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

[Cinders2023]

@Layla thank you for the well wishes. I’m hoping that this next month will begin a turning point for me.

 

[JusticeRider]

I’m hoping that this next month will begin a turning point for me.

I hope so too, Cinders! You could use a break. Here’s to turning corners!

May better days be on the horizon

 

[JusticeRider]

@JusticeRider I know you know what I’m feeling. Just this week I went back through your recovery thread to see your struggle at the 3 month mark

You know, after you said this, I went back and took a quick look at my thread around 3 months. Honestly, I think I was trying to post mostly when I was at my best (didn’t want to be a total downer!) I remember it being so much worse than you can see by my posts. Don’t get me wrong, I had moments of optimism (I’m an optimist!) but some really low lows too. I was so glad when that first 4 months of hell had passed! I’ll be following your thread and can’t wait to see you on the upswing!

 

[Cinders2023]

Honestly, I think I was trying to post mostly when I was at my best (didn’t want to be a total downer!)

I stopped posting frequently, because I felt bad always posting negative feelings. But here goes…
I am getting fitted with a JAS brace to help improve flex today. I was hoping to start this a couple of weeks ago to have some time to use it before my next follow up, but didn’t work out. I have had a flexion of 103 at best, but measured at about 88 on last Wednesday. I feel like I am getting stuck. I am having more pain with activity, and as always, swelling. Beginning to wonder if all that time my knee was so hot an swollen, I began developing adhesions. I have a telephone visit with my OS on Monday and I am thinking I may need the MUA after all. Not sure if that’s even an option with my current flexion. I am taking celebrex, Tylenol, and flexeril but still having pain with activity. still cannot take a proper step. Sick of being stuck on the couch under an ice pack.

 

[beachy]

Sorry you're having so much pain.
Hope the brace helps you. And please let us know what your OS says

 

[indie]

my in home PT had advised me to stop doing exercises and just walk.

I know you must be going through a lot. One thing amaze me, why is there not a universal protocol for TKR recovery? why we have to suffer a lot due to differential recovery procedure of each "expert"

Hospital suggested, to walk 5-10 min every hr. My PT suggest "no walking", as you can't drive car with flat tire. He gave me exercise based plan, so my question, is there a "research based uniform TKR recovery plan for medication and PT?

 

[JusticeRider]

I stopped posting frequently, because I felt bad always posting negative feelings. But here goes…

Cinders, I’m glad you’re posting even if it’s not sunshine and roses. That what we’re all here for. We all need support and I think most everybody here wants to help others too.

Do you have a stationary bike? Sorry if you’ve already mentioned it. Mine has been my main ROM tool since I was first able to make a rotation. But I wasn’t able to do that until my husband found some shorter crank arms and switched mine out for me. The shorter crank arms shrink the diameter of the rotation and the result is, you don’t have to bring your knee up as far. If you want to know more, let me know and I can share the details.

@Roy Gardiner has a tutorial on here for using your bike to work on ROM. You may have seen it already. In my case, lowering the seat a click took weeks, not minutes or even days. But I have lowered it now 3 clicks and every time I am filled with joy and relief because it’s a quantifiable sign of increased ROM.

Heel slides don’t work well for me for some reason, but the bike gives me a perfect gentle stretch. It’s also nice because I can watch a show on my phone, read the news, or scroll through BoneSmart while I stretch my knee. I just pedal at a moderate pace for 20 minutes (worked my way up very, very slowly) Maybe something to try for your knee?

 

[Roy Gardiner]

@Roy Gardiner has a tutorial on here

Using a bike to gain ROM is pretty simple:

• Set the bike to zero resistance
• Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
• Gently turn the pedals, through discomfort but without pain.
• Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
• Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
• Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
• And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't

Here is a bit more chat and some pix and how 'healing' and 'training' are different

 

[Cinders2023]

I talked with my OS for about 15 minutes via telephone yesterday. My bloodwork looked great with no indication of infection. I went and got a new series of X-rays today to be sure we aren’t dealing with an implant issue. We discussed doing an MUA, and he offered that I could wait until I get back from a planned camping trip the first week of May if I wanted, but he didn’t want to wait beyond the 6 month mark. I haven’t felt like I am making much forward progress in the last 6 weeks, and much as I looked forward to camping I think I would be miserable in the truck and trailer All week. So I decided to do the MUA on next Monday the 17th. I will be 15 weeks post TKA. I have slowly changed my mind over the last couple of weeks and think this might be what I need to do. I guess we never really know if it was needed until after it is done. If this doesn’t help me, at least I can say I tried everything I could to get my mobility back. Wish me well.
Moderator, please add the MUA yellow thingy to my post, thanks.

 

[Cinders2023]

@Roy Gardiner thank you for the tutorial on using a bike for rehab. I have a pedal machine that I have been using at home. I can’t lower the seat on a traditional bike enough to keep my feet touching pedals and knee bent enough to make the rotation. I mostly just rock. I can do it on a recumbent bike, but still slide forward and back a little on the seat to keep contact with the pedals. Hoping after the procedure I can get enough bend to use this as an exercise to warm up and keep the knee loosened.

Wish me well, this has been a difficult journey. I am also mindful of the challenges still ahead of me.

 

[Cinders2023]

Here is my update following MUA on April 17. In addition to the manipulation, OS removed fluid from my knee for examination. The only test I have back so far is that fluid is negative for crystals.

Check-in was 530 am for a 730 am procedure. We were headed back home at 1230 so I was pretty wiped out from the 2 hr car ride each way. I mostly rested, icing and elevating the rest of the day.

Had my first post-procedure PT at 6 pm on Tuesday. I did some gentle bending 3 times throughout the day and we did some measurements and gentle stretches in PT. I rocked the bike for 5 minutes and made one full revolution. The super tight feeling of a hard stop is gone. I have an overall ache similar to when you have worked out too hard, but the pain is managed. Had a morning PT session on Wednesday that was not painful and again did some good stretching and was able to do 15 backward revolutions on the bike. I still have some swelling, but can bend 90-100 without pain, something I haven’t been able to ever do before. I am icing, elevating, and resting this first week and doing some gentle bends a few times a day to keep things moving. We are working on finding the balance of enough movement to keep gaining rom without aggravating my knee and causing more swelling.

I’m glad I waited to do the MUA, I was not ready for this procedure at 8-10 weeks. But I am also glad I did it at 15 weeks because I feel like I was getting stuck and more painful. There were adhesions formed and so it was ultimately the right choice. Hopefully, now I can get on with continued recovery.

 

[sistersinhim]

It sounds like your MUA was a correct decision and you are doing well after it.

 

[Cinders2023]

My MUA was 2weeks ago and I am just shy of my 4 month knee-aversary. I had a telephone visit this morning with my OS. I am still struggling with swelling and stiffness, but have had some improvement to my ROM. My extension is up to 105 from 90. The OS was agreeable to my request for a medrol pack (steroids) nice we have ruled out infection as a cause for swelling. I have had relief from swelling and stiffness in the old arthritic knee with previous course of steroids so I figure it’s worth a try to see if it will reduce my swelling some. His only other suggestions for relief was arthroscopic removal of adhesions in the future, or revision surgery, which he did not recommend as success varies.

We decided to see what it feels like once all the swelling settles down (whenever that is). My next follow up is in a month. I am still icing 3+ hours a day and all night every night. Still taking celebrex, gabapentin, Tylenol, and 5mg oxy as needed for pain.

Last week I was able to peddle the bike forward for the first time ever! So I need to focus on what I can do and not let what I can’t do control my mood. I walked a record 8,000 steps on Saturday and paid for it yesterday. I have been averaging about 4,000 a day so that was a big jump and my knee wasn’t happy about it.
Life after MUA is not nearly as bad as I had feared, hopeful for more progress next month!

 

[sistersinhim]

Last week I was able to peddle the bike forward for the first time ever!

Yippee!! That is a big step you have taken there!

So I need to focus on what I can do and not let what I can’t do control my mood.

What I found helpful was to go back on my thread and read my beginning posts. This showed me that I really had improved and helped so much on those many down days.

 

[Layla]

My MUA was 2weeks ago and I am just shy of my 4 month knee-aversary.

Happy Four Month Anniversary!
Not certain if you kept the date for the camping trip first week of May. If so, I hope youre getting some peaceful rest out in nature. If you decide to cancel, you'll be feeling all that much better when you do decide to take that trip.
Best Wishes!

 

[Cinders2023]

@Layla Thank you for the well wishes. After much consideration, we cancelled the camping trip. I’m still icing a lot during the day and didn’t think I would do well with a lot of sitting with my leg down just yet. There will be others. I am getting better flex up to 107 and got my extension to 0 yesterday. Happy to finally see things moving. I still have a lot of stiffness all the time and swelling s hanging on too. Using a cane still, as I am still not walking without stiff legged limp. Fingers crossed that it will come eventually and I can ditch the cane. Probably only have a couple more weeks of PT before they cut me loose.

 

[Layla]

I am sorry you had to cancel, but it is understandable. Camping will be all the more enjoyable after you have some more healing under your belt. Good Luck in PT for the next couple weeks. Remember you're the boss.
Have a nice weekend!
@Cinders2023

 

[Cinders2023]

Have a nice weekend!

Thanks! You too.

 

[Cinders2023]

MUA as 4 weeks ago yesterday. Since my last update I completed a 6 day medrol pack of prednisone and during that pack I had my best ROM numbers 0 and 107. My swelling was also the best I had experienced. Unfortunately shortly after my last dose the swelling is back full force. My numbers have dropped and I realized over the weekend that I may have started going backwards. I feel like I have cement in my knee capsule. It’s tight and heavy feeling. My bend feels like it has a hard stop, much like it did before my manipulation. The last 2 weeks I started going to the gym on non pt days to use the bike 5-10 minutes and walk on the treadmill 10-15 minutes. I bought a used recumbent bike last week and I have been sing it 5 mins a time 3 times a day since Friday.

I have been researching what can be done about adhesions when MUA fails and yesterday I went down the rabbit hole to a place of doom and despair. It seems if I can’t get my runaway inflammation under control, there is little hope for a recovery to a working knee. My surgical knee stays 5-10 degrees warmer than the other knee unless constantly under ice. I am taking celebrex, Tylenol, gabapentin and 5mg of oxy if I am doing any activity like PT or just being on my feet for extended amount of time.

My next appointment with the OS is in 3 weeks. I am wondering if I should give the knee some more time or call and ask what else can be done about the crazy inflammation? Do I risk permanent damage from adhesions by waiting?

 

[sistersinhim]

I feel like I have cement in my knee capsule. It’s tight and heavy feeling.

That is because it is full of fluid. Get that fluid out of there and the tightness will diminish some.

The last 2 weeks I started going to the gym on non pt days to use the bike 5-10 minutes and walk on the treadmill 10-15 minutes. I bought a used recumbent bike last week and I have been sing it 5 mins a time 3 times a day since Friday.

Oh my, you are doing way too much for not even a month out from an MUA. An MUA causes trauma to an already traumatized knee. This results in increased pain, swelling, and tightness. I suggest you stop everything extra and just let your everyday normal daily activities be your PT and exercise. This also means lots of resting, icing, and elevating. Your knee hasn't had a chance to heal yet with all you have been doing. Stop everything extra for at least a month and you should be a vast improvement.

Remember, you can not speed up your healing by exercising but you can slow it down. You are seeing that right now. Your knee wasn't but 4 1/2 months old when you further inflamed it by having the MUA. Now, is the time to let it heal and that means treating it very gently with lots of rest. Overworking, which you are doing, only causes setbacks. This is what you are experiencing now.