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MUA Oct 2017 TKR - Hematoma - MUA - Finally past 90!<

KarriB, Dizzy, Homeport - Thank you all so much for chiming in and giving me more comfort about lack of the PT right now & the med's and your stories! But everyone on my thread who has responded has been great. Once the PT's grind in our heads, weeks before you even have your surgery, that you that you need to get up and get going and then they appear at your bedside shortly after surgery to get you up and going and keep telling you about the scar release surgery that YOU DON'T WANT TO HAVE if you don't get your ROM by a certain date, it's rather hard to change that mindset. But I trust everything I've read here and the recovery stories about PT being overly pushed upon our poor hurting knees. I know for myself, I came home on Thursday the 19th and started right in big time on Friday doing all they wanted me to do - no easing in for this girl - I'm going to do it and get it done - and then Sat the 20th, I could barely do anything and Sat is when I began to notice this awful swelling and pain on top of my knee which was eventually diagnosed as a Hematoma. So I was stopped in my tracks and its actually been a good thing as I have been on here reading NOT to push PT - so again, thank you all... I can see there will be light at the end of the tunnel but some nights the tunnel seems awfully long and dark!

Recently I've been waking up a couple times during the night and my leg feels frozen in the elevated position and it hurts. It's been wanting to 'move!' During the day I have taken to some gentle stretching along with my foot pumps and circles and also about 5 very gentle heel slides.

Today I visit the PA for my 2-week Post Op and I'm anxious to find out if she is going to recommend a drain of this stubborn Hematoma or for me to push through the heaviness of it with some more gentle PT. I'm not sure but it's like a thin swollen puffy cap on top of my knee starting from the scar line, (which is just on the inside of my kneecap), and covering the entire top of my knee... so you can see that it makes it hard to really do much and when I stand up the pressure from it is INTENSE. Hard to deal with. I have to stop after 3 steps toward the bathroom and raise my leg to ease the pain from the gravity.

I'm wondering if a bit more gentle movement at this point, maybe a bit of walking for a few minutes a few times a day slowly working with the aching of the gravity, will actually help the Hematoma begin to clear out faster. I mean it's been 11 days since I noticed it.

Thoughts all on this?

Thanks so much.
 
You should ask your doctor (or PA) first, but I should think a little walking would be good for you. Ask, and if you get the go-ahead, start small. Your knee, even without a hematoma In the equation, is a baby knee and will only be able to take short walks. (And not just your knee... YOU will get tired very quickly.)

This may sound silly, but I would truly listen to my knees. They let me know what they wanted. A few bends while sitting in the recliner... sure thing. A little walk around the house. A couple stretches. I just did whatever they wanted, and it all added up to exercise —just not “PT sets” in the usual sense.

That’s the thing about movements you (and your knee) control: you’re doing exercise. It’s just not regimented. You say how much or how little. Our bodies are built to move, right? When healthy, we like to move. Think of children, and how they never stop. So your knee is going to respond favorably to gentle movement. If it’s anything like mine, it will appreciate and even like bending. Sure, the bending hurts at first, but even so your knee will say, “That’s good. Yeah. Do it again, just that much.”

If you feel like moving, find out from your surgeon if you have any restrictions on how or how much, and start moving. :happydance:
 
funkymuse said:
@KarriB @Dizzy @Homeport - Thank you all so much for chiming in and giving me more comfort about lack of the PT right now & the med's and your stories! But everyone on my thread who has responded has been great.
Click to expand...
I have edited the beginning of your post, @funkymuse , to remove the multiple tags.
Please don't start a post with a list of tags. It makes it difficult for people reading on mobile devices. On their small screens, all they see is a list of tags.

This article explains:
How to tag another member; how to answer when someone tags you
 
Let us know what the PA has to say. I’m of the same mind as Susie, short walks are the way to go, but being aware of the knee is so important. Just getting up for the restroom, kitchen etc is good for the first month or so.
 
Thank you @Celle :) Still having Newbie Growing Pains!!!

So.. went for my 2 week post op - kind of a joke - because yes it is a 2 week post op but I'm not in the condition of a normal 2 week post op patient!!! I'm still using a wheel chair to get around long distances because of this hematoma on top of my knee! So I get in there and when we get to the room my leg falls off of the wheel chair and the knee bends about 75degrees and I cry out in pain begging for the nurse to please lift up my leg so I can get to the table... Awkward situation and the nurse made sure to tell me that I alarmed the entire office. Well... darn it! It was painful... not much sympathy there!

Then finally... the PA comes in and barks at me wondering why I'm still in a wheel chair at 2 weeks post op!! So I gently explain the entire thing again and she softens up and says that she feels my doc needs to take a look. So we wait another 40 min and he comes in and the bottom lines after pushing around and analyzing this thing is that he feels it's best to go in and take out the hematoma due to concerns of infection because the blood clots are just sitting there really close to my scar. So tomorrow at 4pm PST I go in to have this taken care of. I hate the thought of it but to be free of this pressure on my knee will be such a gift.

He also told me that while they were in there they were going to bend my knee back all the way. That kind of scared me but what the hell.. I don't know what to say at this point.

The good news is that my Ossur Cold Rush Ice Machine was waiting for us when we got home from the doc! So my husband is going to get that set up for me to use all night... that will help so much I feel.

Thoughts, comments? Thanks everyone...
 
I well remember that painful pressure of my foot not being up on something!!!

You’d think they’d be more understanding considering their line of work!

So “while he’s in there” your surgeon is going to do an MUA? Just because? At 2 weeks post op? I would need more of a reason than that. Especially with quite the sore on your knee that they are going to take care of.
 
@Jockette - I will definitely request when I see him before surgery that he not do that. I'm just not sure how to go about it because his office does not think like everyone on this board and they do not believe in all this.. they think it's going to seize up and I won't have ROM, etc, etc. I just don't have any medical ground to stand on right now... I can tell him that I'm a bit nervous about him doing that based on how my knee has been feeling and see if I can get some ground there... any other suggestions for what to say? I mean I'm supposed to trust my surgeon and he is one of the best in this area... but I find they all think like this around here! ADHESIONS, SCAR TISSUE, WINDOW OF TIME, ETC.!!!!
 
funkymuse said:
I just don't have any medical ground to stand on right now... I can tell him that I'm a bit nervous about him doing that based on how my knee has been feeling and see if I can get some ground there... any other suggestions for what to say?
Click to expand...
Just tell him you do not want him to do it. He cannot do it without your permission and Informed Consent. You have the absolute right to say what will happen to your knee. He can advise, but it is your right to choose whether or not to accept that advice.
These articles explain:
CONSENT: what it means and how it can be used
Saying no to therapy - am I allowed to?

PS: Can you take someone along with you, to support you and help you stick up for your right to choose?
 
I know, so many want to push, push, push, literally and figuratively!

Maybe you could say you’d rather not he do that now and that you’d like more time before considering having it done in the future. My goodness, two weeks is really early to force that bend, you’ve barely even begun to heal from the surgery.

If I hadn’t found Bonesmart I would have gone along with whatever they said, thinking they knew best, which I did, until I found Bonesmart at 4 weeks post op.
 
Celle, we posted at the same time!
 
MUA has been known as the most effective first-line treatment for knees presenting with <90° of flexion when aggressive postoperative efforts for restoration of joint motion are ineffective and specific factors, such as infection, are not responsible for the stiffness. It can be efficacious for restricted flexion, but not for flexion contracture. Fibrous tissue that forms after surgery needs 6 months of period for loss of cells and blood vessels until maturity. However, the extent of stiffness is more related to the amount and location of the fibrous tissue than to the level of maturity. Joint stiffness tends to worsen and become persistent in 6 weeks; therefore, manipulation for stiffness should be performed before the maturity of fibrous tissue so as to prevent complications and restore joint mobility18). It has been recommended to carry out MUA once joint stiffness is observed even within 2-3 weeks after surgery in some studies19,20) and within 2 weeks to 3 months after surgery in other studies21,22). Esler et al.22) suggested knees with <80° of flexion be treated with manipulation irrespective of the time after surgery, preferably within 4 months after surgery. In the current study, knees with <80° of flexion were manipulated at a mean of 4.7±2.9 weeks (range, 1.4 to 13.9 weeks) after surgery.
From this Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678244/

I was reading a thread from this site from 2008 which was calming down the fears of someone about to undergo a MUA. https://bonesmart.org/forum/threads/after-knee-replacement-manipulation.1768/

So I'll sleep on this tonight and question the doctor extensively tomorrow before I say yay or nay.

But there is no PT scheduled in the near future so I'll have plenty of time to ice and elevate and let the swelling subside before I jump into any kind of exercise. The main thing is the hematoma will be gone! Thank God!
 
For myself, I now only believe what Bonesmart says. I have been mislead by reading orthopedic sites, especially regarding my partial knee replacement.

I’ll be thinking of you tomorrow. I hope all goes well for you!:console2:
 
An MUA would be totally unnecessary and completely unhelpful at only 2 weeks post-surgery. This study refutes the information you found on the internet, @funkymuse .
MUA: the ineffectiveness of early MUA (JBJS)

The only reasons why your knee is not yet bending is because it is so soon after surgery. Your knee tissues are wounded and swollen and the haematoma is making that worse. Adhesions (bad scar tissue) simply do not form so early in recovery. An MUA is brutal. That's why they have to put you to sleep for it. It would force your knee and tear some of your knee tissues. Why have that done when it's not necessary?

Stop worrying about your knee and let it heal naturally - and stop looking up things on the internet. Trust us - we've been through this and have practical experience. I've had three knee replacements.

There is no deadline you have to meet, no magic windows of opportunity.
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.
Myth busting: the "window of opportunity" in TKR
 
Good Morning @funkymuse . Please listen to what the Advisor's and Moderators are telling you. You are only 2 weeks out. That is so early to be thinking along that line. You will have a host of health care professionals tell you a multitude of different information. None of that is directly related to you. I was done the same way with the PT assistant. She would talk MUA and scar tissue. Then would bring up window of time. What the OS expected. I learned early on from reading and listening hear what to divide. She was trying to use misinformation to scare me into rough therapy and to let her bend me farther than needed. All of that causes swelling and pain. Most of which shows up late in the day or even the next day. For the next few days if at all possible just rest, ice and elevate. Find something that will take your mind off of your knee. A good book, a list of movies, or even board games with family. Start out by walking thru the house, making a sandwich. Small things. Then set, rest and elevate. You will see more progress from your knee. Swelling will go down, then your knee will bend more. Mornings will be better than evenings. As the day goes by the swelling will return somewhat. That is very normal. It will happen for you.
Time, rest , elevation and ice should be your best friends after your husband of course.
 
I'm going to talk to him about NOT doing it. I think I got a MUA by accident yesterday anyway when my knee fell off the wheel chair and bent way beyond where it had been going. Very painful and it feels bruised inside. More pain than usual last night and this morning. I've been using the Cold Rush and it's feeling much better but man is that thing cold ! I keep turning it down lower and lower... I'm taking small breaks from it - usually going an hour or so and then a bit of a break from elevation and ice - maybe 30 min. Then back at it. I think it will help me a lot for later on today.

Plus.. in just thinking on all this again... they are opening it up to remove the hematoma and wow.. that's going to cause irritation.. I just can't imagine them bending it at any stage during the surgery!

Thanks everyone for your support and information...
 
I’m sorry you hurt so bad after your leg fell yesterday, we call those times “manipulation WITHOUT anesthesia!:heehee:

I hope it settles down soon for you!
 
Tell them you want the hematoma taken care of first and then evaluate once it is healed. Didn't PT cause the hematoma?
 
I think telling them you want the hematoma dealt with first is a good idea. Icing a lot will help with both the pain and swelling. Moving around --walking as able-- will help move the swelling, because walking boosts your circulation.

It's common sense to think your knee will respond better without that hematoma. That knee has had a rough start, poor thing!
 
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