MUA My new left knee-has Athrofibrosis, what now?

[Cinders2023]

I got a friend to buy one of those pipe insulators that you slip around the pipe to help keep it from freezing. I cut it off to size and put it around the handle of the cane.

Good tip. Mine already has a foam grip, but maybe a little extra cushion will help.

I had my 6 week check yesterday. Two and a half hours in the car, a stop for lunch in the middle, followed by over an hour wait for my appointment. Needless to say, even with some ice on the way down, I was quite stiff by the time the PA saw me. Never saw this one before, she was very nice, didn’t jerk on my leg, BUT overly concerned that I was far too stiff for 6 weeks. I mentioned I had only started PT 2 weeks ago to the tune of 4 visits. I was 5 & 90 on Monday. She discussed the dreaded MUA, and I asked do you really think this is adhesions? She said I was way too stiff for 6 weeks and it was probably due to starting PT so late. I Made a follow up appointment that ended up being almost 14 weeks post surgery due to OS availability. We weren’t 5 minutes down the road and the office called to move my appointment up to 10 weeks post surgery so there would be time to schedule an MUA before the 12 week cutoff. So my next appointment is in 3 weeks. I imagine I will still not be at peak performance after another long car ride to get there. I have been improving week over week since week 4. Frustrated that they are all pushing for this procedure since my second week post op. I could not bend my knee past 77 at home on day 2 and I don’t even remember them bending it in the hospital, maybe I did? All I remember was I had to use the walker and get to the bathroom down the hall. I feel like I’m finally making progress, but it’s never enough.
Anybody decline a suggested MUA at 12 weeks and still keep progressing? How do I know if this is really adhesions? My original knee surgery recovery kept my knee immobile for 6 weeks (broken kneecap) and I remember PT taking a long time, but got my bend and extension back with no adhesions. I haven’t even been immobilized this time! Sorry for the rant, just frustrated and feeling defeated.

 

[Jockette]

There is so much I could reply here, but I’ll just share the following. She says it all!

And by the way, you are doing just fine,


This is what one of our members, TortiTabby, experienced:

(Just so you know, ADL means Activities of Daily Living.)

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."

It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)
So, if a OS or PT bullies you into thinking your ROM will not improve over time they are wrong. By the way, I haven't been back to see the OS since that horrible appointment at 6 weeks, but I sure am going back when I reach 120 just to say, "Ha! You were wrong, BoneSmart was right!" “

And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. “

 

[Cinders2023]

@Jockette I did a search of MUA on this forum and found that post and a couple of similar other posts. This gives me hope. I do feel like I am continuing to improve. I don’t want to hinder my recovery by not getting rid of adhesions, IF I have them. But i don’t think I do. I think I’m going to keep doing what I am doing, and see if I keep improving. I’m not ready to have a setback when I finally feel like I’m making some progress.

 

[Layla]

Go with your gut and keep doing what you're doing. You're making progress and its a process. A recovery you've barely just begun in the entire scheme of things. I wish you all the best and a nice weekend too!
You're doing great!
@Cinders2023

 

[sistersinhim]

She said I was way too stiff for 6 weeks and it was probably due to starting PT so late.

PT has nothing to do with you being stiff. It's the swelling, both inside and outside your knee.

We weren’t 5 minutes down the road and the office called to move my appointment up to 10 weeks post surgery so there would be time to schedule an MUA before the 12 week cutoff.

Don't fall for this! You don't need a MUA since you have already reached 90 degrees and if down the road you find you do, you can do it at any time. There is no cut-off timeframe. If I were you I'd cancel that doctor's appointment. You don't need the stress and aggravation of someone trying to push a MUA down your throat! You are doing well!

I feel like I’m finally making progress, but it’s never enough.

You are the only one that you have to please. It's your knee and no one else's. You know it better than Two and a half hours in the car, a stop for lunch in the middle, followed by over an hour wait for my appointment. Needless to say, even with some ice on the way down, I was quite stiff by the time the PA saw me.

Two and a half hours in the car, a stop for lunch in the middle, followed by over an hour wait for my appointment. Needless to say, even with some ice on the way down, I was quite stiff by the time the PA saw me.

This is why your knee was so stiff. Even at 3-4 months out, most knees would be stiff with all that time with it down. Having it down, causes swelling, that's why we suggest everyone elevate the leg with the toes above the nose. When you can't elevate enough fluid collects in the knee, restricting movement.

 

[beachy]

My first tkr....extension wasn't 0 when I "graduated" pt. But, pt told me it would happen with activity. Currently, I'm at 4 and would never consider an MUA if its suggested. It happens. Some sooner, some later.
You don't need this aggravation now. All that traveling had to make your knee swell.
I would call the office back and tell them you won't be able to come back at 10 weeks. But you'll be available at 12 weeks. Its just a wee fib
Don't let them push you around. You know your body better than they do.

 

[JusticeRider]

Anybody decline a suggested MUA at 12 weeks and still keep progressing?

I declined a MUA. My flexion was limited to about 70 for 2 yrs before surgery. Right after surgery it was about 45. In PT after a few weeks I made it to about 80. I had a LOT of swelling. I couldn’t get further flexion and allowed them to push me hard. The swelling kept getting worse. Then I had a big setback at 4 weeks. When I met with my surgeon’s PA at 6 weeks, he pushed it to almost 90 with tears streaming down my face. He said they wanted to do a MUA if I didn’t get to 120 by 8 weeks. I had done my research, including scientific papers as well as reading on BoneSmart, and I decided I didn’t want to do that. At 8 weeks, I was still at 80 and I refused the MUA.

I had a ton of swelling until about 4 months. I didn’t really see any improvement until the swelling got under control. Then I started gaining ROM and progressing in every way. I haven’t measured my flexion since I refused the MUA because it was affecting my mental health. But I know the flexion has improved so much because of all the things I can do! My improvement has been incrementally slow but steady and I’m ok with it. This is just my knee’s speed and I respect that. I have no doubt my ROM will keep improving for many months to come. It was obviously the swelling holding me back, along with shortened muscles and tendons from years of limited ROM. That’s why it’s continuing to progress as time goes by. So I’m SO GLAD I didn’t do the MUA!

 

[JusticeRider]

She said I was way too stiff for 6 weeks and it was probably due to starting PT so late.

Also: I started PT 5 days post op

 

[EalingGran]

Two and a half hours in the car, a stop for lunch in the middle, followed by over an hour wait for my appointment. Needless to say, even with some ice on the way down, I was quite stiff by the time the PA saw me.

Definitely agree that that could make your ROM worse. I did my first longish drive ( just over 2 hours) to visit my son. My knee definitely felt it and was slightly achey and sore- and I am 16 weeks post a PKR. I drove for one hour and my husband for the other hour and funnily enough it was the hour as a passenger that was definitely more of a strain.
Could you make a video to show what your knee can do at home and send it to your team?

 

[beachy]

I started PT 1x week at 3 weeks.
First tkr I started at 4 weeks. I got perfect ROM well after PT with first tkr.
It's hard to stand your ground when the so called experts are telling you otherwise.
A swollen joint doesn't bend. An MUA is forcing it to bend. And make it swell even more for a longer period of time.

 

[Cinders2023]

I joined the over did it club this weekend. I felt ok after the long day on Thursday so I walked a lot, went on a couple of shopping outings, visited my chickens, did PT Monday morning and by end of PT I was stiff and swollen. Spent the rest of yesterday icing and elevating. This morning after shower, I put on a compression stocking then ice and elevation some more.
Going to take it easy today and probably tomorrow. No increase in ROM (85 and they didn’t say what extension was) over last week, so all the extra things I did over the weekend did not help me get ROM to increase any faster. It actually went backwards. Finding it hard to find the sweet spot of doing enough, but not too much.

 

[sistersinhim]

all the extra things I did over the weekend did not help me get ROM to increase any faster. It actually went backwards.

Oh yes, this is very common. We think the more we do, the more the bend will improve, but that's just not so. It's the opposite, as you found out.

Wait until your knee settles down until you get back to some more of your more active things. This will give it a chance to recover from the ODIC!

 

[beachy]

During my first tkr I was not only a member of ODIC, I was Madam President. We always do it. For second tkr I know better. You're right.... It's hard to find the sweet spot first time around.

 

[Cinders2023]

Since Monday I have been icing, elevating, and taking it pretty easy. Swelling is much better and at times I can even see my kneecap. I am still pretty stiff and when I sit with my leg hanging I do not get a 90 degree bend. I am trying to sit with my leg hanging at mealtimes to try to gentle coax the bend without pushing it. I am doing gentle stretches, both sitting and standing when I shower with some heat from the water. I had hoped with 6 days of rest I would see some bend, but I am at least feeling less inflamed than I was a week ago. I want to make sure I’m moving enough, but not too much so I don’t go backwards. I sure wish there was a better way to determine you have adhesions forming.

 

[JusticeRider]

Cinders, it sounds like you’re doing everything right! I couldn’t believe how long it could take sometimes for a flare-up of swelling to go down. You really are doing great, it just takes time

 

[Layla]

I am at least feeling less inflamed than I was a week ago. I want to make sure I’m moving enough, but not too much so I don’t go backwards.

You're doing well!

Swelling is much better and at times I can even see my kneecap.

Thanks for the chuckle. It's funny when the sight of your kneecap makes you happy. It's the little things!

 

[sistersinhim]

I sure wish there was a better way to determine you have adhesions forming.

Adhesions are actually very rare and are what many people are referring to when they say scar tissues. I will leave you an explanation for the difference:

One of the easiest ways to develop adhesions is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions. MUA (Manipulation under Anaesthetic) and Adhesions

You need normal scar tissue. That's what holds your incision together, and it's part of the normal healing process. Without it, you'd always have an open wound.

 

[Cinders2023]

Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions.

Yikes! This describes my knee for the first 6 weeks. Hot and inflamed to the point I worried I had an infection. It has only calmed down in the last 2 weeks, and still gets that way when I use it too much. I looked over my hospital records and even the day of surgery when they released me the notes said my knee was only 0-90, swelling listed as moderate. Notes that I did not meet baseline (whatever that means) but they released me because I met all other criteria (uses walker and has in home assistance). During surgery they could bend to ”over 125 degrees”. On release 90, next day something like 72. Most I have gotten at PT is 90.
I am not currently having much swelling or pain, but still don’t think I am bending 90. Makes me wonder what the heck is going on in this knee??

 

[beachy]

It sounds like last weekend is what happened. Too much activity then PT.
My tkr was Jan 11. Please don't worry about adhesions. Gentle stretches, postpone PT for a bit and you'll have better ROM.
You might be past 90°.
I thought I was at 90. PT measured and it was 115ish.
I think I'm done with PT. I went 3-4 times, always big swelling after for days. I'm going to walk a little more and gentle stretches.
At my 8 week appointment I plan to knock doc's socks off with no PT progress LOL!
There are great ROM progression charts on this site from real patients up to 2 yrs post op.

 

[sistersinhim]

Here are a couple of the progression charts Beachy is talking about. 1) 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:
Don't worry about your ROM 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 of 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 worried about ROM.

And here is the second one:

This is what one of our members wrote about the slow development of her ROM. Thank you, @Campervan 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 "