MUA RTKR

[mendogal]

Oh! And about nutrition: there's a good amount of research showing that if we seniors want to build muscle, we need a higher percentage of protein than younger folks, and we do best if its spread spread out through the day's meals, not all at a big supper.

 

[sistersinhim]

My doctor said to try Aleve (Naprosyn ). I felt it relieved my knee pain a little better than Tylenol. I'm icing my knee as well and using Voltaren.

Since both of these medicines are NSAIDs be sure to eat something with a good amount of protein in it to help protect your stomach. Please google NSAIDs to find their other side effects.

 

[Birdie23]

Oh, I didn't realize that. It will make a big difference. Thanks for the guidance!

 

[Layla]

Happy Three Month Anniversary, Birdie!
I hope you’re having a good week and you’re making strides with your home workout plan and better nutrition. Best Wishes for all!
@Birdie23

 

[Birdie23]

I was wondering what other doctors prescribe for treatment of pain after TKR.
(I live in the US, so I think UK may have different meds.)
I just feel like I need something stronger, as I don't feel I'm making much improvement. My orthopedist & PT say I am, but I'm the one who's still having severe pain in my knee.

 

[MSuki]

I took hydrocodone 10-325 the first 2 weeks then 7.5-325 for weeks after that, gradually increasing the time between doses until I felt comfortable stopping. But did you say you can’t take these? I would have had a hard time getting through this without opioids. Oh, and I also have gabapentin for nerve pain, I only take 1 at night and I believe it’s a low dosage.

 

[Birdie23]

MSuki- Thanks for your response.
I was taking hydromorphone (Dilaudin) in rehab, but my orthopedist wanted me to stop once I got home. He doesn't want me on opioids. I don't think it was an issue with my psych meds.
But, I think I need stronger meds to get me through healing & PT. I don't drive or do much of anything really, so I don't see why I shouldn't. Doctors here are reluctant to prescribe opiods because of addiction.
I'm going to ask him again.

 

[Birdie23]

I saw a new PT today. I had been going to one of those larger PT centers. I started to feel they were putting too much stress on my body. They had me using the recumbent bicycle, calf stretches, leg press, standing side and back leg raises, quad leg raises, leg abduction w/ band, calf raises, hurdles, chair knee bends, quad contractions, and other exercises I don't remember. (And telling me "Good job!" Like I'm a 3rd grader who passed a spelling quiz.)
By the time I got home from PT, I was in even more pain to the point of crying.
I told my Orthopedist, and he said that shouldn't happen. He referred me to a private practice PT, who has been practicing for 30-years, but up to date in new methods as well. I liked his approach. Less is more. Relaxing the knee muscles, used a TENS unit and ice. No running around the " obstacle course"
I'll see how it goes.

 

[Layla]

Great news! Wise to make that change, Birdie. I certainly hope it works out for you.
Please keep us posted. It sounds less stressful and hopefully less discomfort / pain involved.
@Birdie23

 

[sistersinhim]

Bad PT is much worse than no PT! I'm so glad you changed facilities. Stick to your guns and don't let anyone hurt your knee, not even you!

 

[Birdie23]

Thanks again for your encouragement!

 

[Birdie23]

My new PT is so much better. I feel more relaxed. I think the other place was creating too much tension. It was like boot camp exercises.
I have been relaxed enough to finally be able to bend my knee! I'm so excited about this. I'm also walking more confidently with the cane.
I think in addition to mild exercises, regular icing and knee massages have helped considerably.
I'm no longer afraid to touch my knee. I massage Vitamin E oil in an upward & circular motion all over my leg. I try to focus on my kneecap as much as I can, but with less pressure, because it's still painful.

 

[mendogal]

Yes!!!! Oh what a wonderful update!

I have long believed that relaxation is a key component of improved ROM, as important as stretching and exercising - perhaps moreso as it permits effective movement.

 

[Birdie23]

Hi Everyone- ( TKR Oct 31 2023)
here's an update:
My new PT has been helping somewhat. However, my knee bending is still stuck at 90 degrees. I haven't been able to go beyond that, and am unable to follow- through on a complete walking gait because I can't fully bend my knee.
The PT said it's the scar tissue not breaking down. But that area is so, so painful when massaging and manipulating to break up the scar tissue.
I have been icing, massaging with Vitamin E oil, Voltaren, exercising, stretching, taking acetaminophen & Aleve.
The PT said my orthopedist can perform a procedure to remove or break-up the scar tissue. But, he said it's not a great alternative, and that I should discuss it with him. And that my PT treatment would be different after that procedure.
Any thoughts about this procedure?
Thanks.

 

[Jockette]

The PT said my orthopedist can perform a procedure to remove or break-up the scar tissue. But, he said it's not a great alternative, and that I should discuss it with him. And that my PT treatment would be different after that procedure.
Any thoughts about this procedure?

He’s talking about a Manipulation Under Anesthesia (MUA for short). There are pros and cons. This procedure will help if you do indeed have adhesions. There is a difference between adhesions and scar tissue. I will post an article from our library below.

The PT said it's the scar tissue not breaking down. But that area is so, so painful when massaging and manipulating to break up the scar tissue.

If he is forcing your leg and deeply massaging, causing this much pain, and has been for the last 3+ months since your surgery, no wonder your ROM is not progressing. Your knee might not have been allowed to heal and maybe needs a break from all this PT.

And that my PT treatment would be different after that procedure.

Often after an MUA they prescribe PT that is on the aggressive side, and every day for about 2 weeks. (I am not a fan of this, I personally think the slow and gentle way is the way to go.)

 

[Jockette]

MUA (Manipulation under Anaesthetic) and Adhesions
MUA for Stiffness Following TKR
MUA: the ineffectiveness of early MUA (JBJS)
MUA: Who is more likely to need an MUA after TKR?

 

[Birdie23]

You are all so wonderful, supportive, and knowledgeable.
This is all very interesting and confusing information .
It's a lot to think about. I'll have to address it when I see my orthopedist in two weeks.
I'm 70- yrs old. I was an active person prior to my knee pain. I know I needed this surgery.
I don't know if I can go through an MUA procedure and a different course of PT at this point. (If my orthopedist even agrees to it).
I don't feel I should be experiencing this amount of pain for this long. Maybe I am guarding to a degree, but I'm not being a crybaby because I'm really in pain.


My last PT place was like boot camp. This new place is better- it's one-on-one, with more focused, slower exercises.
But, they still do painful deep massaging and manipulation. I had to tell her to stop a few times.
Whew! Thanks for allowing me to vent!

 

[Jockette]

But, they still do painful deep massaging and manipulation. I had to tell her to stop a few times.

I would stop allowing this “therapy.” At Almost 4 months post op I would also stop going, since it is obviously not helping. By now you know what PT movements you feel help you, and you can do those on your own at home.

I don't know if I can go through an MUA procedure and a different course of PT at this point. (If my orthopedist even agrees to it).

This article applies to both your current PT treatment, and a possible MUA.
Saying no to therapy - am I allowed to?

Just because someone recommends it doesn’t mean you have to consent to it.

If it was me, I would stop the PT and give myself several weeks, if not longer, to see if it improves with TLC, rest, ice, and especially elevation. We all heal differently and I know I respond better to gentle treatment. I stopped going to PT at 8 weeks and over time my ROM came back fine and even continued to improve all through my second year. There is no time limit for ROM.

GIve your knee time to settle down and sort itself out. MUAs can be done any time and if you feel it would benefit you later, you can do it then.

 

[lrj]

Diclofenac (the active ingredient in voltaren) is also available as an oral medicine. It's available by prescription only in the US. It has work amazingly for me! I was also taking it for quite awhile before surgery. Just need to take 1 twice a day. I've also tried the topical version, and it was not nearly as effective, but topical is safer.
It is an NSAID and increases the risk of certain problems more than most other NSAIDs. Works great for my joints and the swelling. Does not work on a headache.
Might be worth a discussion with your doctor. And of course, it might not work as well for you.

 

[MSuki]

My physical therapy never included any deep massage intended to break up scar tissue. They would occasionally massage a muscle that was tight to help me relax. This doesn’t sound like a good idea to me. I would be terrified if someone tried to do aggressive massage even NEAR the surgery area.