MUA Still only 75 degree bend at 23 weeks

[Jo10221]

Hi, I really need some help and hope. I had a knee replacement on 8th Jan 2019 and struggled with getting bend. I had an MUA on 25th June 2019 and it has not helped. I am having hydrotherapy, I use a constant passive movement machine, I do all the exercises given to me at physio.

I work so hard and each week I lose bend. After the MUA I came home with a 95 degree bend, 2 weeks later I am at 74 degrees. I am told it is a tight joint and has adhesions and scar tissue that causes me the problem. I am losing hope and in so much pain.

All that seems to be ahead of me is a second MUA or keyhole surgery to laser the adhesions and scar tissue. I have looked them up on the internet and the results don't seem very good for either procedure. Can anyone help me?

 

[Jockette]

Hi and Welcome to Bonesmart.

I’m sorry that you still have poor ROM and so much pain. I am going to tag @Josephine, our forum administrator and nurse director, to come and advise you.

can anyone help me ?

To be honest I think your medical professionals have overworked you and your poor knee has never had a chance to relax and recover.

What you’ve been doing hasn't worked, why not try BoneSmart’s gentle approach to recovery. Take a rest from all that hard work on ROM and give your knee/leg gentle treatment and a good rest so it can settle down.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

Oral And Intravenous Pain Medications
Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[winemama]

Take a breath, I agree, your poor knee has not had a chance to rest. Read the forum, answer the questions. Good luck, everyone is here for you, there is no stupid question

 

[mainegirl1]

Sounds like your knee needs a rest! Sometimes we have to stop doing what isn't working. Hard work is for after healing and that takes rest
Think of it as working smarter not harder.
I'll betcha its not scar tissue but swelling!
Hard to bend anything thats swollen
Were here for you with ice packs and elevation pillows
I did get into the pool with warm water early
My knee said. Swell!
I waited three months to do that again!
That Time it Was Swell and the knee was happy

 

[Josephine]

To start with, 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?

 

[Irish471]

@Jo10221 , what was your flexion prior to surgery? Josephine will have great advice for you! I agree with the others. Sometimes we overdo it and never really give the knee a chance to heal. I took 2 weeks off from PT recently and I gained 3 degrees flexion. It's definitely worth a try!

 

[sistersinhim]

Working your knee hard has kept it inflamed and swollen. A swollen knee won't bend well. A new knee needs to heal before doing a lot of exercises. Just gentle bending. Many of us never took formal PT or did exercises. I am one of them. I had 11 knee surgeries, 2 of them kneecap removals and 1 tkr. Even after those I never took PT. But, I didn't just sit around and do nothing. I took care of myself, my house and yard as my knee allowed me to do. As I healed, I did more. But, my knee was always in control. This was enough therapy for me and would be for any tkr patient. All the awful pain of PT is so unnecessary.

All you have to do is use it in your daily living. Your knee knows how to rehab itself and doesn't need anyone telling it how. Just use it and it will come back like new. You have to be patient, though, it doesn't happen quickly. ADL,(activities of daily living), going to the bathroom, brushing your teeth and bathing, fixing a light meal, getting something to drink and or a snack, those kinds of things will be all the exercise your knee needs. If you just use it daily in your living, you can have a less painful recovery. We know what works, we've been there.

 

[Relle]

I have been very slow getting my ROM back after my knee replacement March 2018. I too had an MUA which helped a little but I was only at 65 before it. Since then I have been gentle exercises and stretches and very slowly my ROM is increasing. My OS told me that I can continue to improve for at least 2 years which is what is happening. Don't give up, for me it is just taking more time.

 

[Jockette]

My OS told me that I can continue to improve for at least 2 years which is what is happening. Don't give up, for me it is just taking more time.

My ROM not only improved after my one year anniversary, it has improved since my second anniversary.

 

[Rockgirl4]

I agree with the others and had a very similar experience in 2016 with inflaming an already swollen knee that would NOT bend. The MUA may have increased your bend, but continuing to beat it up daily with aggressive PT and repetitive bending is just going to exacerbate the problem. Even with scar-tissue surgery and an MUA, I made loads of scar tissue again that my TKR surgeon spent an hour removing during my TKR---all because of months of aggresive PT, which I bought into because of the scar tissue fear-mongering.

My new surgeon just did my TKR and insisted we do no strength training for 8-10 wks. I was also allowed only 5 minutes of repetitive bending---and only once a day . FOr the first 6 wks, I spent 5 mins a day rocking back and forth on the bike pedals because I couldn't get all the way around yet. Even now at 7 wks, knowing I can get all the way around on my bike, I'm only to ride the bike for 10-15 minutes, and still just once a day. It has worked wonderfully, and my knee isn't angry all of the time. My bend came back slowly as the inflammation/swelling went down.

People also can't believe it when I tell this this time I did NO home exercises, no CPM machine, and most important of all----NO ONE was allowed to force my knee to bend or straighten, per Dr's orders (and my own!). I did that before with disasterous results...now I've proven the gentle Bonesmart way is superior!!!

Last but not least----My surgeon says he's tired of fixing problems created by outdated PT protocols and aggressive PT. He often tells people at the 4 wk post-op visit that no PT is better than aggressive PT, and he even had me back off some things. He wishes PTs and surgeons would recognize current research and keep up with things, but sadly, many refuse to change or won't take the time to change.

 

[eaglemom]

I'm going to echo what the other's have said, you and your knee need rest. I didn't see it mentioned, but even if your knee doesn't appear to be outwardly swollen, it can be internally. Elevation and ice need to be your constant companions, along with ADL's.

I'm about a month behind you with a revision. It's not where I want it to be but patience will win out. No one heals on a schedule. Hang in there.