MUA Sleeping on my side, 5 weeks post TKR

[Andypandy]

@Layla @mendogal @Jockette @sistersinhim
Could I please have some guidance. So my deadline is 28th February to have a good be nd or I will be added to the list for MUA. Problem has been swelling but definitely better than was, I can't take anti inflammatories so maybe that doesn't help. Also my pain meds have been on and off due to stomach problems , back on 15mg codeine, fingers crossed. Took 2 paracetamol in the night, ate 2 digestive biscuits beforehand, sat upright for 30 minutes, 20 minutes later horrendous stomach pain, gaviscon, biscuit and hot water bottle, stomach settled 1 hour later. It seems night time meds always attack me. Anyway my question/query is: I am doing the bend exercises he suggested , told me to leave the strengthening exercises for now as happy what I am doing. Swelling then starts, ice, elevate, have a break couple more sessions, back to square 1. Question: when I stand the knee is very painful, is this normal.
Question: walking heel toe can feel a bend but feels full. So, is there anything I am doing wrong, should I be doing more, 4 sessions a day, slight rocking movement whenever I am sitting to keep it moving. I am just so confused with the swelling as it's a circle, and I hear people have swelling way past my 8 WEEKS which I will be on Monday. He advised my to fit in extra intense pt sessions to help. NO!!!! I have not. Appreciate help, guidance, and anything else beneficial x

 

[Layla]

Hello and Happy Friday, Andypandy!
I understand that you're feeling pressure about the timing and that doesn't help anything. First, keep in mind that MUA is an elective procedure, not an urgent one. You need to be fully informed before YOU make the decision and you need to be comfortable with it rather than feeling rushed by a deadline. I hope with that understanding it reduces a measure of the pressure you're feeling.

Swelling can last for months, usually easing over time, but can last up to a full year post op...to some degree.
Are you elevating "several" times per day, for a good length of time? Lets say 45-60 mins, while icing.
It is our lymph system that rids the body of fluid (swelling). So you want to get the fluid to the lymph nodes in your torso area so your body can more quickly process it. The lymph system works rather slowly on its own and much more efficiently with the assistance of gravity. The fluid isn’t draining into the hips, but contained with the lymph system and moving to the torso and lymph nodes located there.

It is common to experience pain when standing at this point in recovery. Soft tissues, bones, nerves...all still healing. Your muscles are likely weak making it more difficult to support you weight. You have swelling which can cause pain as you shift your leg into different positions. Both too much movement, as well as too little can cause discomfort, you really need to search for a balance and as you're healing, that balance will fluctuate.

I'd only be concerned about pain that is increasing in frequency and intensity. Never ignoring symptoms such as swelling, warmth or redness which can be signs of infection.

walking heel toe can feel a bend but feels full. So, is there anything I am doing wrong, should I be doing more,

The sensation of fullness is inflammation. Here is a visual of heel-toe walking -

I agree with you on the PT, I wouldn't be attending any intense sessions, it will only aggravate your healing knee.
Try not to worry and keep doing what you're doing, balancing rest, Ice / elevation with reasonable activity and you could begin slowly seeing results. You'll get there Andypandy!

 

[Layla]

I just quickly paged through your thread to make sure I didn't already leave the two accounts, from recent members in regard to ROM. You may, or may not have read them on the forum, elsewhere, but it won't hurt to read them again.

Member JusticeRiders post -

"I just want to add, for all those coming along, a note on ROM. I want to share this because nearly all of us have a tremendous amount pressure put on us to increase our ROM by certain deadlines, or else.

Mine has been extremely slow coming. First I had to wait out the swelling, which in my case took more than 5 months. Yes, months. At that point I began to see real progress. It has continued to this day. I have seen improvement in the last 2 weeks. It’s still going. A this point I think the limiting factor is tight muscles, ligaments, and tendons from 3 yrs of very limited ROM and actually about 25 yrs of somewhat limited ROM. Those tissues are slowly stretching.

I have had to be willing to let my flexion improve at a glacial pace, be very patient, and tune out the dire warnings of my surgeon, PA, previous PT, and some well meaning acquaintances. I refused painful PT and refused a MUA. I have absolutely no regrets. I know my body, and I believe those things would have caused a domino effect of swelling and pain that may have derailed my recovery long term and even possibly have torn soft tissue, etc. I now know I have the added challenges of hypermobility and an immune condition that causes an inflammatory reaction. I think a MUA would have been very harmful to me.

Instead of forcing it, I have relied on weekly massage and using my stationary bike as a stretching aid every single day. I have been very active, but I have ramped up really, really gradually. I have not measured my flexion, because honestly I feel almost a PTSD type of reaction around it. All I care about is function and what I can do. My knee is very functional now, and still improving. I love my new knee. I’m glad I let it heal on its own timeline even though it was so much longer than everyone (most of all me!) would have liked."

 

[Layla]

Member VolLady's post -

I want to tell everyone that has went though TKR that it is a long journey to heal. I am going this spring to have my other knee replaced.

"Please do not get discouraged and I know you will because I did with my first one and cried more than I had in a life time. Scared mostly.... Surgeons will not tell you everything that you will experience during your healing. It took me 7 months actually to feel more normal but not 100%.

For the ROM I only got to 112 at 4 months and still cannot bend it all the way back to reach 130. But I can drive, sit at a table, put my shoes and clothes on great without a ROM of 130 or 120. There is no swelling at all at 8 months but I still have some stiffness at times but I deal with it and walk. I also still ride my bike with no trouble.

I am telling everyone this because your body will heal without PT and pushing your limit beyond to the point there is more swelling and pain. I have decided when I have my other knee fixed this spring, that I will do my own PT since I have all the equipment and items that they use anyway.

I had a MUA at almost 6 wks., and regretted it from day one. Simply because it did not help me anymore with my ROM but it did set me back on healing. The swelling was awful. I will not have another MUA even if my ROM was 95 at the time.

I will go in with open eyes on this other knee comparing on what I went though with the first one. So, with all that said, I wish everyone a happy healing and let your body decide with healing than someone trying to push you until you scream with pain. Also don't worry about the ROM, it will come -- it might take a year or more, but it will come. I am 67 years old and I don't expect to get past 120, but I do what I want to do at 67. Oh! and I can even bend down with the knee need to kneel on it..... Best wishes everyone!"

 

[Andypandy]

@Layla thank you for your support, so appreciate the help we receive. In all honesty, I should be icing elevating more. Using the cryocuff 4 times per day, in between I use the gel pads, usually sit in the recliner whilst using those. During the night a gel pack, leg up on pillows. I try to sleep on my side now but that doesn't last too long, nice to get a break from back sleeping. I am very impatient and so this is just causing more grief, when I finish a set of bends then the swelling starts and then I start, poor hubby just gets the ice ready, bless him. Again, thank you and I take all your advice wholeheartedly. Will carry on and that's what this is about , we have to carry on. Wish you a great weekend x

 

[Layla]

You're welcome, dear one. We're here for you always.
@Andypandy

 

[Oldped]

@Andypandy , just my 2 cents worth, I was offered MUA at 8 weeks, decided to decline, I have osteoporosis and worried about fracture, also pain and starting over. My preop bend was only 90 degrees for several years so I’m sure tight soft tissue/ligaments which MUA would not help. I feel like I’m slowwwly getting better , walking better, not much pain, able to do more. I’m 3 months out, think I will continue to improve. I think we just need to be patient, listen to what our bodies are telling us. I think this recovery is hard for some of us, didn’t help to hear “I’m playing pickle ball/golf/dancing at 6 weeks out!!” Tell yourself you’re doing your best.Spring is coming, life goes on , we’ll get here on our own timetables.

 

[Jockette]

8 weeks is still early, in this 52 week (one year, on average) recovery. Other members experience the same issues that you do, at 8 weeks, so, you are not alone. So much of this recovery just requires Time.

I agree that the MUA is an elective procedure, not an urgent one, and you make the final decision, not your medical team.

Problem has been swelling but definitely better than was,

It will continue to get better as you heal, and healing takes time. Too often our medical team expects all of us to recover at the same rate, yet we are all unique.

All this stress caused by your medical team’s expectations are not helping you. I know it’s hard (been there, done that) but try to relax, rest ice and elevate, and just do gentle bending movements for mobility. Doing any exercises that increase the swelling is counterproductive.

Hang in there.

 

[EalingGran]

My preop bend was only 90 degrees for several years so I’m sure tight soft tissue/ligaments which MUA would not help. I feel like I’m slowwwly getting better , walking better, not much pain, able to do more. I’m 3 months out, think I will continue to improve. I think we just need to be patient

Agree with @Oldped. Pre-op bend is probably the best predictor of post-operative flexion and MUA won't help long term tight soft tissues and ligaments.
They can stretch and strengthen very gradually with something like pilates- done slowly and gently. The listen to your body mantra is the one to follow.

 

[EalingGran]

. I think this recovery is hard for some of us, didn’t help to hear “I’m playing pickle ball/golf/dancing at 6 weeks out!!” Tell yourself you’re doing your best.Spring is coming, life goes on , we’ll get here on our own timetables.

This is so true! My daughter in law's father was back on the golf course at 8 weeks apparently- and it really upset me as I was still in pain from an overstretched MCL.
Just remember that everyone is different and also people exaggerate or even fib. It's like everyone else's child is a genius who is reading/doing times tables at some ridiculous age......

 

[westiemom]

@Andypandy
I'm about a month ahead of you and still not running, dancing, golfing, playing tennis either! I actually use my icing machine all day long while I'm sitting and elevating. Yes, it's a huge pain to turn off, disconnect the velcro before I can get up each time, but tried to go without icing at all and that didn't turn out pretty. My doctor was threatening a MUA at my 2 week checkup cause my ROM wasn't 90. That was such a worry to me that I'd wake up in the night worrying about my ROM and the MUA. DH kept telling me that they cannot force me to get the MUA - they weren't going to roll up in the early hours in an ambulance and carry me away to the hospital, so it's not something to worry about. (I still did tho). When my 2.5 month appointment came in January, the doctor mentioned it and I said "no, absolutely not". And that was that. He told me I had 3 weeks to decide because of that idea that after 3 months you can't have MUA. Telling him No and not getting carried away by him to do the MUA at that moment felt so good. I came home weighing 50 pounds lighter from having that off my shoulder.
I tried to sleep on my side, but couldn't get comfortable so back to laying on my back. I usually spend part of the night on my back on the sofa and the other part in the recliner chair. I have a pillow wedge I use either way. I tried sleeping in bed, but we have 3 dogs in bed with us and every time I needed to move, they would all get up to see what I was doing. They also tried to get as close as possible so I couldn't really move around much. So back to the recliner I went.
I still have pain when walking also. Even doing my normal ADL stuff after washing dishes at night, I have pain and aching. So at your point in your recovery, I think you're doing great!
And even tho you're in the UK, I don't think the doctor will sneak into your home in the middle of the night and grab you, take you to the hospital and proceed with the MUA. I was also worried about how the doctor would react to my "No" - would he throw me out of his office and refuse to have anything to do with me. He didn't; just have my appointment in March for my final discharge.
Hopefully, hearing from someone else who had the same thing hanging over her head and managed to live thru telling the doctor "No" helps you feel better.

 

[westiemom]

@EalingGran
My pre-op ROM was 120 and I'm far away from that and not sure if I will ever get to 120 again. It feels like someone chopped out part of my leg from mid-thigh to mid-calf and stuck a log in there. A log that doesn't like to bend. I think I'm just one of the slowest healers there are. Almost 3 months along and still purple bruising and a couple scabs that just do not want to come off (and I'm squeamish about that kind of stuff, so not trying too hard to pick them off). I'm hoping that y'all are correct in thinking that pre-op ROM is a good indicator of how well ROM will get to after the surgery.

 

[beralc]

Member VolLady's post -

I want to tell everyone that has went though TKR that it is a long journey to heal. I am going this spring to have my other knee replaced.

"Please do not get discouraged and I know you will because I did with my first one and cried more than I had in a life time. Scared mostly.... Surgeons will not tell you everything that you will experience during your healing. It took me 7 months actually to feel more normal but not 100%.

For the ROM I only got to 112 at 4 months and still cannot bend it all the way back to reach 130. But I can drive, sit at a table, put my shoes and clothes on great without a ROM of 130 or 120. There is no swelling at all at 8 months but I still have some stiffness at times but I deal with it and walk. I also still ride my bike with no trouble.

I am telling everyone this because your body will heal without PT and pushing your limit beyond to the point there is more swelling and pain. I have decided when I have my other knee fixed this spring, that I will do my own PT since I have all the equipment and items that they use anyway.

I had a MUA at almost 6 wks., and regretted it from day one. Simply because it did not help me anymore with my ROM but it did set me back on healing. The swelling was awful. I will not have another MUA even if my ROM was 95 at the time.

I will go in with open eyes on this other knee comparing on what I went though with the first one. So, with all that said, I wish everyone a happy healing and let your body decide with healing than someone trying to push you until you scream with pain. Also don't worry about the ROM, it will come -- it might take a year or more, but it will come. I am 67 years old and I don't expect to get past 120, but I do what I want to do at 67. Oh! and I can even bend down with the knee need to kneel on it..... Best wishes everyone!"

These stories are so helpful @Layla . It’s doesn’t take much, In my case, my having a call from the Physio today, to start a seed of doubt in your mind about progress and the dreaded window of opportunity in regards to flexion. You start thinking and overthinking things whereas I was perfectly content doing what I’ve been doing.

I know @Andypandy has had that pressure a lot from the start with her PT and it’s really so unhelpful. The stress it causes is opposite to how you should be facing your recovery.
Hope you’re feeling a little clearer about things andypandy x

 

[Andypandy]

@westiemom so sorry you're not feeling to good. You've been through an awful lot and it certainly tells on our bodies and minds. I have an anxiety/sleep tablet now and it seems to be helping, nothing can totally help other than ourselves, we have to do that. Are you still doing gentle exercises for the bend, maybe cut some of the icing out and try a few exercises, then the icing. As this is such a slow recovery it's definitely affected our minds,attitudes, basically everything because it's the same every day. I get an hour on one side sleeping then try the other side and end up on my back legs up on 2 pillows. Usually have to get an ice pack, or 2 during the night, and a cup of tea. Take it slowly and I wish you millions of hugs x

 

[Andypandy]

Hi everyone, hope some improvement, however small might be, but it is an Improvement. That's what we must tell our overactive minds. Off to the stairs now for gentle lunges, and they are gentle, rocking slowly but just wanted to share, my son called earlier asked what I was up to today and as usual, I replied Groundhog Day and apparently he informed me it really is. So, we are famous xxx

 

[beralc]

That explains why the NYT mini crossword had references to Groundhog Day today
Yes every little step forward is something to be added to the long list of little somethings we achieve along the way. I feel a lot more clear headed in my thinking today not so foggy and thinking about things I’ll do in the garden when Spring arrives. It’s probably the first time I’ve looked ahead at anything since the surgery. So even though it’s not a physical step forward, I’m still counting it as an improvement.

@Andypandy yes it is a slow recovery, in sporting parlance it’s called trusting the process. That’s what we have to hold on to. Weather's lovely today might even try a few laps of the garden later. Hope your day is a good one x

 

[Andypandy]

@beralc little by little, funny you mention the forward thinking, I have felt a little similar today, let's hope it's a part of this journey. Beautiful weather here also, just having ice machine now, after doing few more stair lunges. Walking more confident on one crutch and really strange feeling as walking without, albeit not far. Hope you are are feeling better, sun shine clearly says, ice cream van xx

 

[Layla]

I feel a lot more clear headed in my thinking today not so foggy and thinking about things I’ll do in the garden when Spring arrives. It’s probably the first time I’ve looked ahead at anything since the surgery. So even though it’s not a physical step forward, I’m still counting it as an improvement.

Yes, it is! Hoping you ALL feel like this soon!

There does seem to come a time when you feel that mental / emotional boost, especially once you begin to see real improvements in mobility and pain relief. Early on there is frustration, impatience and even the post op blues. Then the day comes when you begin to think - Hey, I think this may be a good thing after all!

Have a great day and week, ladies!

 

[beralc]

Yes I think I’m there @Layla I’m sure there’s struggles to come, but I think ultimately it’s about feeling like you have some control over things and that must come at different times for everyone.

 

[westiemom]

Today I feel pretty good. DH and I started doing my exercises again today. I haven't done any exercises since I came down with Covid over New Years. He said that I actually didn't regress during the month off, but he estimated my bend at around 86. Not perfect but much better than the 70 something when I quit PT. I think/hope my cold is coming to an end also. I have a doctor appointment Tuesday, so pretty sure I won't be sick when I get to see her. That's the way it always is - you can't get in when you're sick and by the time the appointment rolls around, you're better.

@beralc @Andypandy
So glad you're both feeling up today. I do too. We have sunshine and it's nice enough we can have coffee outside this afternoon. Getting out into the sunshine always makes me feel better. I also managed to sleep from midnight to 3:30 and then intermittently till 7:30 this morning. Tuesday I'm going to ask the doctor for something to help me sleep. They have to be very careful with drugs since I have congestive heart failure. Hoping there's one available that I can afford. This is our lousy US health insurance - so many drugs not on our "Formulary" that will be covered and we pay a small (or huge) co-payment.