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MUA One Step at a Time

sectac

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I've had Psoriatic Arthritis which caused the cartilage in my knees to deteriorate. I started using steroid and gel injections until my knees were bone on bone. At that point, the surgeons recommended bilateral knee replacements. I had them done July 2 and have had nothing but issues since.

I am almost three months post op and when I went to my first therapy appointment the therapist was extremely rough on my knees forcing them to go straight. I begged him (after screaming and crying) to stop and he said this is what was necessary to prevent a Manipulation.

After a few visits with him he emailed my Ortho Surgeon (at this time I was only 6 weeks post op) and said I wasn't able to obtain 70 degrees on a bend on my right knee and 60 degrees bend on my left knee and was only at 6 degrees for straightening on my right knee and 12 degrees on my left knee. He recommended a Manipulation Under Anesthesia.

After meeting with my surgeon, she thought this would be best and I would only benefit from this procedure. The day after the manipulation the surgeon wanted me to go to therapy for 10 straight days.

Well the torture began once again. My knees swelled up, I wasn't going forward in my ROM and was getting very disappointed as well as depressed thinking this was all my fault.

I had requested a new therapist and he was very gentle but effective and he was able to get me to 90 degrees on my right knee and 75 on my left and straightening was 4 degrees on my right and 9 degrees on my left.

The problem is I keep swelling and my knees are very hot all the time. I elevate and ice them when possible but I feel like I've hit a wall.

My three months of time off was officially over on September 23 and I had to go back to work where I work in an ER setting with a lot of walking.

Any idea why I'm having a hard time with my ROM. I do my exercises three times a day and still ice and elevate when I can. Thanks for any advice you can give and sorry for the long story.
 

Jockette

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Hi and Welcome!
Any idea why I'm having a hard time with my ROM.
The answers are:
when I went to my first therapy appointment the therapist was extremely rough on my knees forcing them to go straight. I begged him (after screaming and crying) to stop and he said this is what was necessary to prevent a Manipulation
He recommended a Manipulation Under Anesthesia. After meeting with my surgeon, she thought this would be best and I would only benefit from this procedure.
The day after the manipulation the surgeon wanted me to go to therapy for 10 straight days. Well the torture began once again. My knees swelled up,
The problem is I keep swelling and my knees are very hot all the time.
I hope you are not still going to PT. This facility does not have a good rehab approach for you.

You need to stop all this hard work and rest and let your knees recover. Spend as much time as you can icing and elevating. (Always keep a cloth between you and the ice medium.)

Going back to work while you still have a lot of swelling is not in your knee’s best interest.

I’m so sorry your experience has been so bad. It shouldn’t have been like that.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this
6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs

Elevation is the key

Ice to control pain and swelling

Heel slides and how to do them properly

Chart representation of TKR recovery

Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 
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sectac

sectac

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Thank you for your information and yes I am no longer going to therapy. My ortho surgeon told me to continue doing my exercises at home and go back when I want to which will be at a totally different location. However, I forgot to initially post that I was wondering if the swelling around my joints can be caused by my psoriasis. I don't take anything for my psoriasis because most of the recommended medications cause cancer and my family is full of that. My mom died from Pancreatic Cancer, my dad had prostate and skin cancer and sister had colon cancer, my grandfather died from stomach cancer and my aunt had breast cancer. Also, once I rest my knees by elevating and icing them how much ROM exercises should I be doing. Therapy told me that if I stop doing them I will get scar tissue causing me to not reach my ROM goals and the only way around that is to get another manipulation. This has caused many sleepless nights crying wishing I had never had this done. BTW... I am so happy I found this forum.
 

jeffjob

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ER Girl, I have to agree with the others. Your legs are not bending because they are begging for some healing time.

I had both knees done this year, 6 weeks apart and I listened to them. I did not do all the exercises PT wanted me to do, I also fired my first out patient PT person. I would not allow any PT person to push my legs.

What I did do is keep moving and get back to daily activities ASAP. My wife said wane me to get your coffee and I said I will figure it out. Small movements, constant movements and some exercise gave me great results.

Your legs were just starting to heal and then you had to start all over again after MUA. How doctors think this is right I do not understand.

So I agree, stop the exercise, ice, elevate, move on with your activities of daily living, do not go back to PT and maybe even find another OS.

Even my OS that has been operating for over 35 years has moved on from the torturous way that you are going thru.

I am sending you hugs and wish you the best!
 

Jockette

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. Also, once I rest my knees by elevating and icing them how much ROM exercises should I be doing.
You can just do gentle bends that cause no pain, and move around doing your regular activities as you are able. As you heal and get stronger you’ll be able to do more, but don’t rush it. Walking is good later, but not to excess, increase it gradually.

This recovery takes an average of a full year, so you have a ways to go. It will all come together given time.

It’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.
Therapy told me that if I stop doing them I will get scar tissue causing me to not reach my ROM goals and the only way around that is to get another manipulation. This has caused many sleepless nights crying wishing I had never had this done.
This is not true, it’s only his opinion. Since it’s only his opinion, you can choose to rehab the way you want to, it’s your knee, your recovery.

Saying no to therapy:
Saying no to therapy - am I allowed to?
BTW... I am so happy I found this forum.
We’re glad you found us, too! I don’t know what I would have done if I hadn’t found Bonesmart to support me, teach me a different approach to recovery, and give me the confidence to choose my own path.
 

Pumpkln

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@ER Girl ,
Glad to hear you stopped PT, right now it is best for you to rest, ice, and elevate.
Your knee needs time to heal, and for the swelling to go down.
Suggest you look for a Lymphedema Specialist to help with your swelling.
 

Celle

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Therapy told me that if I stop doing them I will get scar tissue causing me to not reach my ROM goals and the only way around that is to get another manipulation. This has caused many sleepless nights crying wishing I had never had this done.
Your therapist is totally wrong - and he was a bully as well.

I'm so glad you stopped going to PT. The ordinary activities of your daily life are enough exercise for your knee, especially as you have a demanding active job.

You know that the bad "scar tissue" that therapist was threatening you with is more correctly called adhesions and normal scar tissues is necessary, to heal your wounds.

Adhesions after a TKR aren't just sitting there, waiting to pounce if you don't exercise enough. In fact, the way that therapist treated your knee was more likely to cause adhesions than to prevent them. Why? Because over-exercising a new knee and overworking it keeps the wounded soft tissues hot and inflamed. Hot, inflamed tissues are drier than normal tissues and they're more likely to stick together and form adhesions.
MUA (Manipulation under Anaesthetic) and Adhesions

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. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee is capable of achieving good ROM right from the start and ROM will gradually increase as your knee heals and the internal and external swelling decrease.
 

newlybionic

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I’m so sorry you were put through so much torture. Once you ‘work’ at getting the swelling down by icing and elevating as much and as often as you can I’m sure you will find that your knees will have change in range of motion so that you’re much closer to full extension and will be able to bend them much easier. Hang in there. You will be better.
 

Rockgirl4

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I'm here to say YES YES YES!!!! I can almost guarantee your PsA has affected your recovery. My surgeon and Rheumatologist both agree there is a low-level inflammation present in these people that just adds to the surgical trauma/inflammation....and IT MUST BE CONSIDERED in your recovery, as we're not starting out at the same place as other people. It makes battling inflammation/swelling even trickier and keeps us from being "normal"----though there's a huge range of "normal" in joint replacement patients. :) I guess it's better to say it makes us more abnormal. :)

My recovery case was a doozy!!! :headbang: I had an "acute inflammatory response" to the surgery, requiring my surgeon to put me on bedrest from post-op Days 5-9, as the swelling was severe, along with the pain. He didn't allow me to do any bending for those days, as I had already done too much on Days 1-4 (though only the amount a normal person would do!!) and it made matters worse. Much worse!!!:tantrum: He sees this a lot in women aged 40-55, especially those of us with Autoimmune disease/inflammatory arthritis and those with a tentative "undifferentiated inflammatory arthritis" diagnosis. He is almost positive I have PsA too, like my Rheumy suspects, simply because of how bad my recovery pain/swelling was. He was already suspicious because of how my knees started falling apart at age 25 with no injuries to predispose me.

Personally, I think you have been done a huge disservice by both your surgeon and the PTs. Technically, I only have a suspected Psoriatic Arthritis diagnosis....but my Rheumatologist sent me to a Reconstruction/Revision specialist anyway--this is a fancy name for an Orthopedic surgeon who does >400 knee/hip replacements a year and has seen it all, ESPECIALLY lots of Psoriatic Arthritis, Lupus, and Rheumatoid arthritis patients whose joints tend to wear out early because of these Inflammatory diseases. He has a "Bonesmart" approach to recovery which is "slow and steady." He is strict with PTs and says they CANNOT treat us like everyone else (though I agree no one should be forced into bending or straightening). He made sure I found a PT who follows his philosophy, and even then he had her slow things down with me, as he felt we were doing too much.

I also had to take a strong anti-inflammatory (Arthrotec) from week 4-9, then again in weeks 10-12, to get the swelling down and regain my range of motion. He never threatened an MUA----he just made sure we did everything possible to limit inflammation and ease stiffness. It worked, and when I finished PT at week 12, I had 104 degrees flexion, 0 extension. It's even inproved a bit in the last 2 months. He says the Arthrotec is something he often has to give to people with PsA, Lupus, RA, etc. It often does NOTHING for so-called "normal people" because they're not dealing with the same always-present, low-level inflammation like we are.

The BIG thing is my surgeon was strict in not letting anyone ever force my knee to bend or straighten, and he made me wait on all strength training or "normal PT" until the 12-wk post-op mark. :yikes:The goal was to get the swelling/inflammation down and worry about everything else later. All I did at PT was gentle stretching,lots of massage, and ONLY 5 minutes on a stationary bike (once I could get all the way around). He says anything over 5 minutes just keeps the knee inflamed.

As for me, I'm now 18.5 wks post-op from a right TKR. He was right, and I love love LOVE that man!!! He'll do my left TKR in a couple of years when the time is right. :)

Lastly, keep in mind my PsA cannot be proven yet, as all blood tests have been negative for 6-7 yrs. I have LOADS of visual/physical symptoms though, so my Rheumatologist says she's "pretty sure" it's PsA and one day the blood will prove it. It always does eventually. I had a check-up with her 13 wks after my TKR, and she said this severe inflammatory response to surgery just adds to her suspicions of PsA---plus I'm finally getting a few more skin lesions on my hips this year. My point is my long, slower recovery adds to her suspicions too....so in a nutshell, I'm more proof of how autoimmune conditions can impact joint replacement recovery and MUST be taken into consideration after any surgery.
 

Celle

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@sectac

Please will you tell us the full date of your knee replacement, whether it was a total or a partial, and which knee it is, so we can make a signature for you? Thank you.:flwrysmile:
 
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sectac

sectac

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Hi Celle,

The date of my total knee replacement was 7/2/2019 and I had both knees done at the same time. Let me know if I can be of any further assistance. Thanks!!
 
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sectac

sectac

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Hi Celle,

I do have one more question. How do I post a comment to someone's message on my thread? Thanks!
 

Jaycey

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@sectac to post just scoot down to the empty box at the bottom of any page on your thread and post. If you want to tag someone type the @ sign and then their user name (no space). You should then get a drop down menu that lists this tag. Just click on it and the tag is applied. Here's a more detailed thread on doing this:
How to tag another member; how to answer when someone tags you
 
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sectac

sectac

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@Jaycey Thanks so much. Also, how do you add a picture of yourself?
 
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sectac

sectac

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@Celle The date of my total knee replacement was 7/2/2019 and I had both knees done at the same time. Let me know if I can be of any further assistance. Thanks!!
 
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sectac

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@Rockgirl4 Thanks for ALL the information. It's so nice to finally meet someone that actually knows what I'm going through when it comes to Psoriatic Arthritis.
 
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sectac

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Since I had an MUA at week 6 I feel like I started back at ground zero, how should I approach my weekly healing time. Should I start with the day of my surgery or the day of my MUA. I just want to be able to gauge when I should be doing certain things and when I shouldn't. However, I do realize that I can't go by what everyone else is doing only what my knees/body is telling me and I am listening to my knees (now) since I found this forum.
Also, once in a while my legs will buckle right above my knees. Is this normal?? I still walk with a cane but at times I will walk very short distances without it (from the kitchen table to the sink, etc).
 

Rockgirl4

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I'm pretty sure the moderators here tell everyone that an MUA sets you back to zero. So count your recovery from the MUA date because all if the sift tissue was traumatized again, which creates swelling and inflammation.

Also, I too had the knee buckling at random times. It's happened after 2 major knee surgeries with a 6 inch incision, and I was told it's from quadriceps weakness. Once your quad muscles get strong again, that buckling usually goes away.
 

kneeper

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Swelling (to various degrees) can last a long time. Ice and elevate whenever you're not up and moving. Do some bending but not to the point of intense pain. What I would do is see how far I could go--such as with heel slides--but not do them intensely with a lot of repetitions in a row. Just a few (maybe 5) a few times a day.

Rockgirl4 is right about the buckling. I had that too for a while sort of randomly, but it gradually went away as I was able to get more active. It's fine to keep using the cane--and to try a little bit without it if you're near a counter or something. There's no set schedule to be rid of the walking aids. Most important is to have that security.
 

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