TKR Question on pain and swelling six months post TKR

[Jockette]

You are not going backwards. It is natural for the ROM number to fluctuate. Like Layla said, the MUA does set your recovery back as it causes more trauma to your already traumatized leg. An MUA is not a quick fix to full ROM. It still takes healing time to regain the ROM we had before surgery. Swelling determines the ROM number, and swelling will vary from day to day.

You are barely 2 months into a year long recovery and have now had another procedure. Improvements happen very slowly under even the best of circumstances. Try to relax, stop measuring, and do some quiet things you enjoy to take your mind off your recovery while you are resting, icing and elevating.

 

[mendogal]

You were doing okay before the MUA regardless of what you were told, and now you just have to Let The Knee Heal.
On a cellular level, that's your body's priority, and it doesn't care about anything else.

 

[benne68]

So now I am going backwards. My bend was 98 at PT this morning.... I am feeling concerned the MUA is not helping and I will need additional intervention.

What you are experiencing has been reported by many of our members who have been through MUAs.

Their surgeons report getting great bend during the procedure and the patient notices significant improvement for a day or two afterwards. Then the swelling sets in and the knee can't bend. They worry the procedure failed or that there are complications.

But, with time and patience, they do have successful recoveries.

Here are links to three different threads by members who, like you, felt they had a set back post-MUA. I hope you find the stories reassuring as you continue your healing journey:

Mutley's TKR and MUA Recovery
Birdie's TKR and MUA Recovery
Kenjo's TKR and MUA Recovery

 

[Onestepatatime]

Thanks everyone. I will take it one day at a time. I work from home and planning on phasing back in next week. I think it will be good for me mentally. I’ll have PT 3x a week still and will have to be mindful to do my exercises, elevate when I can etc.

 

[Jockette]

will have to be mindful to do my exercises, elevate when I can etc.

You should reverse this, elevate as much as you can, do a few reps of an easy exercise here and there, just for mobility. It’s not reps of a bunch of exercises that gets your ROM back, it’s TIME. Time to recover, time for pain and swelling to go down, and time to heal.

 

[mendogal]

I agree with @Jockette - you're going to exercise yourself right back into the cycle of overworking a traumatized knee -> more swelling -> less flexion.

 

[Onestepatatime]

Then why is the protocol to do PT 5 days a week for 2 weeks then PT 3x a week? Nothing I’m doing in PT is forceful. All gentle stretches.

 

[mendogal]

Because you didn't say "gentle stretches," you said "do my exercises"?

 

[Jamie]

“Exercises” can be interpreted many different ways. Even your daily activities and just walking around your house are considered exercise. It would be beneficial to us if you provide more details about what formal exercises you are attempting to do 5 days a week in addition to your 3 days a week at the therapist.

In between your activity and exercises, your number one priority right now should be elevating and icing your knee until you find swelling and pain has improved. Doing this on a schedule every day will usually provide much better results than just “when you can.”

 

[Onestepatatime]

@Jamie @mendogal
Hi. First, good news. At PT today I measured 110 without a lot of effort. Was so relieved.
Ok so here is the breakdown of my days since MUA:
PT - 1 hour every day for two weeks. In PT, they do manual massage and a fair amount of stretching me, 10 min on the recumbent bike peddling back and forth, heel slides, stair stretches, leg presses, and a balance board.

Home::
Ice and elevate using the lounge doctor for 30 min about 3-4 sessions a day
Very small loads of laundry every 3 days
Load/unload dishwasher
Take out garbage
Shower, dress, etc
Try and take short walks every 60 min. I am able to walk 5 blocks with the cane or I use the rollator. I cannot walk that far without a walking aide.
Do heal slides 2x a day and stretches at home

I have gone out for a quick dinner Saturday night, and went to my friend's pool Sunday for a couple of hours and got ice cream. Sadly, I was very sore yesterday and spent the whole afternoon and evening icing and elevating.
If I have an errand to do, I cannot do more than one errand a day. I get my groceries delivered.

I think that about sums up my existence. I am going to do a better job of sticking to a schedule. And I need to think through returning to work.
Thanks!

 

[Jamie]

Thank you so much for the detail. It helps and actually it doesn’t sound all that bad. I’m assuming you’re not doing all those home activities each day. At your stage of recovery, it’s typical to do one or two things like this a day. One errand (or trip to the therapy sessions) per day is very typical. So, I’m thinking that maybe you’re just expecting too much too soon from your newly manipulated knee. It’s still recovering from that very rough trauma.

If you are still going to therapy 5 days a week for an hour, that is a lot. Remember that you may spend one hour at the session, but there is the effort to get dressed to go, get into and out of the car, and drive there and back. This effort all counts as “activity.” So…..if you do this every day, plus several of the other things on your list, you easily could be overworking your knee. When you have an MUA, it does set your recovery back and reset your recovery time clock. I definitely would not do any outdoor walking on the days you have therapy sessions.

I might suggest you do a little less walking overall right now. The every hour walking can be as little as just some circles around the house for 5 minutes or a trip to the kitchen or bathroom from your resting spot. Five blocks may be more than your knee is ready for right now….it depends on the time/distance involved. If you limp at all with your walking, you’re not ready to go without an aid at this point.

We usually advise people to elevate and ice for at least 45 minutes at a time. I would recommend those longer periods and maybe drop back to 2 times a day if you need to do that. As long as your skin is shielded from direct contact from the ice, you can use ice as much as you want to. It’s a great pain reliever for most people. I even iced my knees all through the night for months. I’d only have to get up once in the night to replace the gel packs and would do it when I got up to use the bathroom.

Congratulations on your good measurement at therapy. Keep in mind that these numbers can go up and down and it’s best to concentrate on functionality rather than a number.

Your body has had a lot of major surgery in a relatively short period of time and it’s likely to take you a bit longer in recovery because of that. Give yourself some grace and allow that healing to take place. It’s a gradual process over months (sometimes even years) and is not something you can rush by pushing yourself when you have pain.

 

[Nekocarlo]

You are gaining rom much faster than I have after an MUA. I was between 80 and 90 the first 2 days after the manipulation (even though the Dr got it to 125 during the procedure). My mua was May 30.
I just reached 120 (cold reading, up to 128 at end of pt session) the last week so the pt sessions definitely pay off. I also went every day for the first 2 weeks, then 2-3 times per week for about 6 weeks, though many of the later sessions were 30 minutes. I now go 1-2 times per week to learn about going down stairs, gait, etc. I still have swelling but learned that does not prevent improvement in rom, just slows it down. Sounds like you’re doing very well.

 

[benne68]

Thank you for sharing that detail, @Nekocarlo! I'm sure @Onestepatatime will find it reassuring to read.

 

[Onestepatatime]

@Jamie thanks for the great info! @Nekocarlo thanks for sharing your situation as well. Are you able to pedal all the way around on a stationary bike? I still can't. it feels completely stuck on the inner side right above my knee cap. It just will not go. PT seems a bit concerned.

 

[Jamie]

Have you tried pedaling backwards on the bike? For some reason people can sometimes do that before they can go around frontwise.

 

[Nekocarlo]

I can do full rotations on bike when I’m at pt, after the therapist massages my knee and thigh well and I do some stretching / bending exercises. However when I try it at the gym I get stuck, or maybe im just afraid of how it will feel if I do full rotation without the massage warm-up so at the gym I mainly rock back and forth for a little while. Not sure how helpful that is but the bike seemed to have helped my rom early so I’m just continuing. At pt the only exercises they have me do outside of the table exercises are the bike and leg press machine (think it’s called a total gym machine?)

 

[mendogal]

@Nekocarlo - can you do self massage to loosen up your knee? Definitely makes life easier!

 

[Layla]

Happy Two Month Anniversary!
I hope you've had a few good days since you last posted.
A great month of August to you!
@Onestepatatime

 

[Onestepatatime]

@Layla thank you so much! I got to 114 yesterday at PT and my therapist gave me a fist bump lol. I got my hair cut and colored yesterday. And other day I got fresh mani and pedi. These are milestones for me. I’m struggling with still being limited to what I can do. But will be nice not to go to PT every day anyone! Hope all is well with you.

 

[Layla]

I got my hair cut and colored yesterday. And other day I got fresh mani and pedi.

Yay! Mood boosters for sure.
It is a struggle feeling as though we're being held back, but taking it slow and easy in an effort to avoid set-backs is the way to go. Your future looks bright!