TKR Nine weeks out and still limited ROM
- Thread starter Gilina
- Start date
KameronSteele
junior member
Gilina[/QUOTE]
@Gilina, I have that same feeling..something (cement it feels like in my knee) is preventing it from moving past a certain point. do you think yours is swelling?
Josephine
NURSE DIRECTOR EMERITA
If your knee feels like it's hit a brick wall, as in coming to a complete stop, then the chances are you have adhesions.
MUA (Manipulation under Anaesthetic) and Adhesions
MUA (Manipulation under Anaesthetic) and Adhesions
KameronSteele
junior member
@Josephine , can adhesions form this quickly post op? 5.5 wks out?
Gilina
member
So, tigz, how did you and your knee feel afterwards? How long after your surgery did you have the MUA? Were you able to drive and walk unaided afterward? Were you able to manage on your own? Or were you "set-back" for a period of time? TIA.
Yep, still hedging on my decision. And still not quite at 90 degrees, but the "tugging" or "pulling" sensation I have when I bend my knee is much less (though not gone) and it still gets cranky when I try to "work it" to get it bend more.
Gilina
Yep, still hedging on my decision. And still not quite at 90 degrees, but the "tugging" or "pulling" sensation I have when I bend my knee is much less (though not gone) and it still gets cranky when I try to "work it" to get it bend more.
Gilina
Gilina
member
Well, I thought so at first--esp. when I could still see swelling and my knee was still warm/hot. But, my knee cooled down at about 6 weeks and has looked only minimally swollen since--if at all now. But that "bends to a certain point and then stops" feeling started at about week 4 after I had been very ill and very dehydrated. It was a sudden change at the time, but has not changed since.
@Josephine In your experience, is there usually bruising after an MUA? I didn't have one single bruise after my TKR, which made me very happy.
I just have so much to do in Sept and Oct (to get ready for winter) that I don't want a big setback in my functionality. I have to be able to drive and run errands.
Gilina
tigz
graduate
My MUA was 9 weeks post TKR. The initial pain was overwhelmingly from the quads and other dormant muscles, I didn't really feel or notice the knee pain until three days after the procedure. I was back on meds (tramadol) 'round the clock for three days. I used the walker for the rest of the first day only, then back to my cane. The therapist gave me a quad massage for several days after the MUA, which helped tremendously. I didn't drive until day four, because of the meds more than anything else. Even though I was close to maintaining (for the most part) the bend he got me to, it wasn't a natural bend for a while. My leg wanted to stay stuck at my previous (lack thereof) bend, and I had to consciously bend it more. Was it a set-back? I guess, to many it would be, but it was my only way to go forward, and it worked for me. The daily PT drove me crazy. PT told me not to get rid of the cane until I had a normal gait, which for me was week 11, but if they hadn't have told me that, I probably would have been walking unaided sooner.
Initially I was counting each week as x number of weeks from the MUA, x numbers of weeks from the TKR, but last week I lost track and just starting counting four months from the TKR. It's been a long haul, I'm still working on quad strength and extension. Finished PT week before last.
I had no bruising after the MUA.
Initially I was counting each week as x number of weeks from the MUA, x numbers of weeks from the TKR, but last week I lost track and just starting counting four months from the TKR. It's been a long haul, I'm still working on quad strength and extension. Finished PT week before last.
I had no bruising after the MUA.
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Gilina
member
@tigz Thanks for all the information! It actually made me question my decision briefly, but then I decided to just go for it!
So, now the irony: I had made up my mind yesterday to go ahead with the procedure and called the OS's office. Guess what? He does not feel it is safe to do the MUA procedure after 3 months (I just counted and I am at 14 weeks!), but what he can do is at/after 6 months, what is called an arthroscopic lysis, which is an outpatient procedure. So, all my hemming and hawing resulted in overshooting a deadline I didn't know I had!
So--ask the experts @Josephine Have you any familiarity with arthroscopic lysis?
Who knows, maybe by that time my knee will have decided to bend more on its own. Can't decide if I feel relieved or that I just wasted weeks of stressing out and changing my mind 8 times a day! :-/
TIA----Gilina
So, now the irony: I had made up my mind yesterday to go ahead with the procedure and called the OS's office. Guess what? He does not feel it is safe to do the MUA procedure after 3 months (I just counted and I am at 14 weeks!), but what he can do is at/after 6 months, what is called an arthroscopic lysis, which is an outpatient procedure. So, all my hemming and hawing resulted in overshooting a deadline I didn't know I had!
So--ask the experts @Josephine Have you any familiarity with arthroscopic lysis?
Who knows, maybe by that time my knee will have decided to bend more on its own. Can't decide if I feel relieved or that I just wasted weeks of stressing out and changing my mind 8 times a day! :-/
TIA----Gilina
Gilina
member
@skigirl Contacting you with a question (not sure this is the correct way, but...)
Just found out I missed my "window of opportunity" for an MUA procedure. OS says he can do arthroscopic lysis after 6 months. @Josephine said you have had this done, so I wondered what your experience with it was and if I may ask you some questions. Thanks.
Gilina
Just found out I missed my "window of opportunity" for an MUA procedure. OS says he can do arthroscopic lysis after 6 months. @Josephine said you have had this done, so I wondered what your experience with it was and if I may ask you some questions. Thanks.
Gilina
Gilina
member
OK, thanks. I have been reading everything on the site I can find about adhesions--but am also finding a lot of information on forum members' experience with arthrofibrosis. It appears these are not the same thing, so I am researching more. Any clarification or additional information is most appreciated.
Besides the continued lack of ROM, I guess my main complaint is that in the last month or so I am stiff when I stand up from a chair or get out of bed and often grab my walker for the first 5 or 6 steps. That was not the case initially, so the change seems odd to me. Have been trying to blame it on the weather.
Gilina
skigirl
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I actually had an "open lysis of adhesions" which is just a removal of scar tissue or adhesions, but he Opened my knee---cut open the old scar to get at the extensive scarring that I had in my knee.
I know that @maryo52 did have an arthroscopic lysis of adhesions and she was really pleased with the result. To me, it opened the knee so that it moved more freely. I had some bruising--pain for three days or so.
The biggest thing is that my OS was very careful with rehab. I had no rehab for three weeks---he felt that if you exercised an inflamed,hot knee it would cause more adhesions to form.
feel free to ask any questions that you might have. Kelly
I know that @maryo52 did have an arthroscopic lysis of adhesions and she was really pleased with the result. To me, it opened the knee so that it moved more freely. I had some bruising--pain for three days or so.
The biggest thing is that my OS was very careful with rehab. I had no rehab for three weeks---he felt that if you exercised an inflamed,hot knee it would cause more adhesions to form.
feel free to ask any questions that you might have. Kelly
Gilina
member
@skigirl Thanks. I had planned to ask my OS a bunch of questions at my Monday appt.--but I was sick and couldn't go (2 hour round trip drive for me). So....I'll probably do more research and ask some more questions here before my next appt. in October.
@maryo52 doesn't seem to be around anymore, but perhaps I can find her posts still on the forum. Thanks.
Besides the adhesions blocking my ROM, I think I have some muscle spasms or maybe muscle contraction (?) that isn't helping. But, no real pain (just a weird, really tight, something in the way feeling) and I can do so much more than I could before my surgery without all that pain. Hopefully, the lack of ROM will sort itself out with or without the arthroscopic procedure.
Supposedly, someday the other knee will need to be done--and I will take all that I have learned here and be much more informed (and bossy) next time.
Back to researching.
Gilina
@maryo52 doesn't seem to be around anymore, but perhaps I can find her posts still on the forum. Thanks.
Besides the adhesions blocking my ROM, I think I have some muscle spasms or maybe muscle contraction (?) that isn't helping. But, no real pain (just a weird, really tight, something in the way feeling) and I can do so much more than I could before my surgery without all that pain. Hopefully, the lack of ROM will sort itself out with or without the arthroscopic procedure.
Supposedly, someday the other knee will need to be done--and I will take all that I have learned here and be much more informed (and bossy) next time.
Back to researching.
Gilina
skigirl
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I had to have a spacer replacement---the first one was too small, so I had to have an open procedure. I am convinced though that an arthroscopic procedure is best. Also, after reading lots about adhesions, I think that if the doc cauterizes them instead of cutting them he causes less bleeding and thus less chance of more adhesions.
I have a list of specialists in arthrofibrosis.
Docs for arthrofibrosis
Dr. Colin Eakin, Palo Alto Medical Foundation, California
Dr. Steadman, Steadman-Hawkins Clinic, Vail, Colorado
Dr. Peter Millet, Steadman Hawkins, Vail (as of 10/1/05)
Dr. Lonnie Paulos, Texas
Dr. Frank Noyes, Cincinnati Sports Clinic, Ohio
Dr. Wojitys, Ann Arbor, Michigan
Dr. Folk in South Carolina
Dr. Mike Terry, University of Chicago
Dr. Shelbourne, Indianapolis, IN
Dr. Flandry, Hughston Clinic, Columbus, Georgia
Dr. Gill Boston
Dr. Tomas Sculo HSS
Dr. Answorth Allen HSS
Dr. Paulos Pensacola
Dr. Glynis London
I have a list of specialists in arthrofibrosis.
Docs for arthrofibrosis
Dr. Colin Eakin, Palo Alto Medical Foundation, California
Dr. Steadman, Steadman-Hawkins Clinic, Vail, Colorado
Dr. Peter Millet, Steadman Hawkins, Vail (as of 10/1/05)
Dr. Lonnie Paulos, Texas
Dr. Frank Noyes, Cincinnati Sports Clinic, Ohio
Dr. Wojitys, Ann Arbor, Michigan
Dr. Folk in South Carolina
Dr. Mike Terry, University of Chicago
Dr. Shelbourne, Indianapolis, IN
Dr. Flandry, Hughston Clinic, Columbus, Georgia
Dr. Gill Boston
Dr. Tomas Sculo HSS
Dr. Answorth Allen HSS
Dr. Paulos Pensacola
Dr. Glynis London
Gilina
member
@skigirl Thanks for the info. Not able to get to any of those docs, though, so I'll stick with my OS. I'll have to ask him if he snips or cauterizes the adhesions.
Well, after a couple of weeks trying to not think about my knee (unsuccessfully), today I read through a long, 12-part "course" on arthrofibrosis from a link I found on this site. The author included adhesions as a form of arthrofibrosis, near as I can tell. This article is from 2008 and was about more kinds of knee problems than just replacement surgery. One quote: "After approximately 2 to 3 weeks, patients should be able to regain normal flexion and extension or demonstrate a normal progression of motion."
Here is another quote: "This [post initial surgery] inflammatory response usually becomes quiescent at approximately 2-4 weeks after surgery." I thought I was doing great when my knee cooled down at about 6-7 weeks! He does mention that "blocked" from additional bend feeling that I had starting around 4 weeks post-op as being a sign of adhesions.
He makes several comments which are at odds with things I have learned here--like if post-op PT isn't aggressive enough/done well enough, you can form scar tissue (adhesions), i.e., it's the patient's fault, and therefore have a loss of ROM (yet I have read here that aggressive PT can cause adhesions). Sometimes I think too much conflicting information is just too confusing--and upsetting.
Well, I won't find out what is up until Oct 5, but it sounds like the sooner the lysis is done the better so my muscles and tendons/ligaments don't shorten or atrophy. That strange achy, stiffness, tightness was relieved by muscle relaxers--but I can't take them forever, so that's another problem to be resolved.
But--I can walk essentially normally and am reasonably pain free (when on muscle relaxers) though I definitely have some discomfort ongoing. The road is still a long one, despite some great progress.
Gilina
Well, after a couple of weeks trying to not think about my knee (unsuccessfully), today I read through a long, 12-part "course" on arthrofibrosis from a link I found on this site. The author included adhesions as a form of arthrofibrosis, near as I can tell. This article is from 2008 and was about more kinds of knee problems than just replacement surgery. One quote: "After approximately 2 to 3 weeks, patients should be able to regain normal flexion and extension or demonstrate a normal progression of motion."
Here is another quote: "This [post initial surgery] inflammatory response usually becomes quiescent at approximately 2-4 weeks after surgery." I thought I was doing great when my knee cooled down at about 6-7 weeks! He does mention that "blocked" from additional bend feeling that I had starting around 4 weeks post-op as being a sign of adhesions.
He makes several comments which are at odds with things I have learned here--like if post-op PT isn't aggressive enough/done well enough, you can form scar tissue (adhesions), i.e., it's the patient's fault, and therefore have a loss of ROM (yet I have read here that aggressive PT can cause adhesions). Sometimes I think too much conflicting information is just too confusing--and upsetting.
Well, I won't find out what is up until Oct 5, but it sounds like the sooner the lysis is done the better so my muscles and tendons/ligaments don't shorten or atrophy. That strange achy, stiffness, tightness was relieved by muscle relaxers--but I can't take them forever, so that's another problem to be resolved.
But--I can walk essentially normally and am reasonably pain free (when on muscle relaxers) though I definitely have some discomfort ongoing. The road is still a long one, despite some great progress.
Gilina
If that article was written in 2008, it's out of date.
The philosophy is changing and more and more surgeons are realising that you do not have to do lots of physical therapy in order to ward off adhesions. Quite the reverse, in fact - too much exercise irritates and inflames the healing soft tissues, which makes them hot and drier than usual. This then predisposes them towards making adhesions.
It always surprises me that many people in the US still believe you have to exercise madly in order to regain full use of the knee after a TKR, while those of us in the UK and several other countries do minimal PT and still have excellent results.
The knee anatomy isn't different, so why the difference in approach?
The philosophy is changing and more and more surgeons are realising that you do not have to do lots of physical therapy in order to ward off adhesions. Quite the reverse, in fact - too much exercise irritates and inflames the healing soft tissues, which makes them hot and drier than usual. This then predisposes them towards making adhesions.
It always surprises me that many people in the US still believe you have to exercise madly in order to regain full use of the knee after a TKR, while those of us in the UK and several other countries do minimal PT and still have excellent results.
The knee anatomy isn't different, so why the difference in approach?
Gilina
member
@Celle Thanks for that. I wasn't sure if 2008 was old news or not. Glad it is because some of the things in the article upset me. Now I can calm down again.
As for post-op everything, even within my group of docs/PAs/PTs here I got conflicting "advice" and actions. PA said I should be at 90 degrees ROM at two weeks out, i.e., it was my fault (with a leg the size of a watermelon), but the OS said don't do anything that causes pain because that will make it worse, and the PTs couldn't even understand back issues, muscles spasms, and thought I should "catch up" with my reps despite having been ill for days. Ugh.
This forum has the best advice I have found. Living in the US, I have known for years how far behind the rest of the world we are on so many issues, medical and otherwise. Besides the differences in approach from country to country on TKR post-op, docs need to realize that every patient is different and stop trying to put us all in the same protocol box.
Just read another link I found here to a site on arthrofibrosis and the great info gave me some more questions to ask my doc (How do you do the lysis procedure? What equipment/methodology, etc.). Even though I often only have time to drive by this forum, I always find information that helps me. Thanks.
Gilina
Exactly! Esp. when outcomes in the UK and elsewhere are the same or better!
As for post-op everything, even within my group of docs/PAs/PTs here I got conflicting "advice" and actions. PA said I should be at 90 degrees ROM at two weeks out, i.e., it was my fault (with a leg the size of a watermelon), but the OS said don't do anything that causes pain because that will make it worse, and the PTs couldn't even understand back issues, muscles spasms, and thought I should "catch up" with my reps despite having been ill for days. Ugh.
This forum has the best advice I have found. Living in the US, I have known for years how far behind the rest of the world we are on so many issues, medical and otherwise. Besides the differences in approach from country to country on TKR post-op, docs need to realize that every patient is different and stop trying to put us all in the same protocol box.
Just read another link I found here to a site on arthrofibrosis and the great info gave me some more questions to ask my doc (How do you do the lysis procedure? What equipment/methodology, etc.). Even though I often only have time to drive by this forum, I always find information that helps me. Thanks.
Gilina
