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PKR Slow, steady recovery....challenging gains in ROM

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Don't take the MUA lightly. While it's not a surgical procedure, it is a good "workout" for a tender knee. It is not done just because a person doesn't have the expected range of motion. It is performed when a patient has adhesions that are keeping you from achieving full motion. The purpose is to break up those adhesions. This is not a common thing to have.

It is much more likely that your ROM is restricted because of swelling. If an MUA is done under those conditions, you'll just irritate an already angry knee. So please don't try to "work harder" to achieve ROM in these coming weeks. Do gentle bends and stretches of your knee (5-10 of each) throughout the day and evening. You will get exercise walking from room to room for meals and bathroom breaks. When you're not up, elevate your leg so that toes are above your nose. Put ice on both the front and back of your knee whenever you are not upright....even when sleeping. Just be sure you put a kitchen towel between the ice source and your skin so that you don't damage your skin.

Try this for a week or two and let's see where you are then. I'm betting you'll see improvements.
 
Hi @maui I'm 6 weeks post op from a partial too. The stationary bike really helped me early on, mostly as a tool for extending, flexing and stretching.

You're at a point now that you need to focus on the fine line between physical therapy and swelling. Find a compromise between the two and you'll do great.
 
@Jamie. Thank you for your advice. Is it rare to form adhesions at 6 weeks post op? How does the OS ultimately determine that I do have adhesions and am not just swollen? I spent the first two weeks post op with my leg straight. No one told me to bend it so I did not take my brace off till my post op apt at two weeks post surgery. I think this could be what killed me and sent me into such a tight knee situation. I feel like I have a very inflexible ace wrap around my knee (especially on either side of my kneecap). I'm struggling with the right "path to take" at this point. My OS seemed pretty confident that an MUA was the way to go because my tightness (as he said) was not due to swelling. Although, I'm clearly still swollen....it's obvious which knee was worked on because of swelling alone. I guess my main question is twofold... a) what if the likelihood of adhesions? B) how long should I wait and to what degree of bend before I "cave" and consent to MUA?
 
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I had that "tight ace bandage" feeling for about two months after my surgery. It was due to the swelling - and my ROM went from 90 in the hospital to 70 at PT. Once the swelling started going down, that tight wrap feeling around the knees started going away. It was then that I slowly began to regain my ROM, with only a few degrees each week. But, now at almost 5 months out from surgery, I'm at around 125 on each leg.
 
maui said:
Oh...another thing, he said it's mostly mental at this point.
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What a horrid thing to say! Sorry, it's not in your head - it's from swelling! I agree with the advice about waiting. Too early to be talking MUA. Ice and elevate, meds and take things slowly. Reread the articles Judy left you about MUA and gaining ROM. It's never too late. Just give it time.
 
@maui

I'm no medical expert, but my understanding is that MUA can be successful well out in time. When discussed w/my OS on first knee, 12 weeks was the earliest he would do an MUA (thankfully unneeded). I agree with Jamie's take on the dangers of a too early MUA on still healing, swollen tissue. Do some careful research.
 
Celle said:
I have had a PKR, a revision to a TKR and a TKR on the other knee. Of my three recoveries, the PKR was the hardest and the longest.
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Same here (sorta), I had a LPKR and revision to LTKR. The partial was a MUCH harder recovery.

I also didn't bend my leg for the first 6 days after the partial. I had an allergic reaction in the hospital and no one focused on anything but that, then was released on a weekend. It was VERY hard to get that leg to want to bend at all. I remember the feeling you're having VERY well. My question is...are you seeing a physical therapist? What is their opinion? I would think a PT could help you through this stiffness, without pain or another surgery.
 
@kaydubs. I am working with a PT...2 times per week. I have been a total of 6 times as of today. I am getting constant increase in my bend but it still seems slow. He has said that we will keep working until we hit a plateau before he recommends an MUA. Do you remember when you started to feel that stiffness dissipate and what your ROM was at what week post op?
 
maui said:
a) what if the likelihood of adhesions? B) how long should I wait and to what degree of bend before I "cave" and consent to MUA?
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a) Although people worry about adhesions, very few actually develop them.
b) Wait as long as you like. Very few surgeons will consider a MUA once you get to 90 degrees.
Did you read the articles I left you in Post#15?
There's absolutely no point in having a MUA if you do it before all the swelling is gone and before you have stopped increasing your bend - no matter how slowly the increase happens. A MUA does cause some re-injury to your healing tissues and it does involve having a general anaesthetic, which is not entirely without risk. It is not a quick fix for a slowly increasing range of movement. Rather, it's a procedure to be done when there is no improvement.

I do think that you are feeling impatient and worried because of a couple of additional factors that many of us don't have.
First, your surgeon set you up with totally unrealistic expectations about your recovery time-frame.
Second, you are an athlete and, being fit and used to exercise, you probably thought that your recovery would be easier than some. This article might help you there:
TKR recovery and an analogy to athletic training

The stiffness and that tight feeling around your knee will probably be with you for a while yet. It's just past 3 months since my surgery and the tightness only disappeared last week. This article will explain a bit abut it.
"Tight band" feeling across the front of my knee
 
Hi - sorry to come into this so late but I've been ill. Going into the TKR I was vehemently opposed to the idea of an MUA.

However I can say now that I'm an early MUA'er and it was a godsend for me.

I had an MUA early because at 6 weeks I was only able to achieve 65 degrees ROM. My knee was tight, not dissimilar to a tight ace bandage, but rather than swollen tight it felt more like concrete. I felt if it was forced it would crack/snap/break. It was clear to me that no amount of anti inflammatory, ice, time or rest was going to change this. I had a miserable post-op inpatient rehab experience where I was told I wasn't trying hard enough and gung-ho doctors who tried to take me off pain relief far too early.

At my 6 week surgeon apt I told him how disappointed I was, how hopeless the current treatment was and how little movement and how much pain I was having. I brought up the subject of MUA. He showed me in his surgical notes that he predicted a poor outcome due to previous injury and surgery and noted old adhesions. He didn't mention it to me because he didn't want to influence my recovery. He also mentioned there is some evidence that younger patients appear to develop adhesions more than older patients.

Booked in for the procedure two weeks later and he allowed my physio to attend in theatre. I had a femoral nerve block and a general. I was told it took a minute to perform and there is a distinctive crackling as the adhesions break. I was put in a CPM whilst still in theatre and getting 125 ROM. First night I had to keep the CPM going overnight and the next day 2 hours on, 2 hours off. I made the mistake of pushing myself to 135 on the machine, I was too aggressive and caused myself terrible muscular pain for the next week and a half. Live and learn.

I am very glad I had my MUA and I wouldn't hesitate to recommend it if you're stuck. It is not nearly as bad as the original surgery but it does set you back a couple of weeks - but if you're not bending you're behind anyway.

There's more information in my recovery thread if you want an alternate view to the 'wait for the MUA' school of thought.
 
maui said:
@kaydubs. I am working with a PT...2 times per week. I have been a total of 6 times as of today. I am getting constant increase in my bend but it still seems slow. He has said that we will keep working until we hit a plateau before he recommends an MUA. Do you remember when you started to feel that stiffness dissipate and what your ROM was at what week post op?
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I'm sorry I don't remember my ROM's from the partial, but I can tell you it was between 2 and 3 months post op that I finally felt like I was making progress (more steps forward than backwards). It was kind of all of a sudden, around 3 months post-op that I felt the stiffness lessen and I could stretch the joint more.

I honestly think time is what will determine things. Please try to be patient and don't push your already sore knee too hard! I'm here anytime if you have questions.


Sent from my iPhone using BoneSmart Forum
 
I had my tkr the same day as you - I am 46 and a former athlete. The past couple years, I have only been able to mountain bike.

I am at 57 degrees and suffer the same tightness around the knee and have intense pain on the medial side of my knee when I try to extend my ROM. I have my next appt with my OS on the 14th of January. He is in the "no pain, no gain" camp. I am dreading seeing him and am also worried about an MUA. I have decided that I will not have an MUA as long as I am progressing in ROM and not plateauing. My PT is amazing and is working with me the bonesmart way. Slow and steady...

Here's to a smooth recovery. All the best in the new year!
 
@Wrangler. We are in the exact same boat... I agree with your PT. My PT said the same thing to me yesterday. My aunt is a nurse and I have been consulting with her regarding my situation. She said this..."55 degrees is remarkable after only a couple of weeks PT. Secondly, patience!!! This is a huge surgery you will NOT heal as quickly as you would like to heal. By 10-12 weeks post-op you will look back on today and say wow! I have come a long way. Active people have the hardest time. It simply drives us crazy to be still" This advice brought me a sense of relief...hope it does the same for you. Good luck and keep me informed of your progress.
 
maui said:
I am getting constant increase in my bend
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As long as you are making progress, you are doing fine. This recovery is a marathon, not a sprint.
Give it time and your ROM will increase and allow you to do what you want.
 
@maui I will keep you posted. I have a massage appt tomorrow and my next pt session is on Monday. Patience has certainly been the hardest part for me. But I am getting there.
 
@maui
I'm so glad that your aunt's advice reassured you! I agree entirely with what she said.
 
I appreciate the slowly,slowly mantra. Those that have followed my ordeal will agree I'm a huge fan of the Bone Smart mantra and I tell all the newbies at Rehab that they need to follow this methodology. Having saud that and having done an MUA, I have to stand up and say IT IS NOT THAT BAD. It is not NEARLY as painful or agressive as a PKR or TKR.

Having lived for 2 months at 65 ROM I know how impossible it is to do the simplest things for yourself. You can't take stairs, get out of a chair properly or even dry your feet off. It sucks and I recommed if your surgeon wants to do an MUA - go for it. If you're still at 55, you'll get an immediate improvement that will allow you to start working on getting back to what you love doing.
 
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