TKR TKR Progress

[benne68]

Hi @Odieodell -- It is very possible that the reason you are "stuck" is that you are doing too much. Just because you don't see external swelling doesn't mean there isn't inflammation inside the knee. Inflammation is the biggest impediment to your flexion. Here's a good article about this:

Swollen and stiff knee: what causes it?

One word - fluid! Swelling is fluid in the tissues and is a perfectly normal reaction to trauma - anything from hitting your thumb with a hammer, twisting your ankle or have a knee replacement! All of those will cause the body to send blood to the area to protect and start the healing process...

bonesmart.org

I’m guessing the surgeon may suggest MUA and I was initially thinking no to that, but now I am unsure about declining that.

With a bend of 95 already, It is awfully early in your recovery for you to be considering an MUA. We have many members whose ROM has returned slowly -- but even in those cases, it DOES return. Here are a couple of their timelines that might be helpful for you to see.

Campervan’s ROM history
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months and still this now at 1yr 10 months

Bertschb’s ROM history
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

 

[Jockette]

I’m a little disappointed since I have been quite active and have even golfed 9 holes four times since last week.

How much walking does this entail? As much as it seems you love golf, maybe you should consider dialing it back a bit, until you heal more. Remember, recovery is temporary. I was a bowler at the time of my recovery. I waited until 3 months post op to start back to bowling, and over the next 3 months built my time up gradually for when our league started up again, when I would have to bowl 3 games.

I want to believe my ROM will continue to improve over time as many others have stated will happen as my knee heals. Am I being realistic about that with a stall in my ROM after 3 weeks?

Yes, your ROM will improve. Mine continued to improve well into my second year, after 2 major setbacks in my first year, one at 4 months (a weekend away with friends) and then another one at 5 months (my son’s out of town wedding weekend) becuase I totally overdid things. After each of these times my ROM dropped back to 90-ish. I couldn‘t see much swelling, but my whole leg got really tight. I don‘t recommend pushing the activities this early in recovery as it can stall your recovery, like you are going through now, and that can cause a lot of stress.

 

[BBCG]

Hi @Odieodell, I also was threatened with a MUA, too, which I declined at 3 months because my ROM wasn't to the level my surgeon wanted, and indeed, when I backed off on my activity level and was "lazier"(!), my ROM did slowly improve. By my 6 month visit I had excellent ROM of about 120, so no further mention was made about a MUA.

The thing about it is, ROM is not improved by much except for those things that decrease internal swelling. Your external swelling might not be much, but if your ROM isn't where you want, it may be swollen internally... and a MUA isn't going to help that, but will only re-start the clock all over again since it's so much force on the soft tissues inside your leg.

In my experience, waiting to do a MUA until you give your knee time...not extra work but time... makes sense, as long as you understand certain things. Some doctors and staff may tell you there is a timeline that you have to have ROM of a certain level by a certain date or "you'll never get any better ROM"... that's a myth many of us here have proven is false!

I am a "sweller", too, both externally and internally, so I just heal slower. I learned that with TKR #1, so I was much more confident by TKR #2, knowing I would indeed heal, and my knee would take it's sweet time and just be fine if I left it alone!

Good luck with your appointment tomorrow -- I'll be thinking of you!

 

[Odieodell]

With a bend of 95 already, It is awfully early in your recovery for you to be considering an MUA.

Thank you for this information and reassurance. My knee feels so good when walking. Just not when bending it beyond 95 degees. I do still have some swelling. I measured both knees and my surgical knee is two inches bigger diameter than the non-surgical knee, so it does make sense the ROM is going to be limited.

I read this quote from someone on BoneSmart and it has stuck with me: “If the knee isn’t ready, the knee will push back and the knee will win every time.”

 

[Odieodell]

How much walking does this entail?

We do ride a golf cart, so really not too much walking. I love being outside and I’m not one to sit around, so I have been planting flowers too. The doctor encouraged walking and the knee feels so good 90% of the time. Sometimes I now call it my good knee! I’m sure everyone is right that my activity level is why I still have swelling, but it’s going to swell until it’s fully healed which I understand may take a full year or more. So as long as my daily activities don’t cause me pain, I consider them therapeutic PT.

 

[Odieodell]

I also was threatened with a MUA, too, which I declined at 3 months because my ROM wasn't to the level my surgeon wanted, and indeed, when I backed off on my activity level and was "lazier"(!), my ROM did slowly improve. By my 6 month visit I had excellent ROM of about 120, so no further mention was made about a MUA.

Thank you, thank you for this reassurance.

 

[sistersinhim]

So as long as my daily activities don’t cause me pain, I consider them therapeutic PT.

That is so true.

 

[Odieodell]

I saw my surgeon today and he is wanting to do a MUA. He said I have an area above the knee that has scar tissue. It’s a very small area and it is the area that can be painful during PT. He wants to schedule it for next week. I’m tempted to have it done since it is a small area, However, I have done some PT with a looped strap over my foot that I pull up over my back towards my head while laying on my stomach that really stretches this area without a lot of pain while doing it. Plus, the bike pedaling can challenge it too. Am I crazy to consider the MUA since it is such a small area? He, of course, said it would speed up my ROM.

 

[benne68]

Hi @Odieodell Less than 2 months post-op seems kind of early for an MUA -- especially since your flexion is already past 90 degrees. You might want to give it another month to see if your flexion continues to improve on its own.

This article provides a bit more information on MUAs and might be helpful as you make your decision:

MUA (Manipulation under Anaesthetic) and adhesions

First let me first put your mind at rest - this is quite probably nothing to do with not having done enough PT or been 'good enough' in following orders. Here is my standard mini-lecture on the subject so read and absorb ... All the structures in the body, muscles, tendons, ligaments, even gut...

bonesmart.org

Good luck, whatever you decide, and keep us posted.

 

[Odieodell]

I spoke to my chiropractor and he definitely recommended waiting until at least 12 weeks before considering a MUA, so I am going to cancel the appointment scheduled for next week. I read the following on the surgeons report today too which is another reason I want to wait:

Good grief!

LEFT KNEE Manipulation. Potential
surgical risks and complications include but are not limited to DVT, infection, neurovascular injury, fracture, Implant wear, failure, possible need for revision surgery, loss of motion, dislocation, limb
length changes.

 

[Jockette]

Wow. And not a good wow!

He, of course, said it would speed up my ROM.

It will only “speed up your ROM” if you have a true adhesion, which is different from scar tissue.

If no adhesion, it won’t make much difference, and you will need a recovery period after the MUA. Some doctors are too quick to recommend this procedure, when patience and being careful with your activities early in recovery, and time to heal, are all that is needed.

 

[Jockette]

It does seem that many MUAs are done before 12 weeks, but that is becuase many surgeons are not patient enough to let each patient recover on their own timeframe. MUAs can be done much later. We’ve had members who had them later with success, and there is no window of opportunity to improve ROM.

At not quite 2 months post op you still have a lot of healing to do. I would not have the MUA done now just because of a small spot of ”scar tissue.” This spot will most likely lessen with time and be fine.

 

[Odieodell]

It does seem that many MUAs are done before 12 weeks, but that is becuase many surgeons are not patient enough to let each patient recover on their own timeframe.

@Jockette I think you are spot on with this comment. As I previously mentioned my surgical knee is two inches larger than my other knee. I can feel the swelling when I try to bend it and honestly fear the MUA would set me back and I don’t think there are any guarantees that this scar tissue wouldn’t come back or that I would have more. I’ve also read where massaging can help breakup scar tissue. I’ve definitely decided I’m going to let it heal, even longer than 12 weeks, if I still have swelling at that time.

 

[Odieodell]

My chiropractor may not be a surgeon, but he has performed many knee MUAs for surgeons. I’ve seen him since I had my surgery and he was impressed how well I was doing at the 4 week mark. I trust him. I still have swelling and as you mention, I’d rather have arthroscopic down the road than for him to use brute force on my entire knee now for one small spot of scar tissue.

 

[Jockette]

This early in recovery, the scar tissue you have is not a problem. It’s a normal part of recovery.

Also, this early in recovery, your swelling is limiting your bend. This is also normal. Swelling is par for the course, as a reaction to all the trauma your soft tissues received during the surgery. Treat your knee gently, don’t overwork and keep a balance of rest and activity. When you rest, don’t look at it as doing nothing, look at it as giving your knee the best opportunity to heal.

 

[FCBayern]

I’m a little disappointed since I have been quite active and have even golfed 9 holes four times since last week. I want to believe my ROM will continue to improve over time as many others have stated will happen as my knee heals.

Your level of activity may be slowing your increase of ROM. You are still VERY early in recovery and all the activity will cause swelling that limits your ROM. Maybe try taking it a little easier and keep icing and elevating, you just might find your ROM suddenly improves when the internal swelling goes down.

 

[Odieodell]

I canceled the appointment for the MUA next week and I feel good about my decision. Many thanks to BoneSmart members for reminding me that I simply need more time to heal. With an already swollen knee it makes no sense to force my knee to bend. At 7 weeks my knee feels pretty darn fabulous. I played my first 18 hole round of golf today. My ankle is no longer swelling either. Honestly, it is the best form of PT!

 

[benne68]

Good for you, @Odieodell ! It's your knee and your recovery -- and only you can decide what's right for you.

 

[sistersinhim]

You are in control and you know what's best for you and your knee! Good job taking care of yourself and your knee.

 

[Odieodell]

I decided to end my PT today. I’m still stuck at a 95 flexion and -15 extension. Soft tissue surrounding the knee is still sore and I continue to have swelling. I’m just going to give it time to heal and continue icing it in the evenings.

I was told along time ago that I had a Baker’s Cyst behind this knee and I’m wondering if I may still have it since many bending exercises during PT hurt behind the knee. Do they ever go away on their own and if not could my TKR have caused mine to flare up? Anyone else deal with one of these and have suggestions that may help?

I had 120 degree flexion before surgery and I’m praying I will get back to that or better.