could have a successful revision or a successful joint replacement in your other knee. But, knowing that you've had arthrofibrosis once will mean you definitely need a surgeon who understands this problem and is willing to take a gentle approach to your recovery. It sounds like neither of your current surgeons fit in this category.

We have contacts with a surgeon in Chicago, Dr. Saravanaraja Muthusamy, who has an excellent informational website on arthrofibrosis here: broken link removed: https://kneearthrofibrosis.com/about-us/ Read up on his work and I think you'll have a better understanding of what you're dealing with. Please don't hesitate to ask any questions that you may have. Just tag me if you need a response to a concern or question to be sure I see the post.
 
:console2:
 
For everyone on this form. I have had 3 injections ,3 arthroscopic surgery, 2 partial tkr. first the tibia and femor..then the patella with some kind of Button inserted on the side to???? help with moving my knee ! All these procedures done on the right !knee. along with left tkr, and both hips. now I have a Medtronic Pain pump replaced twice, I am explaining all this because there is no Cure for nerve pain or Arthritis. So it's either be in pain or take what ever works for YOU to ease the pain. Once they Cut scar tissue follows. How long for me 2003 . revision 2008 Disability at 58.
 
It’s been awhile since my last posting. I am now almost 8 months from my knee replacement surgery and about 7 months since my Manipulation. I am still dealing with my Arthrofibrosis (Excessive Scar Tissue) of the knee. But, I am doing better. My range of motion was up to 93 when measured a couple of weeks ago. I still continue with my once a week Physical Therapy and am blessed with an incredible Therapist named Dan, at Heartland Rehabilition. He has been working with me since I switched to Heartland in January. That was one of the best decisions I ever made. I do believe the Astem scraping of me knee he has been doing to me, has helped, albeit slowly. They say for Arthrofibrosis, that is one of the best treatments for it.

I used to exercise for 30-40 minutes per day on my recumbent bike, wearing compression sleeves before my surgery. I have tried like crazy to get back to exercising on the bike, but am unable to sit straight and pedal properly without moving my hips and my butt to do complete revolutions. It’s also painful. So, I was able to do slow walking on a treadmill at PT. This was much easier than fighting to get exercise on the recumbent bike. I went out and purchased a nice Horizon Fitness T-101 treadmill for $599, and am restarting daily exercise on it. I can only go 1.7 MPH for about 20 minutes each morning. And, I have to hold on to the rails when on it. But I am eternally grateful that I can do this, even though it probably does not look pretty. I had gained a lot of weight since my surgery. I hope just starting the treadmill exercise gets some of that weight off.

I still have swelling issues, and occasional heat to the touch, but again my knee is better and my swelling is not as bad as it has been. I really hope and pray that I may one day have a 115-120 range of motion and get my extension back closer to Zero. I still spend a great deal of time icing and elevating, but again my knee is certainly better now, then it’s been since before my surgery. The pain is less and my mental state has improved. I will again reiterate that this knee replacement and then the diagnosis of Arthrofibrosis, has been one of the most difficult chapters of my life.

Thank You Bonesmart!

Scott
 
Glad it's improving for you, recovery not always as expected based on reading the threads here. My mantra is 52 weeks these days!
 
So, I have not posted for eons. My TKR surgery was in Dec 2018. My 1st manipulation was Jan 2019. Having been diagnosed with Arthrofibrosis, I still constantly deal with pain and swelling. I believe that my ROM at one point was close to 109 degrees, but I was not happy with my continued pain and swelling.

Fast forward to today. I researched and found Dr Dale Flandry at the Hughston Clinic. I was impressed with him and decided to have him do surgery (clean out scar tissue and open me up) to improve ROM and decrease pain and swelling from Arthrofibrosis. I recently had the surgery but because my ROM was only 60 degrees one week out, they did a manipulation on me. Surprisingly, I feel better after the manipulation. Swelling and pain are obviously an issue, but my daily PT therapist has decided to give me some TLC and massage and not major force bending. I am thankful. I also have a CPM machine which gently bends my knee without over doing it. I see the surgeon later this week but am hopeful that irrespective of a certain ROM, that he can release me going forward.

It really helped me reading over all my old postings and postings from others. My experience was a nightmare, but looking back and seeing that my ROM got to 109 degrees from the initial knee replacement when things settled down proved to me that slow and steady is the best course of action. I hope and pray that once I recover from this recent surgery and MUA, that my Arthrofibrosis will be less of a nightmare going forward because I am under great care from Dr Flandry and his team.
 
Welcome back!

Please give us the dates of your recent surgery and MUA and we’ll add them to your signature.

Here‘s a refresher course. Even though you didn’t have a revision theses guidelin will still help. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The 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​
ice​
take your pain meds by prescription schedule (not when pain starts!)​

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. At week 4 and after you should follow this

6. Access to these pages on the website
​

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.
 
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