TKR One year after surgery

[Jamie]

For instance, is it possible for your knee to get "stuck" and just not ever go further back than, say, 90 or 100 degrees?

This is the myth that just won't die. There is no "window of opportunity" for ROM, but still you hear that from some doctors, therapists and your neighbor down the street. We have legions of people here on BoneSmart who disprove that idea and gain ROM up to two years after surgery. We have yet to see a member who ended up with limited ROM because he or she did not exercise "enough." Listen to your body and trust in your knowledge of your own self. It's better to take the time needed and do recovery right. You'll have your whole life with this knee and you want it happy.

 

[Spex10]

Well I'm one of the people who actually had a MUA and am really glad I had it. It was done at 12 weeks. I had developed arthrofibrosis and my ROM was reducing week by week.
This forum led me to believe that it was a painful procedure which would set my recovery back. Well like some others on here I found the opposite to be true. The procedure was very quick. I had one night in hospital as I'd had a GA. I was on a CPM overnight which kept the knee moving as I 'slept' (haha). I was absolutely thrilled with the result next morning when I could sit and look down on both feet neatly tucked at 90 degrees. I was waiting for pain and swelling to kick in but it was no more than it had been before. I'm now 16 weeks post TKR and discharged by physio. My knee still has some way to go but looking back its come a very long way.
Please don't worry about a MUA. It could be just what you need or may not even need one.

 

[Celle]

@Spex10
Thank you for your input and your alternative perspective.
You had an MUA for a very good reason and you are one of the few who possibly genuinely needed it.

However, as in Laurenkate's story, there are a lot of people who are rushed unnecessarily into an MUA because their surgeon or PT is impatient. For them, the MUA does not help and we see them here, complaining later that they still cannot achieve ROM. Some of them end up with chronic inflammation of their soft tissues.

That's why we recommend waiting and not rushing into an MUA.

You did wait, and your ROM didn't improve, so there was a valid reason for you to have your MUA - and I'm truly glad it has been such a success for you.

 

[Josephine]

I'm going to do those heel slides

If you do, please read this first Heel slides and how to do them properly. But do remember that these exercises do not guarantee an improvement in ROM.

I put my foot on my husband's hip and then he leans into me which really bends the knee.

NOT a good idea!

my leg is moderately swollen all the time - and has been for the past year. Unless I spend the majority of the day with my leg elevated and iced, my "new" knee measures 3-4 inches bigger each evening than in the morning just after getting out of bed. Yesterday the doctor seemed a little more concerned about the swelling in my ankle and indicated if that didn't get better, it would eventually become very tender and painful.

This will be the primary cause of your low ROM and doing more exercises will increase it. I've seen it too many times to now know this.

Well I'm one of the people who actually had a MUA and am really glad I had it. It was done at 12 weeks which recent research shows is most useful.

That's actually very true.

I had developed arthrofibrosis

Arthrofibrosis is actually a jolly good reason NOT to do an MUA.

This forum led me to believe that it was a painful procedure which would set my recovery back. Well like some others on here I found the opposite to be true.

If you got no pain after the MUA then it's pretty clear that you didn't need it. I've assisted at scores of MUAs during my career. Those that genuinely needed it sounded like Velcro ripping apart and those patients were always in varying degrees of pain afterwards. In fact, one patient who I remember to this day - his name was Tony Scratchit and he was a teacher - was in so much pain we had to anaesthetise him in recovery and he came back for a redo about 4 months later. But those whose MUA was easy and required no effort, had no pain post-op and required no pain meds. That's why I caution against MUA. It's based upon cold hard experience garnered over 40 years of nursing. There are no scientific articles to prove or disprove that but I know for sure that if your MUA was easy then you had no adhesions torn because you had no adhesions. Why you had a good outcome after it is a mystery but there is a word for it.

 

[KarriB]

@Laurenkate you should be spending the majority of the first month post op resting, elevating, icing. Please take a look at the activity progression chart. I was unaware of BoneSmart during my recovery, but reflecting back my recovery very closely followed the chart. You may be trying to do too much at this early point in recovery and your knee is reacting be swelling.

https://bonesmart.org/forum/threads/activity-progression-for-tkrs.14334/

 

[Laurenkate]

Thanks everyone. With the exception of "walking" up and down the block, (and no physical therapy), I elevated, iced and wore the dreaded compression stockings (although not the ones from the hospital - mine are a tiny bit more comfortable) and my leg and ankle didn't balloon up like it did all last week. (And I thought I did a lot of it last week!) This is more proof that elevating and icing all day will get the swelling down and has to help with ROM. It just makes so much sense that the knee is going to move like it should when it isn't swollen and hurting all the time.

I'm not going to be rushed into an MUA. Going to take this day by day and see what initially happens with the physical therapy. Spex - so relieved to read your experience because everything I've read makes it sound like the MUA is much worse than the original operation and recovery!

All of you have convinced me that using my husband as a piece of therapy equipment isn't a good idea. He definitely needs a break and this will keep him from having to do one more thing for me.

And oh.....it would be wonderful to take a nice, warm, soaking. Good Sunday everyone.

 

[Celle]

And oh.....it would be wonderful to take a nice, warm, soaking. Good Sunday everyone.

Just be careful not to soak for too long. The warmth can bring extra blood flow to your knee, which could increase your swelling.

We recently had someone who soaked in a hot pool and ended up with a very swollen, stiff knee.

 

[zzevi]

I was reading thru, your postings, I think the talk began around the same time period of yours or maybe even earlier about my needing a MUA, all it did was stress me out. When your trying your hardest to achieve what's being asked but it just doesn't happen. I finally got fed up and said wasn't interested at this time to have a MUA, I was happy where I was at.

People who are recovering just don't need this extra stress, weeks after the initial talk of MUA I was still seeing progress ahead, and still now at 8 Months out. I don't regret saying I wasn't interested, think my extra pushing in the beginning only led to to other issues down the road for me in my recovery.

Swelling, it's been said on here before it's like a rubber hose full of fluid, it can't be bent, but once the swelling goes down you able to bend the joint so much easier. Icing and elevation, and pain medication can help move you ahead better than p/t and forcing your knee to bend. I had my husband help me in the beginning also under the advice from p/t,

I can't say that any of that extra pushing to achieve a better ROM worked at all for me. I see no reason why you can't wait for a while and then make a decision at that point if MUA is needed or not.

To early my thoughts for a decision to have to be made yet at this time. I consider myself one of those that is still seeing improvements yet at 8 months and still wouldn't consider myself a 100% healed or to the point where I still won't continue to see additional improvements.

 

[agarrett]

Just be careful not to soak for too long. The warmth can bring extra blood flow to your knee, which could increase your swelling.

We recently had someone who soaked in a hot pool and ended up with a very swollen, stiff knee.

I tried the hot tub and not sure if it was that which set my knee off for a few days or something else. But did decide to not jump back in yet. Waiting until I can get the daily swelling more in control, before adding something that might add to it.




Right TKR 27 December 2016

 

[Jamie]

It most likely was the hot tub, @agarrett. It's usually not a good idea to put a lot of heat to a TKR until all swelling is history. A couple of months isn't long enough out from surgery. Four to six months would be more like it and even then it could be a problem for some folks. However.....you didn't really hurt anything. It just slows down your recovery.

 

[Booboo55]

I also had problems with the pain meds. My doctor prescribed some anti sickness tablets to get me through that. But was also having stomach problems brought on by ibuprofen. So stopped the ocyxcodone because didn't like how it made me feel and was living on ice paracetamol and ibuprofen and still am 3 weeks post op

 

[Laurenkate]

Celle; we have a big, deep tub and I don't even remember how to get down into it!! It sounds so ridiculous but when I tried a month or so before surgery, neither leg wanted to bend enough to make a bath possible. All I could picture was slipping around in it and not being able to get out of it like some poor beached whale. Baths are probably going to be a thing of the past but it's nice to dream about them!

Zzevi; so agree with you about the stress. As much as I like and trust my doctor and his staff, I was disappointed the possibility of an MUA was brought up on my first visit after surgery. Now it's going to be difficult to get it out of my mind regardless of how much I'm not going to be rushed into it.

Josephine; that's quite a description of what an MUA sounds like - and just what I imagined! Forgive me though because lack of sleep and drugs have completely killed whatever brain cells existed before surgery - but what is making that sound? Scar tissue? I need to read back over various posts but not sure I understand what actually determines if an MUA is absolutely needed? Just because the ROM isn't where the doctor and pt think it should be? It's all a little confusing.....

Thanks again for all the good comments and information.

 

[newlybionic]

I understand your beached whale anology and can't fathom getting into a nice hot bath and being able to get out. I wouldn't have to call 911 for help!

There is no rush to get a MUA. I even had a PT that within 24 hours of my revision threatening me with a MUA because I couldn't bend my knee enough. At my 6 week checkup with my OS he made a statement that if my knee didn't improve in flex ion to let him know. I did very gentle PT consisting of stretches, massages and a few minutes on a recumbent bike. I avoided anything that caused any pain at all. I took my time and the last time it was measured I was at 130 degrees.

 

[Celle]

I had surgery the same day as you and my flexion is only 83 although it's perfectly straight at extension. Care to pass along any tips about how to get to 115 degrees in such a short amount of time? All surgeries and knees are different & this website is so helpful but sometimes I feel like a wimp in comparison. It's wonderful you're doing so well!

@Laurenkate - you asked this question on Booboo's thread and I have moved it here.
There's no need to rush to get your ROM, as we've explained before. The answer you received advocated a ridiculous amount of over-exercising, which is far more likely to inflame your knee and make it more swollen and less inclined to bend.

Just keep doing gentle exercises, and nothing that hurts or tires your knee, and I'm sure you are going to do just fine.

 

[Laurenkate]

Goodness; just realized I lost a week somewhere since surgery. It's been a month since surgery and everything seems to be going ok. Ice and elevate for 1-1/2 to 2 hours at a time, get up, walk around, do a few easy chores for 30 minutes and then repeat. That and putting the dreaded compression thigh high stockings back on seems to help with swelling so hopefully I'll be ready for out patient physical therapy on Monday. Oh, I found a good way to stretch out the stockings so it isn't so difficult to get them on - we put them over gallon size Ball canning jars and let them sit overnight. Now if my arms would grow 2 inches longer, my husband wouldn't have to help me put them on at all.

The weather here has been very strange - record warmth - which may be causing this but I can't get rid of a constant headache. It isn't one of those pounding, miserable aches - just uncomfortable enough to know it's there. Could it be caused by taking oxycodone for a month? Has anyone else experienced this and did the headaches stop once you stopped taking pain mediciation? The pharmacist said I couldn't take the sinus medication which usually gets rid of these headaches - maybe an ice pack will help. So glad I bought an ice machine because I seem to be using the freezer ice packs for every other part of my body which aches. Hope everyone has a good weekend.

 

[zzevi]

Don't remember getting headaches from the RX meds, but this up and down weather is triggering sinus issues with me. I've really been dealing somewhat all winter with upper respiratory ills, more so this past Fall,Winter than previous yrs. I would say it's weather related your headaches and such, but I could be wrong.

 

[KarriB]

Everyone here, including me, has had ongoing headaches for the last week. I'm putting it down to the wacky weather! Beautiful, but wacky!

 

[Laurenkate]

Today was my first outpatient physical therapy appointment and it wasn't as bad as expected. The therapist first massaged the scar for some time and it was amazing how much that instantly helped my range of motion. I could hear and feel something under the scar break up so will definitely do that a couple of times a day. The other surprising thing was that it took a few minutes and a little bit of cheating initially, but I was able to do rotations on the stationery bike. Couldn't do that until my 4th p.t. visit after the meniscus surgery. The p.t. gave me the business about MUA and said if I didn't have 5 degrees of additional flexon at each visit, he'd recommend one, blah, blah, blah. Will worry about that when the time comes. It was just such a relief that what he did was uncomfortable but not hurtful.

 

[Spex10]

Its not up to a physio whether or not you have a MUA! I found that my ROM could vary from day to day and even within the day. You could be at physio on a 'bad' day so ROM might seem bad.
I bought my own goniometer so I could check for myself. I don't bother any more though! Believe me there is light at the end of this particular tunnel!

 

[Celle]

I was able to do rotations on the stationery bike. Couldn't do that until my 4th p.t. visit after the meniscus surgery. The p.t. gave me the business about MUA and said if I didn't have 5 degrees of additional flexion at each visit, he'd recommend one, blah, blah, blah. Will worry about that when the time comes.

Congratulations on doing a full rotation on the bike. At only a month after surgery, that is wonderful - and it tells me that your flexion is already pretty good!

Don't take any notice of the PT's talk about an MUA or his targets for your knee. All he's doing is trying to frighten you into working harder, so that the numbers he writes down make him look good.

You know that your knee is doing OK. Let it progress at a speed it is comfortable with.

In any case, you have a choice what happens to your knee. No one can make you have an MUA without your full and informed consent. If your surgeon should suggest it, you can always ask for more time.