MUA Stiff Knee

[Doula1st]

Hi, my name is Teri, I have read many post but this is my first time posting.

I had my Left knee replaced on Aug 15 this year, I am about 9 weeks post-op. I have not had an easy recovery. Going into the surgery, I thought to myself that I would breeze right through the recovery (I am 54 and people much older get through it). I am only at 90 degrees of flexion and my extension varies from +4 to +2.

At my 4-5 week post op appointment my surgeon said I may need to do a MUA. I see his assistant tomorrow afternoon. My PT also thinks I will likely be advised to do the MUA. I have Type 1 diabetes, and also a history of Frozen shoulder on both shoulders 1 year apart (no known reason for the adhesions both times...no previous injury). I tell you this because I do believe I build adhesions easily and probably do need the MUA.

My concern if they do recommend this, is how does the surgeon know it is adhesions that need to be broken up and not a muscle or ligament problem? At almost 3 weeks post-op I had "an event" coming down my stairs (I have no idea what I did, maybe stepped down with my good leg on that step) that brought me to tears. The pain was in the back of my knee/upper calf area.

I need to return to work, and if MUA is recommended I will do it. But I am nervous about damage being done. Any feedback from others about recovery after MUA would be appreciated. Thank you!

 

[doegirl999]

Hi Doula, I had an MUA and took 2 days off. The day of the procedure was full of drugs and I felt no pain. I was sent home with Percosets. I needed 1 or 2, especially to sleep, for maybe 2 days or 3. Then back to PT and Tylenol. I will say that they warned me, and they were correct, that the pain level is re-set back to where you were after surgery. That was a setback, but my ROM went from 70 to 95 degrees and I am now at 110, so I do believe it is helpful. I did not have other injuries AFTER surgery but I did have one BEFORE surgery, which is why I had the surgery. I had been slammed by dogs running in the dog park. So chances are good that I had scar tissue and limited movement prior to surgery but we can't know if that is true. Best of luck to you.

 

[Doula1st]

Thank you Doegirl for your response.

 

[Celle]

Hello @Doula1st and

You're a doula? I worked for a long time as a midwife, so I understand what you job entails.
However, I must tell you that we usually advise taking about 12 weeks off work and then doing a
Phased return to work , if possible.

Knee replacement is major surgery and you can't hasten your recovery, no matter how you want to, and no matter how young and fit you were before surgery. Unfortunately, the knee of a 50-year-old takes just as long to recover as the knee of an 80-year-old. Recovery from this surgery is a marathon, not a sprint, and it takes a long as a full year for complete recovery, although you will feel almost back to normal long before that.

Your knee is going to recover on its own schedule, not on the schedule you would prefer.
Where are you in recovery?? (TKR)

You can't make your knee recover faster by working hard at it either, and doing too much can actually slow down your progress.
Knee recovery - Lose the Work Ethic!!
TKR: work “smarter” and not “harder”

If you decide to have the MUA, don't expect a miracle-fast recovery. It may help, or it may not. Whichever, having the MUA will tear some of your soft tissues, which will set back your recovery temporarily.

Quite honestly, although it isn't marvelous, a ROM of 90 and 4 isn't too bad at 9 weeks.
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

You may even find that cutting back your exercises and spending more time resting, icing and elevating your knee to reduce the swelling works better than anything else.
It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

I'm going to ask @Josephine , our Nurse Director to advise you about this. She will probably ask a lot of questions. Do try to answer them as fully as possible, so she has all the information she needs, to advise you appropriately.

 

[Celle]

Hi again, Doula,
Here is the regular post-op reading we give to everyone:
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now; they are almost certainly temporary
2. Control discomfort:

rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy​

5. Here is a week-by-week guide for Activity progression for TKRs


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs
Elevation is the key

Ice to control pain and swelling
Heel slides and how to do them properly

Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[cnm1]

Hi Doula
Nurse-midwife here!! I am 16 weeks post op. I went back to work at 12 weeks ( 9 days instead of 10 days pay period). Do not rush back if you can. I am doing ok but am exhausted. Recovery is a slow, frustrating process for most of us

 

[SusieShoes]

Consider carefully whether you wish to go through with an MUA. It's still early in your recovery and your swelling is still going down. Less swelling means more flexion. You might want to wait a few weeks to see how well you progress. The question you ask is a good one: how does the surgeon know you have adhesions in your knee? Experience, perhaps, but in truth he cannot "know" unless he goes in with a scope.

I too had a frozen shoulder. It was corrected to full ROM with intensive physical therapy. Was I breaking down my own adhesions? Perhaps, but my doctor and the therapist told me the condition was due to atrophy of some of the many muscles in the shoulder. Through PT I strengthened and balanced those muscles again.

Adhesions in TKR are rare, but they do occur. An MUA will set you back in that you will be recovering all over again from the swelling caused by the procedure. It should not, if performed properly, damage your joint.

Oh, and "events"... I think all of us have an "event" story to share. Mine was making a sideways leap on my 12 week old knees to avoid a pugnacious pug! Sore for days after. But that's the case with TKRs -- life always serves up something unexpected. Our joints are surprisingly resilient.

 

[Doula1st]

Wow, thank you all so much!! What an excellent forum with so many caring, helpful people. Thank you, thank you, thank you.

The reason I believe I may have adhesions, is when I reach right around 90 degrees, it is a solid stop, like hitting a brick wall.

 

[kmak81230]

Hi Teri: What does your PT think? While my knee seemed "stuck" at 90 (to me anyway), my PT said that I did not have adhesions but rather, since I was early in recovery, swelling and healing were keeping my knee at 90 and that time (and not being aggressive with exercises) would allow the ROM come when the knee is ready. The other thing to consider according to others, is that there is no "window" or time frame to have an MUA. So not a decision you have to make immediately. I did not have an MUA and perhaps others who have had one can give you some more wisdom than me. I can say that I am a "slow bender and straightener" - was at 90 degrees for many weeks and only in the past week (at 5.5 months) got to 120 - and my knee still does not fully straighten. There are many instances of people making gains in ROM a year or more post-surgery. Hang in there!

 

[Doula1st]

My PT is thinking there may be adhesions. She has been more gentle on my knee the last 2 visits also.

 

[Josephine]

I tell you this because I do believe I build adhesions easily and probably do need the MUA.

Unlikely. A frozen shoulder has nothing to do with adhesions, simply a stiff, painful set of ligaments/muscles.

My concern if they do recommend this, is how does the surgeon know it is adhesions that need to be broken up and not a muscle or ligament problem?

Well the simple answer is that he doesn't! But then neither will it be a muscle or ligament problem. It's much more likely to be as simple as swelling.

So based upon that, I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Doula1st]

Sure, I would be happy to.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[becticu]

Hi, I had my Lt knee done in March and the Rt in June. I had good flexion in the Lt at 135% when I had the Rt done 10 weeks later. I was finally able to get to 90% with the Rt but had a hard stop there. My Rt was totally different than the Lt. I did choose to have a MUA at 9 weeks post op because I had been out of work since March and it was August.

I am also a RN and had excellent STD (short term disability) but only for 6 months and I only had a month left. It is a difficult decision when work becomes an issue.

My pain after the MUA was not near as bad as the weeks following surgery. I had swelling afterwards and I did have pain but nothing awful. I went from 90 to 105 that afternoon at PT. My OS had me go the same day.

I had an amazing PT who was very protective of that knee and only did gentle stretching for weeks afterwards. 4 weeks post MUA I was at 131degrees. I went back part time at that time for a few weeks before I phased back full time. I was right at 12 weeks when I went back full time and I needed every bit of that time!

I'm not doing patient care so I don't have that wear and tear but have a very demanding job and I have done ok. My Rt knee still doesn't feel as good as the Lt but it's not as old! Everyone responds differently but my OS said he heard adhesions break loose and I had great results. Best wishes for whatever decision you make.


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[Pheebs52]

Hello Doula! At 9 week’s post op, I also had 90 degrees flexion and I broached the subject of an MUA with my surgeon. His take? Let’s wait and see what happens over the next few months. Now, at 5 months post-op, I have reached 110 degrees flexion. I’m “slow,” what can I say, but I also still swell, so this makes sense. Like you, I also feel as though there’s a solid wall somewhere blocking my flexion, but I have felt this from day one and my flexion does keep increasing very slowly.

Unlike you, I am retired, so didn’t feel any pressure to return to work with a super bendy knee. In other words, I had and have the luxury of time. As can be seen from other posts here, some people do very well with an MUA. It’s a tough choice to make but try to make it be your choice either way. Don’t get pressured into it by anyone. Go with your gut instinct. Best of luck with whatever you choose!





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[Josephine]

had excellent STD

@becticu what does STD stand for? The acronym in the UK I don't think you'd want to be associated with!

 

[becticu]

Oh dear @Josephine. I guess if one had a STD it would be good to have an excellent one as I so happily stated, lol. So let me re-phrase that. I had excellent short term disability at 100% pay while I was out of work.

 

[Josephine]

short term disability

Oh well that's better than the one I was referring to!

 

[Doula1st]

So, I have struggled significantly with this knee replacement. Full knee replacement was 8/15/17 and MUA was 10/30/17. PT 2-3 times a week.

I saw my surgeon today who said unfortunately I have a continued "Stiff knee". It is still quite painful and I still take hydrocodone around the clock. He discussed the fact that this condition is not common, but feels given my history of Adhesive Capsulitis I am prone to increased scar tissue. It may get better over the course of a year, or it may require a future surgery where they possibly replace the plastic piece in the joint to a smaller one to "make more room" for increased motion.

Very frustrated

 

[Pumpkin]

@Doula1st
You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.