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TKR too soon for MUA?

The PTs so far have looked disapprovingly at my walker like it’s a crutch I need to be weaned off of so I appreciate your full throated support of walkers!

It looks like we were both typing at the same time- I was editing my post at the same time you were replying. Oops.

Had edited out question about buckling because found a good video about it but it’s much better to have confirmation from you that it’s normal! Asked about Meloxicam because of the possibility it interferes with healing in cementless surgery - will check with surgeon.
 
Last week I canceled today’s MUA and yesterday I canceled all my upcoming outpatient PT appointments. I had just started with new PT but realized she has no clue about the time needed for surgical healing from TKR. She’s treating me like a healthy perdon who hasn’t had major surgery and who just needs to boost strength. My quads are now angry and weaker. After I saw her and the surgeon last week I was back to limping. It took days to get the pain and swelling at least back to where they were before the visits. This morning for the first time the swelling is low enough that I can feel by touch something on each side of the underside my knee - don’t know what they are - ligaments? tendons? bone? Have no idea but seems like a good thing they are no longer submerged by swelling?
 
Hello and Happy Tuesday!
I am guessing you won't regret your decision. Glad to read that with rest and ice you're feeling back to "your current normal" again, which will keep evolving. The buckling happens with many due to the trauma to the soft tissue, muscles and ligaments during surgery and it will ease with time. Use an assistive device for stability for as long as you feel the need. I hope you have a good week, russny.
@russny
 
I also took the path of canceling PT sessions when they were clearly counterproductive.

Rest, ice, elevation, walking as tolerated, increasing my activities in home, garden, and community as tolerated at my own pace. I did a few select exercises that seemed to benefit my body, but never all at once, and never even counting repetitions - just working them into my own daily routine.

No regrets - my "younger" new knee is approaching it's one year birthday and I'm in way better shape than I was before surgery!
 
I took no formal PT at all, just natural PT, doing my daily living activities. I was alone most of the time, so I had to take care of the house, yard, and 13 rescued kitties. I had a great recovery, though some days were spent in the ODIC, (overdid it club). When this happened, I stopped all unnecessary chores then iced, elevated, and rested until my knee calmed back down. I, and many others on here, are proof that formal PT is not necessary. Bad PT is worse than no PT. What a joint recovery PT should include are gentle movements and working on gait. As the swelling goes down, the ROM naturally improves. If your knee wouldn't bend appropriately during your surgery, then your surgeon wouldn't have rolled you out of the theater into recovery. Time is the key, not aggressive exercises.
 
It’s so great to have this support! The rush to MUA was especially risky because I have nobody at home to help. Even successful MUAs can cause a lot of pain in the first week. For the TKR I was hospitalized 4 nights then transferred to inpatient rehab for seven days. So eleven days to heal before having to fend for myself. No such plan for MUAs.
 
I’ve been trying to buy time to heal naturally before resorting to an MUA. I thought I had 12 weeks but the doctor’s PA says he won’t do one after eight weeks. Also said that if I decided after the eight weeks were up that I wanted an MUA, no doc would agree to do it. PA claims no doc is willing to do an MUA unless they are the surgeon who did the TKR. Is this true? Has anybody been able to get an MUA from a doc who did Not do the TKR?
 
russny said:
Also said that if I decided after the eight weeks were up that I wanted an MUA, no doc would agree to do it.
Click to expand...
That's simply untrue. We have lots of members who have had MUAs well beyond 8 weeks post-op!
I think the PA is trying to scare you into agreeing to have the procedure, which is completely unprofessional.

There is NO time limit on regaining ROM. While your range of motion is currently limited, it will naturally continue to increase as the swelling subsides and the pain eases. Please give it time.

Here is a link to threads of this that experienced Manipulation Under Anesthesia -
MUA
Hopefully you'll hear from someone that had the procedure. I will leave a few articles also, if interested.
MUA (Manipulation under Anaesthetic) and Adhesions
MUA for Stiffness Following TKR
MUA: the ineffectiveness of early MUA (JBJS)
MUA: Who is more likely to need an MUA after TKR?

Remember: this is your knee and your recovery. Don't let the PA bully you into doing something you don't want to do. It is your decision to make.
 
Thanks. She didn't say no doc would refuse to do it after 8 weeks. She said they would refuse to do an a MUA on a patient who had received their TKR from somebody else.
 
Yes, few surgeons will even see a patient for a second opinion until they are at least one-year post surgery.

That said, she is absolutely wrong about the 8 week time limit.

According to the American Academy of Orthopedic Surgeons:

" Studies have shown that performing an MUA within 3 months after surgery is the ideal time with the best outcomes... You can still have an MUA after 3 months, but the results are not as reliable. Sometimes your doctor will recommend additional testing to determine the exact cause of your stiffness, or arthroscopic surgery to break up the scar tissue if the stiffness has been present for a long time."
 
Ouch - can't even get a second opinion, much less an MUA, for an entire year after surgery?

My doc will not do an MUA after 8 weeks, so if I don't get this MUA done in the next two weeks, that's my last chance to have this procedure for nearly a year.

Given my lack of progress so far, I can't afford to be dismissive about the procedure. ROM dropped from 85 to 70 within days of surgery and hasn't budged. Doesn't matter what I do - PT, no PT, ice, rest, etc.
 
Our overall philosophy is for a more natural healing, but there certainly have been members who've had successful outcomes from an MUA.
We absolutely support each member making their own decision in consultation with their health care team.
If you decide the MUA is your best option, we'll be with you wholeheartedly.
 
russny said:
Ouch - can't even get a second opinion, much less an MUA, for an entire year after surgery?
Click to expand...
You can get a second opinion at any time, if the first physician refers you - then the second physician won't feel he is poaching another doctor's patient.

It is a good idea to find the second physician yourself and then go to your current surgeon and ask for a referral to this new doctor. If they have a problem with this that reflects very poorly on them. In the end if you stand your ground and demand it, they will cave. This is what I have done and it worked for me.
 
The ROM in my right knee, measured while seated with feet on floor, hasn’t budged from 70 since 4 days after surgery.

ROM was not measured while lying down for nearly two weeks after surgery because I couldn’t raise my leg higher than a couple of inches - but suddenly when I woke up one morning, voila! I could raise it as high as I could presurgery. A miracle! I hoped that one day I’d wake up and my knee while seated would suddenly bend to at least 90. But no, day after day, week after week hasn’t changed.

At 4 weeks post-surgery my ROM while lying down was measured for the very first time - turned out to be only 55, even worse than the seated ROM.

Weeks 4-6 I spent most of the time homebound. On the chance that going down the 28 steps from my apt to the street and to take out garbage was impairing recovery, I stayed home doing ADL, self managed PT. Rapunzel isolated on the 3rd floor.

Yesterday, at the start of the seventh week, I left the building for the first time in two weeks to try out a new outpatient PT who then measured ROM. Seated ROM, no surprise, still 70. Used to disappointment I expected the PT to report that my lying down ROM was stiil only 55. But surprise! It had increased from 55-65, ten points in only two weeks!!!!

I had been doing a lot of sessions daily of heel slides while lying across rhe sofa mostly because the knee seemed to want me to. And it didn’t hurt like it used to. So now I’m wondering is it possible to keep gaining? Or will it stop at 70, like the seated postion? Or will it surpass the seated position? If so then what good is that because the seated isn’t good enough? I do the seated assisted knee bend exercises not because my knee seems to want it - in fact it seems happy to stay there at 70. Forever.
 
Hi @russny I can’t answer your specific question but what struck me about your post is that they are measuring your rom while you are seated.
they have always measured mine only when I’m on my back on the table. My surgeon has looked at it while I’m seated on his exam table with legs dangling off the side and told me I was at 90-92, but apparently he can ‘eyeball’ it. Neither of my p therapists have ever measured it unless I’m flat on my back so I’m wondering about the significance of giving you 2 rom measurements. Perhaps because of the trouble you had early on lifting it? Congratulations on gaining 10 points!
 
My surgeon is excellent and can eyeball too! He only measures lying down. Your reply is very helpful because when people report ROM on bonesmart, I’m left wondering whether it is seated or supine. Had no way of knowing whether or not apples to apples. Maybe from now on I’ll just ask.

The PTs meaure both. You’re right that early on they couldn’t measure lying down - first because the leg couldn’t rise enough and then the inhome PT I had for two weeks didn’t even bother to bring a goniometer to measure!

If the standard is lying down then I was worse off than I thought I was, with supine ROM of only 55 at four weeks. On the other hand if it is the standard then the increased ROM is a sign that the doctor, who said there’s no way I can increase ROM, is mistaken. I willmeet with him Monday to discuss whether to do MUA.
 
sistersinhim said:
I took no formal PT at all, just natural PT, doing my daily living activities. I was alone most of the time, so I had to take care of the house, yard, and 13 rescued kitties. I had a great recovery, though some days were spent in the ODIC, (overdid it club). When this happened, I stopped all unnecessary chores then iced, elevated, and rested until my knee calmed back down. I, and many others on here, are proof that formal PT is not necessary. Bad PT is worse than no PT. What a joint recovery PT should include are gentle movements and working on gait. As the swelling goes down, the ROM naturally improves. If your knee wouldn't bend appropriately during your surgery, then your surgeon wouldn't have rolled you out of the theater into recovery. Time is the key, not aggressive exercises.
Click to expand...
exactly! well said! I think a lot of PT's need to go back to school and learn how to treat a knee than instead of pushing it to the limit and doing more harm than good within the first 3 to 4 months range at least. ADL's actually is the best thing for me with this knee after I had a bad experience with PT guy less than 24 hours after surgery. After what my surgeon saw and what damage he created by being rough ,my surgeon said no more PT for good. He knew this wasn't my first rodeo so to speak with TKR. So with this surgery and last one I am doing my own get-go and when my body says enough, then I stop and sit for awhile and rest. It is good for the mind and healing to get outside if you can and just enjoy life and the sunshine! God Bless to all going though this long healing journey:prayer:
 
russny said:
I’ve been trying to buy time to heal naturally before resorting to an MUA. I thought I had 12 weeks but the doctor’s PA says he won’t do one after eight weeks. Also said that if I decided after the eight weeks were up that I wanted an MUA, no doc would agree to do it. PA claims no doc is willing to do an MUA unless they are the surgeon who did the TKR. Is this true? Has anybody been able to get an MUA from a doc who did Not do the TKR?
Click to expand...
that is not true at all for MUA's. The surgeon that did your surgery will most likely remove the scar tissue But if you are having a hard time bending -70 at least then you might have to have it done. A lot of scar tissue forms on the sides of the new implant and sometimes near the quad muscle tendon where they cut. If your body keeps forming it for example and keeps the knee not bending at all after 5 to 6 months, then the surgeon will want to go in the knee and scope it to cut the thick tissue..... By all means I am not telling you what to do but I would wait and see because you are still swollen and been sawed, cut with many tissues and layers, tendons,ligaments and then hammered into the bone. Let time heal you and I think you will be fine
 
@russny You bend might still be constrain by internal swelling. Are you still icing and elevating regularly? That's the best way to get the swelling down.

Please don't get caught up in the "numbers game" of ROM measurement. The goniometer is inexact at best and often misleading because it is hard to replicate from one time to the next. Plus, as you note, PTs put patients in different positions for measurement. I know one person who was measured lying on her stomach with her knees up in the air!

I know 7 weeks seems like a long time, but it is still early days in this recovery. Keep icing and elevating and moving gently. Try to be patient a bit longer to give things a chance to improve.

Sending hugs :console2:
 
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