Bilateral TKR No progress ROM

[JojoFitness]

@JojoFitness I tend to “nerd out” on things so I have a goniometer (tool PT uses to measure angles) It Is pretty straightforward but I can’t use it on myself so (it’s hard to tell if it’s lined up for right) I judge ROM by are my feet parallel when I sit in a chair (surgical leg not kicked out but equal to normal leg), Is my bike seat where is was prior to surgery (somewhere between 110 and 120 degrees of flexion) can I bend my leg while standing and putting a sock or shoe on, am I using both legs when rising from a seated position (not favoring surgical leg- strength) can I walk DOWN stairs (getting better- also use this for a quad stretch as that seems to be primary thing keeping flexion from happening) I am super goal oriented and love “numbers” but It took a couple of months to realize I really don’t care what “the number” is - it is all about being able to move & do the things I want to. Everyday a millimeter closer.

Great explanation - thank you, Samsrf! Makes sense, and happy I can do all those things. I do still have discomfort on the medial side of my knee. And my right shin looks darker than the other leg, so is probably still bruised too. Ugh, glad I'll see the surgeon for the second time on Monday.

 

[Butterfly22]

 

[benne68]

Today I am finally able to stand up from the toilet and a chair without using my arms to pull myself up. Not consistent or easy and I do have my arms bent to help give me some stability but it’s progress.

That's a real milestone -- something to celebrate! Congrats!

 

[Butterfly22]

I'm getting a MUA next week. I'm at week 7 almost and 97/-4 on left and 108/-6 on right. The surgeon says he does 1000 knees a year for 26 years and 1-2 times a year he needs to do the MUA.

I'm nervous, but the surgeon said I should have been biking, screaming and crying in pain and he will get my knee to bend and then if I cant do it, it's me. My therapist vehemently disagrees with the surgeon. He does PT on those 1000 knees a year and they all get ROM without screaming or crying. He has been adamant if it's too painful I should NOT do it! He tells me occasionally the ROM doesnt come and a MUA is done.

He will gently help me through the month after it and tells me if scar tissue is the issue the MUA will make me better. If that's not the issue, I wont get worse bend by doing the MUA. He says I'll be swollen a few days then I should see improved ROM. He says it will be sore, but not hugely painful after the MUA and to ice!

I know bonesmart has a dim view believing ROM will improve over the year, but when the 95 year old lady beside me at 2 weeks has 115 degrees and I've seen nothing like that and not an ounce of change in a month, I feel I have to try to get more ROM. This has been relatively painless all along for me so I'm not happy about the MUA, but I'd be more upset if I dont try and this is all the better I get.

 

[Jcx]

Hope everything goes well for you. It's your decision. Take care Jcx

 

[WFD]

but when the 95 year old lady beside me at 2 weeks has 115 degrees and I've seen nothing like that and not an ounce of change in a month

This is so my life....

 

[Susie-Q]

I know these are your knees but I really don't think you need an MUA at this point. Please don't compare yourself to that 95 year old woman. Everyone is different and recovers at different speeds. It took me over 2 months to get from 103 to 117 ROM (5 weeks post-op to 3-1/2 months). I think your tissues are still swollen, which is why the knees won't bend. At 7 weeks you are still doing a lot of healing, your bones haven't healed yet! You need to do what's best for you but I urge you to give yourself time, not an MUA or tons of exercises (which set you back).

Your recovery will be longer because of the fact that you are healing two knees, not just one. You don't have a "good" knee to help you. This is my opinion and you do what you think is best.

 

[Axx72]

I say, don’t let anybody tell you what you can’t do. Comparing yourself to other people won’t help you improve. I found embracing the discomfort of static stretching in flexion and extension, to get those extra degrees is what helped me.

Starting the day with heat then stretching then your favorite activity then icing and elevation. I’m sure all stuff that you’ve heard before. Keep your head up and focus on the positive stuff and those little achievements. Once you get enough of those, you will find the angle wasn’t as unattainable as you thought.

2.5 Months post surgery

 

[InkedMarie]

I’m 7 weeks & about 110.
IMO you’re too early for MUA. You have a great PT; I’d listen to that person. If you choose to do it, we’re all here for you.

Marie

 

[2hips1knee]

I read up on the MUA's prior to getting mine done, and 3% to 5% need to have an MUA done. For what it's worth, I had mine done after 10 weeks and I did have more ROM, but it was short lived, and seemed to only last a few days and my knee was tight again. Now I'm dealing with the swelling from the MUA, which I think is limiting my ROM.

 

[Odieodell]

My therapist vehemently disagrees with the surgeon. He does PT on those 1000 knees a year and they all get ROM without screaming or crying. He has been adamant if it's too painful I should NOT do it!

Sounds like you have a great therapist. I can’t imagine a surgeon saying you should be crying and screaming in pain during PT. I’m at 10 weeks and my ROM hasn’t changed since 4 weeks. My surgeon wanted to do a MUA on me at 8 weeks, but I declined. I trust that as my knee heals my ROM will return through daily activities. I haven’t read where anyone here on BoneSmart has really retain great ROM after a MUA, so my thought was why irritate my knee again by brute force? Something to think about.

 

[benne68]

I'm at week 7 almost and 97/-4 on left and 108/-6 on right.

Those numbers are fine for seven weeks. It seems very strange that your surgeon would recommend an MUA if you are doing that well.

We have members who didn't get past 90 degrees until 4 or even 5 months out, and whose ROM continued to improve well into their second year.

I also encourage you to listen to your therapist on this!

 

[sistersinhim]

I'm getting a MUA next week. I'm at week 7 almost and 97/-4 on left and 108/-6 on right.

Why? You have great ROM and it sounds like you have no signs of adhesions. A MUA will just set your recovery back. Sure, you'll get a better bend on the operating table because of the forced bend, but the swelling and pain will come back in a few days, lessening that bend. So the MUA will be all for nothing. Tell your doctor you want to wait a couple of months and let your knee heal before considering a forced bend like that. Your therapist is right!

when the 95 year old lady beside me at 2 weeks has 115 degrees

Think of the difference between your muscle mass and that of the 95-year-old lady. All your muscles and tendons have to heal, which takes a lot longer than hers because it is so much more of it. Besides that, your OS might have had to do a lot more repair work inside your knee than she had done. No two knees are alike. It's like comparing apples and spinach! You eat both of them but that taste really different and they do different things for the body.

 

[kneeper]

For what it's worth, none of the surgeons we had at our JRAD conference said anyone had to be crying and screaming in pain to recover.

 

[sistersinhim]

For what it's worth, none of the surgeons we had at our JRAD conference said anyone had to be crying and screaming in pain to recover.

Why scream and cry when you don't have to?

 

[Butterfly22]

I'm at week 5 on BTKR and left is at 95 degrees, down from 100 and right is stuck at 106. I've been at the same values since week 3...not improving, actually worse on left! I do ROM exercises 4-5 times day, have been on just Tylenol since home from hospital. I do housework, laundry, cleaning, and walk outside house 15-45 min/day. I ice 2-3/day. Will I ever get better ROM and what can I do to make it better?

So I had the MUA on both knees yesterday. It wasn’t bad at all. My left knee already shows great improvement, not sure on right yet without measuring. I decided to take pain meds this time. After surgery, I didn’t really hurt so I was only taking Tylenol. I feel I may have been guarding my muscles in exercise then, so I’m on the pain pills, which wear me out, but I’m not in lots of pain....the exercises hurt, but I can see my knees are doing more so I can handle it. Start another 3 weeks of therapy on Monday. I would do the MUA again if needed, as I was pretty much 97 and 107 on my knees with about 5 degrees off in straightening. I had been stuck there for 4 weeks. I was terrified of the MUA, but it so far is just tiring, not really painful and the viselike grip I had on both knees is gone, so I’d say I feel better right now, just setme back in strength a little bit. Monday will be 8 weeks since my surgery.

 

[Susie-Q]

I'm glad the MUA seems to have gone well. Yes, I agree you should take the pain meds. You don't want to be guarding your movements so much that you hardly move at all because of pain. That won't help your recovery. You also need to make sure you aren't taking them prior to PT and masking any overly aggressive exercises that you will pay for later with swelling and pain. It's a fine line. Also, don't worry about strengthening exercises at this early stage. You have basically reset your recovery back to day 1 with the MUA and need to give yourself time to heal. Lots of icing, elevating and healing. Gentle movements and activities of daily living should be your main focuses now.

 

[Butterfly22]

So I'm at 9 weeks post btkr, it's been 11 days since I had MUA. I'm on Tylenol only, pain isn't bad at all, just some stiffness when I exercise. Left knee is at 105, right at 111. The MUA helped left knee 8 degrees, and right knee 4 degrees and I've been steady on that for the 11 days. I'm much weaker then before the mua, but no other negatives that I see. How long will it be now before I gain more bend? I think seeing no progress, despite therapy/week and exercising 3x daily is wearing me out

 

[kneeper]

Go easy on the exercises. When you get an MUA it re-traumatizes the knee. It's ok to do things like your heel slides, but you may be keeping the knee inflamed if you're exercising too intensely.

 

[Butterfly22]

So I had btkr end of april and MUA at week 7. Now I'm nearing week 10. I measured left 103, down from high of 106 and right at 110, down from high of 112. My doctor wanted me to do cpm but when it came, it only goes to 110. I sent it back, called the doctor and said....I'm almost there on my own, past that on my right. Why do i need this? He said, you're doing great without it, no need. I just want the tight feeling in my knees to go away. I can manage to do everything I need, it just takes longer as I tire easily. Then again I had btkr, then double mua in the past 2 months, so I get it...I still am recovering, exercise 3x day and ice and adl.how long until the tightness goes away?