MUA TKR on 1/25/23; facing MUA

[DEL2023Apr35]

Hello, all! I had a TKR on 1/25/23, and had a very terrible time of it regarding care at home, etc. for the first several weeks, so I definitely overdid it and caused more pain and swelling. Then, at 4 weeks post-op, my husband went in for a (somewhat) unexpected major surgery himself, and was in the hospital for 2 weeks. I was left completely alone here, to try and care for myself and the dogs. Then, when he was discharged, I had to care for him as well.

So here at nearly 9 weeks post-op, my ROM is barely 100, and it feels like there is a tight plastic webbing inside my knee preventing it from moving properly. Adhesions? No idea, but it feels that way. Not a lot of swelling. But not making any progress.

I took the initiative to ask my surgeon to schedule a MUA as soon as possible, as I'm sick of torturing myself several times a week at PT for no progress. Luckily my husband is making an amazing recovery and able to do more, so I'm not too terribly worried about going in for this procedure. I understand that I'll have a lot of pain afterwards, but it sounds like it's somewhat short-lived. The bone pain has nearly gone away, it's the soft tissue pain and the freaky nerve pain that has me bothered. Can anyone give me any encouragement? I've been so traumatized emotionally from all this: the horrible surgical pain, the abandonment in my time of need, and just trying to keep this train on the tracks if you know what I mean. Also: I live on a 10-acre farm and it's lambing season. Gah.

 

[Susie2023]

Hello! I had LTKR on 12/27. After a rough start, no reliable home care, swling was terrible and the area above the implant on the quad was so enlarged by the time I saw OS 10 dsys post op, I finally started outpatient PT on 1/17, faithfully going 3xweek, then down to 2xweek due to seelling and pain. I understood there would be swelling and pain so iced and elevated as much as possible. I had the "band" too but I think a lot of folks do. I had the stiffness and just a brick wall type blockage. Went to my OS 2/17 with concerns about ROM going backwards and pain. I also had a lot of nerve pain from the surgery. We decided to keep doing pt, more intensive. Against my better judgment, I pushed myself and was laid up for a week. I continued pt after that but not aggressively. And I was going backwards, ROM was 70 and I was in pain. My OS scheduled an MUA which I had on 3/21. I fretted so much about the anticipated pain and being pushed back more weeks. But the pain was increasing. Tomorrow will be 1 week from my mua. I think in my case, my doctor has been very good with pain management and that has helped me tremendously. I still have swelling and nerve pain but I can bend my knee now. I'm in pt, which has been better than I anticipated. The area above the implant still wants to thicken and gets very tight but I know what I need to do to help it. My pt works on that area too when I go in. I did experience pain and a bit of bruising where the anesthesiologist blocked my knee but that is starting to get better. I didn't experience a lot of calf or quad pain like I thought. I was already taking muscle relaxers so that may have helped. I am getting zingers and nerve pain probably from places I wasn't able to bend before. I got that after surgery and it was starting to go away, I expect this to get better too. I take gabapentin for the nerve pain. The back of my knee hurt a lot due to the manipulation, getting extension.

My ROM is much better now too. The OS was able to get 120+ during the procedure. My pt measured 106 last week, I was really happy about that. It will improve as the swelling goes down.

Some people have different experiences with this procedure for sure. I can't say yours will be like mine. I do wish you the best of luck. I felt like my life was given back to me. My mental health was starting to be affected.

 

[volLady]

Hello! I had LTKR on 12/27. After a rough start, no reliable home care, swling was terrible and the area above the implant on the quad was so enlarged by the time I saw OS 10 dsys post op, I finally started outpatient PT on 1/17, faithfully going 3xweek, then down to 2xweek due to seelling and pain. I understood there would be swelling and pain so iced and elevated as much as possible. I had the "band" too but I think a lot of folks do. I had the stiffness and just a brick wall type blockage. Went to my OS 2/17 with concerns about ROM going backwards and pain. I also had a lot of nerve pain from the surgery. We decided to keep doing pt, more intensive. Against my better judgment, I pushed myself and was laid up for a week. I continued pt after that but not aggressively. And I was going backwards, ROM was 70 and I was in pain. My OS scheduled an MUA which I had on 3/21. I fretted so much about the anticipated pain and being pushed back more weeks. But the pain was increasing. Tomorrow will be 1 week from my mua. I think in my case, my doctor has been very good with pain management and that has helped me tremendously. I still have swelling and nerve pain but I can bend my knee now. I'm in pt, which has been better than I anticipated. The area above the implant still wants to thicken and gets very tight but I know what I need to do to help it. My pt works on that area too when I go in. I did experience pain and a bit of bruising where the anesthesiologist blocked my knee but that is starting to get better. I didn't experience a lot of calf or quad pain like I thought. I was already taking muscle relaxers so that may have helped. I am getting zingers and nerve pain probably from places I wasn't able to bend before. I got that after surgery and it was starting to go away, I expect this to get better too. I take gabapentin for the nerve pain. The back of my knee hurt a lot due to the manipulation, getting extension.

My ROM is much better now too. The OS was able to get 120+ during the procedure. My pt measured 106 last week, I was really happy about that. It will improve as the swelling goes down.

Some people have different experiences with this procedure for sure. I can't say yours will be like mine. I do wish you the best of luck. I felt like my life was given back to me. My mental health was starting to be affected.

you will get better after the MUA. what you are experiencing right now afterwards is normal. Bruising and lots of swelling is to be expected to. Remember pushing, shoving,bending and more pushing will cause more trauma to the knee has well. I had a MUA 3 wks ago and thought I was going to die afterwards. My ROM now is at 119 and it will get better but be gentle and don't let PT shove you to pain. You are having more bruising right now. I was released 2day from my OS at 3 months with no PT because my ROM was good, anything over 100 after a MUA is good, that is what he said but he did admit that it takes 6 months to a year sometimes for people to heal and get better ROM'S. That made me feel better because I was beginning to feel like I was a failure in trying... Restive or use a heating pad on the thigh area or hamstring but never on the knee/incision area and it will make them calm down and also helps with the zingers too. The tightness you are feeling is probably the IT Band. That is normal to but it gets stressed to like everything else is...... hugs to you and recovery!

 

[DEL2023Apr35]

Hello! I had LTKR on 12/27. After a rough start, no reliable home care, swling was terrible and the area above the implant on the quad was so enlarged by the time I saw OS 10 dsys post op, I finally started outpatient PT on 1/17, faithfully going 3xweek, then down to 2xweek due to seelling and pain. I understood there would be swelling and pain so iced and elevated as much as possible. I had the "band" too but I think a lot of folks do. I had the stiffness and just a brick wall type blockage. Went to my OS 2/17 with concerns about ROM going backwards and pain. I also had a lot of nerve pain from the surgery. We decided to keep doing pt, more intensive. Against my better judgment, I pushed myself and was laid up for a week. I continued pt after that but not aggressively. And I was going backwards, ROM was 70 and I was in pain. My OS scheduled an MUA which I had on 3/21. I fretted so much about the anticipated pain and being pushed back more weeks. But the pain was increasing. Tomorrow will be 1 week from my mua. I think in my case, my doctor has been very good with pain management and that has helped me tremendously. I still have swelling and nerve pain but I can bend my knee now. I'm in pt, which has been better than I anticipated. The area above the implant still wants to thicken and gets very tight but I know what I need to do to help it. My pt works on that area too when I go in. I did experience pain and a bit of bruising where the anesthesiologist blocked my knee but that is starting to get better. I didn't experience a lot of calf or quad pain like I thought. I was already taking muscle relaxers so that may have helped. I am getting zingers and nerve pain probably from places I wasn't able to bend before. I got that after surgery and it was starting to go away, I expect this to get better too. I take gabapentin for the nerve pain. The back of my knee hurt a lot due to the manipulation, getting extension.

My ROM is much better now too. The OS was able to get 120+ during the procedure. My pt measured 106 last week, I was really happy about that. It will improve as the swelling goes down.

Some people have different experiences with this procedure for sure. I can't say yours will be like mine. I do wish you the best of luck. I felt like my life was given back to me. My mental health was starting to be affected.

Hi Susie2023 -- I too have a OS who has been very supportive with pain management. I know some doctors don't like to prescribe narcotic pain meds for very long, but my doc knows my situation, that my husband was ill, and that I live on a farm. It is encouraging to hear that you're doing well after your MUA. I have that 'brick wall' feeling, too, of not being able to budge, and not just because of the pain. It feels like an impediment in there wrapped around my knee. I've been reading tons of posts here, and it makes me sad to hear how so many, including me, have gone more than a little bananas from this process. I just wish I stumbled upon this site prior to surgery, so that I could know what I was really in for - so many websites gloss over the horrors of it all.

 

[benne68]

Welcome to BoneSmart

Even though your surgery was 2 months ago, 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.

Just keep in mind we are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

KNEE RECOVERY 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.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

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
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.

 

[benne68]

Also, please let us know if it was your left or right knee so we can create an accurate signature for you.

 

[DEL2023Apr35]

Also, please let us know if it was your left or right knee so we can create an accurate signature for you.

Hello, so sorry, it's my left knee.

 

[Jaycey]

My suggestion is that you don't go for MUA. Your ROM will increase naturally as you continue with daily living. If you have MUA you will begin the same process all over again.

And no need for PT torture. Gentle bends and regular walks is all that is needed.

Have you tried ice and elevation? Ice for 45-60 minutes several times per day.

 

[DEL2023Apr35]

My suggestion is that you don't go for MUA. Your ROM will increase naturally as you continue with daily living. If you have MUA you will begin the same process all over again.

And no need for PT torture. Gentle bends and regular walks is all that is needed.

Have you tried ice and elevation? Ice for 45-60 minutes several times per day.

Thank you for your advice, but my 'daily living' is vastly different from most people's (I run a farm), and I need to have proper range of motion sooner than later, that just won't be had puttering about the garden for a few weeks. And yes, ice and elevation have been my life the past 2 months.

I understand that MUA isn't for everyone. Frankly, it's not for me, either, but as things are now, I don't see any other option but to use the MUA to catapult me forward into a proper recovery.

 

[Susie2023]

I, too, did not want an MUA. Period. I exhausted all my insurance covered pt sessions while giving pt another month, willing to take the time needed to get enough flexion to just do ADL's! I live on a small farm. I don't have livestock to care for but do have a horse and small pets that are in my charge. My poor husband has had to shoulder all responsibilities, even the horse since 12/27. He has taken off so much time too. When my flexion started going backwards and I began to experience a lot of pain, my mind changed about getting an mua. It was not my first choice. I just figured I was a slow healer.

 

[Jaycey]

but my 'daily living' is vastly different from most people's (I run a farm

I fully understand. Up until this time last year I too ran a farm. The activities in doing this should provide plenty of opportunities to work on ROM. However, nothing is going decrease the time your knee requires to get that increase.

I don't see any other option but to use the MUA to catapult me forward into a proper recovery.

There are no guarantees that MUA will shorten your recovery time so please reconsider this if you are assuming this.

The decision is yours of course. You might want to read a few threads in the knee recovery area with MUA prefix.

 

[DEL2023Apr35]

I, too, did not want an MUA. Period. I exhausted all my insurance covered pt sessions while giving pt another month, willing to take the time needed to get enough flexion to just do ADL's! I live on a small farm. I don't have livestock to care for but do have a horse and small pets that are in my charge. My poor husband has had to shoulder all responsibilities, even the horse since 12/27. He has taken off so much time too. When my flexion started going backwards and I began to experience a lot of pain, my mind changed about getting an mua. It was not my first choice. I just figured I was a slow healer.

Totally not my first choice, either! Just last week I told my PT that I wanted to 'work really hard' in PT to get more flexion, as I wanted to avoid MUA at all costs. But over the weekend I did some thinking, and realized that was an emotional response, and not a sensible one. I'm not making any progress at all in PT. It feels like an unbreakable plastic web has encased my knee. I don't have the fortitude to push through ::whatever that is:: to get a few degrees more. I have been off track in my healing since I came home from the hospital (long horrible story), and I'm sick of wasting my time and the shreds of mental stability I have left. Sure, there are no guarantees. But I'll take the choice that has a 'probable' good outcome, as opposed to this one, where I'm just immovably stuck.

I do so envy the people who, after surgery, are in wretched pain like the rest of us, but for whatever reason, are 'easy healers' and don't struggle terribly with ROM issues. They just heal in baby steps as expected, and eureka, by week 8, they are feeling good physically and have their sights set on other things, and see a way out of all this. For me, now, this knee is the center of my universe, and I've absolutely had it.

 

[JusticeRider]

I have a farm as well and ride horses. So I totally understand your concern and your desire to heal faster. Just know that regardless of what you do, it is most likely going to take a year to heal. Your knee will continue to be the center of your universe for probably 6 more months, or thereabouts. Just be aware that the MUA isn’t going to somehow make you heal in 8 weeks.

Moderators please do correct me if I’m wrong on anything.

You may be inhibited by adhesions although it is uncommon. If that’s the case, a MUA could help you gain more ROM. You may be inhibited by swelling (more common). If that’s the case a MUA could decrease your ROM by making the swelling worse. You will also be set back in your healing process to the date of your MUA (basically starting over again on healing). Unfortunately there’s no way to know if it is swelling or adhesions restricting you.

I was very restricted in my ROM for quite a while. I had prolonged swelling. As soon as the swelling eased, my ROM began to improve. That tells me that in my case, it was swelling restricting me. That tells me that a MUA would have made me worse instead of better.

Again, I don’t know which is the case for you, and I’m not telling you what you should or shouldn’t do. I just couldn’t in good conscience not try to help you prepare for the possibilities. I personally find that helps my mental health. So I’m going to tell you what I wish someone had told me: this is a long dang recovery, and there’s no way to get around it. As for the MUA, it may or may not be a help along the way.

I wish you all the best with your farm! And best of luck in your healing journey.

 

[DEL2023Apr35]

Just had X-rays done, and OP said they looked great, and MUA will be scheduled for next week.

I have very little swelling in my knee, except for when I've been on it for a bit, and even then, it's not much at all. I do understand that this is a long recovery. But there is a difference between a long recovery, and recovery stopped in its tracks.

@JusticeRider - an MUA will not set me back in my healing process to the date of the MUA. Not having an incision made, not having bones cut, not having bones drilled, not having a prosthesis hammered into my bones, not having layers of tissue stitched up. Will it hurt afterwards? Yes! But I'm not pain averse. I'm stagnation averse, and I don't want to wait around for (fill in some random amount of time here) to pass and realize I'm totally screwed and have lost the opportunity to get some real flexion again.

I have chosen to do this MUA based on my particular medical situation, my particular healing, and my particular set of circumstances. I understand its not for everyone. But I'm giving it a try, since nothing else is helping.

 

[sistersinhim]

an MUA will not set me back in my healing process to the date of the MUA.

In my years on the Bonesmart staff, I have learned that if a member does not have adhesions and has a MUA, this does set the recovery time back to the date of the MUA. At 2 months out from surgery, the knee is healed on the outside, but a far cry from healed on the inside. Forcing these healing tissues inside to bend farther than they are healed enough to be causes extra inflammation. This causes extra pain and swelling. These newly inflamed and stretched baby tissues have to begin to heal from that forced bending. If a knee truly does have adhesions, then the forced bending of the knee breaks through those stuck-together tissues. The OS can feel when those adhesions are broken up and he doesn't have to force the knee past that point.

Since you are having the MUA, I hope you do have adhesions and that this surgery will improve your bend. I know what it is like having to take care of things in your daily life. At the time of my TKR, I was alone and had to take care of my house, yard, myself, and 13 rescued kitties. It was rough, but, with God's help, I did it. You will, too!

 

[DEL2023Apr35]

The singular idea that having an MUA (with or without adhesions) sets the recovery date back to the MUA is absurd and simply not true. There are no incisions. No bone cutting. Et cetera. Where does this false science come from? just because it's repeated a dozen times doesn't make it true. It doesn't even make sense.

No one denies the fact that a MUA will cause pain and swelling, but to assert that it boomerangs the healing process all the way back to the beginning of the surgical process is bad medicine, and unnecessarily frightening. Also, it's just not true.

 

[MarkTKR]

Not a physician, nor a PT, just a guy with a LTKR followed in 2 weeks by a ruptured patella tendon requiring a second surgery and a very long recovery period.

I would strongly advocate against a MUA (I had to look that one up). When I was finally out of the cast after the patella tendon repair, keep in mind this was on top of a TKR in the same knee, I took a bad step off a small 5 inch step and as I started to fall I started to try to use my new knee and tendon and felt a very definite pop. This time in my quad muscle.

As I lay there on the floor I thought, oh , ruptured the tendon again, another surgery, 8 weeks in a cast, I was freaking out. I rolled over and carefully tried to move my knee/leg and it responded. When I first ruptured the tendon I could not move it at all.

I got up and was able to walk but there was a lot of pain in my quad muscle. But seeing that I had made the stupid step I toughed it out. I got to PT a day or so later and told the PT about the accident, he just laughed and said you just did your own MWA. Manipulation Without Anesthesia. He said it would would be highly unlikely I could damage the new tendon.

However, for the next 2-3 weeks my quad muscle was just painful as could be. It actually hindered my recovery because it caused swelling and decreased my ROM until the swelling went down. When I did the MWA I had a ROM of only about 80 degrees. I kind of stayed there for a while instead of making more progress until things kind of healed.

Anyway, I know your situation is probably motivating you towards the MUA, but you may actually delay your recovery if you do undergo the MUA. But again, I am on the outside looking in.

 

[DEL2023Apr35]

@MarkTKR what a dreadful run of luck for you, I do hope you're feeling better! Falling and injuring oneself is rather unlike a MUA, but thank you for your comment. Very much hoping you've recovered from such a nasty spill!

 

[Jamie]

The singular idea that having an MUA (with or without adhesions) sets the recovery date back to the MUA is absurd and simply not true. There are no incisions. No bone cutting. Et cetera. Where does this false science come from? just because it's repeated a dozen times doesn't make it true. It doesn't even make sense.

No one denies the fact that a MUA will cause pain and swelling, but to assert that it boomerangs the healing process all the way back to the beginning of the surgical process is bad medicine, and unnecessarily frightening. Also, it's just not true.

I think you're misunderstanding what is being said about the possibility that an MUA may set you back in your recovery. Of course, you're correct that you won't have an incision and bones that need to heal. Those do take time and are not what people are referring to that must start healing all over again when a manipulation is done. It's the soft tissue that will be traumatized in the process and it can be pretty severe. I hope you are reading those recovery links that were posted above for you. In there you'll find this recovery chart that illustrates what people are trying to tell you. Depending on how your surgeon manipulates your leg during the procedure, you'll be impacted in the areas reflected in numbers 2, 3, 4, 5, 10, and 11. This is all soft tissue that can undergo severe stretching during an MUA.

This is by all means NOT a gentle procedure. It is possible that your soft tissue recovery will be set back from the trauma. This can be especially true for people who don't actually have adhesions and their ROM restrictions are more due to inflammation and swelling. Even though you don't see any swelling on the outside, the knee compartment is very compact, and it doesn't take much fluid to cause the type of problems you are describing. If this is the case, those already-angry tissues won't be happy to be forced into a series of bends and stretches and will let you know it afterwards.

Based on your description of your activity levels since your surgery, it is possible that you do have swelling that is inhibiting your range of motion and not adhesions. Granted there are people who have an MUA and recover from it without much delay to their overall recovery. Everyone is different in their response to the procedure. But there are certainly a lot of people we've seen over the years who go into the procedure thinking their knee will hurt for a few days and then they'll be right back on track again for a return to normal activity. We would be doing you a disservice not to advise you that this may not be the case for you. An MUA can set your recovery back at least 3-4 weeks, if not more.

I'm sorry that you didn't have a clear understanding of what recovery from a knee replacement can involve prior to surgery. Unfortunately, this is quite common and one of the reasons BoneSmart exists. No one is back to "normal" at just a couple of months. People are mobile immediately after surgery, but the progress to a normal strength and activity level takes much longer than I think you believe it should. Your body is in charge and there is nothing you can do to "hurry things up." In fact, the harder a person "works" at recovery, the longer it can take.

I sincerely hope the MUA you have scheduled helps you. But please also consider this may not be the case and be prepared with a plan for the weeks and months after the procedure if you are not "catapulted into a normal recovery." Try brainstorming ways to get help with your animals if needed. There surely are friends, neighbors, family members, teenagers in the area, church "family," or others that can assist you for a short time while you are unable to operate at full speed. It's okay to lean on those people that can help and who care about you.

All the best to you and we'll be here to support you if you need us following the procedure. I'll look forward to hearing from you once you're back home again.

 

[DEL2023Apr35]

I have not had much swelling after surgery, something my OS confirmed at last visit. My PT told me that even if he had the opportunity beforehand to tell me about all the ins and outs of knee surgery, I still wouldn't have a complete understanding of the healing process, because it's impossible to really describe the wretched level of pain, even if you have an intellectual preparation for it, and the fact that people experience the procedure very differently.

Of course nothing is a sure thing, and people in a terrible state can do very well with a MUA, and people who are doing better can have a botched experience. This is one instance where the devil you know is not better than the devil you don't. I know where I am now, and it's stuck in a block of concrete. Whether I have a smooth recovery with little pain and spectacular flexion, or a rocky one with ups and downs, either outcome is better than what I've got now.

I do wish that there wasn't so much dumping on the MUA procedure on this site, as clearly some folks have had a really good response to it, and how wonderful for them! I'm hoping I'm in that group, but even if not, getting my knee bent and unblocked will be terrific. Having a nerve block in my knee will be terrific. Going to PT every day to keep my knee moving, after a good bend under anesthesia, will be terrific. Will it hurt like hell? Probably, but it hurts now, with ZERO PROGRESS AT 9 WEEKS. So unless they accidentally remove the leg while I'm under, I don't imagine a worse longterm situation on the other side of it.