TKR Unknown lump on front of knee'

[Jackieray]

I'm heading out to see my doctor in a few minutes. Will let you know what he says.

 

[Jackieray]

Well, I saw my doctor today. I'll have to say he didn't listen to a word I said. He said that the bump was normal swelling and asks me what my ROM was and when I told him 95 (and this is 6weeks out), he told me that wasn't enough so he wants to do a MUA. Then in the same breath he tells me I am a high risk patient because I have soft bones. He said I could go home and MAYBE I would get to 115. There was just no way of telling. I told him after resting from PT for a week and continuing to ice, I could bend my knee better with less pain but he didn't seem to hear that.

 

[Celle]

Don't worry about it, Jackie! Just wait and see if the lump goes away. it's not unusual to get odd lumps and bumps after the surgery. Much of your soft tissue was pushed aside and moved around during the surgery. given time, most of the bumps go away.

A ROM of 95 at 6 weeks is perfectly OK. Your surgeon can't force you to have a MUA and most surgeons don't do them once you reach 90 degrees anyway. It's your knee. Just tell him you want more time.

You've seen how easing off from the exercise is helping. Keep doing what you feel is right for your knee.

I see no reason to worry about his prediction of only a possible 115 degrees either. There's no need to rush to get ROM, because it can continue to improve for a year (or even longer) after a TKR.
Myth busting: the "window of opportunity" in TKR
It's never too late to get more ROM!
It's worth the wait for ROM

And, just to encourage you, this is what one member posted about her slow, but successful, increase in ROM (thank you, @Campervan ).
"I had a slow recovery. Here's my flex measurements at various points:
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"

 

[Jackieray]

Thanks for the encouragement! I told him I would have to talk to my hubby and pray about it. He said well there's only a small window of opportunity to do these usually between 6 and 8 weeks. I'm not going to let him pressure me into it.

 

[Celle]

He's wrong about that window of opportunity, too.
It could well be that is what he was taught, but that thinking is out of date now.

 

[webbie73]

Jackie, pure hogwash! At 6 weeks I was not even close to 90 degrees. I am 3 months out and only at 110. Not even concerned. I told PT I wanted to be able to walk, climb stairs the normal way and just enjoy life. I am there! Don't let the OS bully you.

 

[referee54]

You are doing just fine! Do not worry about---this recovery is a slow process---I am not sure why your OS is in such a hurry.

As others have said though---stay the course. They cannot do an MUA unless you let them, and you do not need it!

 

[Jackieray]

I went into his office really feeling good-I was walking better, bending a little more, feeling this was all going to work out. Then I felt like I had been slapped in the face. Plus rushed and pushed. I can't believe he would tell me I was a high risk patient for a MUA then want me to hurry and make that decision. No way! He left the office to talk to my PT (the doctors in this practice own the physical therapy division$$$$$). I stopped by to see what the PT told him. The PT kept talking about how spending too much time making my breakfast in the morning caused this swelling. I'm diabetic and my breakfast consists of scrambling an egg and toasting a slice of zucchini bread. Takes 15 mins tops! And I didn't do that until the third week. It has always been my fault never too much PT or too agressive. He stayed on my case so bad one day that I sobbed all the way home. He apologized the next day. The only reason I chose him was he was a little gentler when he pushed to get higher rom. Sorry for dumping all this.

 

[smarttoys]

It makes me wonder if some doctors push for a MUA because it's good for their pocketbook and not necessarily for the patient.

You sounds like you are doing great and if would give your knee some time to heal you should progress nicely. As long as you do some gentle movements and gentle stretches during the day.

I usually do some flexion stretches in bed before I get up in the morning. That's when my knee is the most limber.

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[referee54]

Sorry for dumping all this.

No need---absolutely no need what so ever---to apologize to us. That is what we are here for.

Do not let any PT bully you---it is your knee, your recovery, and you set the limits. The OS may want to do an MUA, but nobody can do that to you unless you let them.

Draw that line in the sand and do not let anybody cross it. You are doing fine, and do not let anybody bully you or push you too hard or too fast.

he only reason I chose him was he was a little gentler when he pushed to get higher rom.

ROM is something that you do not push to get---it really just happens. If you are gentle and do not go past the point of discomfort, you will be doing great.

 

[Josephine]

1. I'm not very good at this pain scale but I'm probably a 5

okay

2. For the knee, I'm taking 20 mg of oxycodone about 2 or 3 times in a 24 hr period for breakthrough pain. And Tramadol 50 mg the same as the oxycodone.

2 or 3 times a day is totally inadequate. You need to take it at least every 6 hours and if the oxycodone doesn't have Tylenol in it, add 1,000mg to the mix but only 4 times per 24hrs. You might also try not taking the oxycodone but taking 100mg Tramadol instead.

This was my routine for knees 1 & 2

It's at PT that I have difficulty. My sessions usually end with me in tears.

Exactly! It very often is! More on this later ...

3. I ice my knee all the time both night and day. The only time the swelling goes down in this area is when I don't exercise it.
4. Whenever I'm sitting down, I'm elevating. I've done that since my back injury because it takes pressure off.

Jolly good!

5. Flexion is 95 and extension is 0

That's not at all bad for 7 weeks out.

6. The swelling is probably slight to moderate

Gotcha

QUOTE="Jackieray, post: 871333, member: 20778"]7. For about 4wks PT had me only up for 5mins an hour then we upped to 10 mins every hour. I held to this pretty good except when I had to get my meals. The last 2 days I've done a little laundry and cooked an easy dinner last night. After fast food for 6wks, home cooked chicken and pasta was a feast![/QUOTE]Well, mind you stick to the routine here Activity progression for TKRs

My comments in bold
8. Exercises at home: 1 session per day - good!
Heel slides with strap x 20 holding for 10 sec - well first, don't ever use a strap. Either do it under your own steam or don't do it at all! Read this too Heel slides and how to do them.
Straight leg raises x 20 - a tip: when you can do SLRs you don't need to do them any more!
Leg raises while sitting in a chair hold for 3 sec - same as above
Knee extension sit x 20 holding for 3 sec - do a few every so often during the day. Doing that many in one session causes pain
Hamstring stretch x 5 holding for 30 sec - do you actually have hamstring pain? If not, don't do them!
CPM machine started at 70 and got up to 112 on Monday and was told to do it for 2 hrs 2x per day but I could
only do it 1 time a day - I wouldn't use it at all. Evidence shows that it's a pointless exercise. The clue is in the name - continuous passive motion. If your own muscles aren't doing it, then it achieves nothing.

Exercises at PT: 3 days per week for about 2 hrs
10 min on recumbent bike - okay
10 min on the seated elliptical - the elliptical is quite a punishing machine. I'd leave it until you are at least 4 months out
Heel slides 20 w/o strap and 20 with strap and PT pushing on leg - don't ever use a strap. Either do it under your own steam or don't do it at all! And do not EVER let the PT push on your leg. Biggest n0-no going!
Wall slides 10 - don't do wall slides! They are very hard on the knee!
Marching and butt kicks 20 each - same again
Hamstring stretches - do you actually have hamstring pain? If not, don't do them!
Straight leg lifts 30 using a med roll under the knee then a smaller roll each for 30 reps - a tip: when you can do SLRs you don't need to do them any more!
Something where I sat in an elastic sling thing and slowly squatted - don't do these either. They're even worse than wall slides!

So my assessment is that your exercise regime is too rigorous and much of it is totally unnecessary. If you want confirmation that this approach works, I recommend you read my recovery threads to see how little exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!

I was taught how to massage my incision w/ vit E and to move the patella

Another no-no! It's okay to mobilise your patella if you want to though it's not entirely necessary but the cream is UNnecessary! Massage post THR It won't do any harm but why waste your money?

What about the build up of scar tissue? (Dr) said aggressive physical therapy causes pain which causes swelling which causes scar tissue.

I totally agree with the bit about swelling but the bit about swelling causing scar tissue is utter nonsense! He's inferring that the swelling causes adhesions which block ROM. Yes, swelling does block ROM but not because of any adhesions, it's because it's swelling! Swollen and stiff knee: what causes it?

Other professionals feel that scar tissue starts building up immediately if you don't start all these leg bending exercise.

Of course it doesn't! What nonsense some of these people talk. Besides which they are confusing two very different things. Scar tissue if what forms when wounds heal. It's necessary, unobtrusive and harmless. The 'scar tissue' they are really talking about is adhesions which is stuck down tissues in places they are not wanted, like weeds in a garden are really just plants in places we don't want them. So yes, scar tissue does get created immediately but it's not going to impact on your ROM or ability to be mobile. On the other hand, adhesions are relatively uncommon and generally don't show up until some weeks post op. But these bosoes, not knowing the difference, don't realise that the post-op swelling their exercising is causing, is the cause of problems with ROM.

He said well there's only a small window of opportunity to do these usually between 6 and 8 weeks. I'm not going to let him pressure me into it.

Don't you either! You have the right to withhold consent and without it he can do nothing.

It makes me wonder if some doctors push for a MUA because it's good for their pocketbook and not necessarily for the patient.

You betcha!

 

[Jackieray]

Thank you, Josephine! I was near panic this morning because my knee felt stiffer and I felt I was losing the rom I had so stupidly I got on the CPM machine bumped it up to 95 and stayed on for an hour. Now I've been in pain for the afternoon. I had forgotten that I was up and out to the doctor yesterday which probably caused the swelling and stiffness today. Now I've set myself back a little. My panic shows how brainwashed we are here in the states. But I have to ask...has anyone ever heard of anyone's knee locking up?

 

[kneeper]

95 at 6 weeks is not bad at all. I wasn't at 90 at 5 weeks and I got the old "he might want to do an MUA" comment from the PT.

But as I knew from the first knee and the Bonesmartie wisdom, as the swelling went down I continued to gain. I did just a few exercises (10 minutes tops) 2x a day, (and PT only 2x per week), lots of ice and elevation,( and naps ) said NO to squats and I was at 90 by the time I saw the OS at 6 weeks. He never even mentioned MUA. He just told me to keep doing what I was doing and more bend would come. And it did over the next few weeks.

It sounds like you need a "knee-cation" today and tomorrow. Just a little walking around the house and lots of lying around icing and elevating.

 

[Lovestoread]

You need to take the weekend off....I'm guessing your knee will thank you! By the way, I never used a CPM machine and I didn't develop adhesions. Don't believe them when they tell you you will develop adhesions if you don't use one. Not true at all!


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[Jackieray]

I'm going to see my internist on Tuesday to see what he says. He recently told my husband and me that he's listening more to how his patients say they feel. If they feel good where they are at then he says great! That's oversimplified but you understand. During my grandson's nightmare into paralysis, we met some folks who have a company in a suburb of Atlanta that uses a technology that was used to break up kidney stones in the body. They use acoustic wave technology. They would bring it to where my grandson was doing therapy and use it on the people there. It's complicated and I don't know all the technology behind it but I contacted them to see they have used it to break up adhesions (now I know the correct term) and they told me they have. It uses sounds waves. If I need to, I'm doing that before I have a MUA. This could be a Godsend for people who are high risk for bone breakage like myself.

 

[Clipless]

Why do you still have a CPM machine? Studies do not bear out their effectiveness. You can bend your knee under your own power- it's called "active flexion".

 

[Jackieray]

The prescription for the CPM was to start at 70 and and get to 120 but both the PT and the OS said they weren't reliable and weren't very effective. So why the heck was I given one? Reading a lot of the informational material and your stories on this site has made me realize just how aggressive my PT was and on top of that I was made to feel I wasn't working hard enough! No wonder my knee is stiff and swollen!

 

[Celle]

It's complicated and I don't know all the technology behind it but I contacted them to see they have used it to break up adhesions (now I know the correct term) and they told me they have. It uses sounds waves. If I need to, I'm doing that before I have a MUA.

Sweetheart, you don't have adhesions. Try to forget all the rubbish you were told about them.
If you had adhesions, your knee would not bend as far as it does. You've already passed the point where adhesions inhibit your bending.

You don't need to work hard to increase your ROM. Just do a few, gentle heel slides and walk around the house.
Heel slides and how to do them
That's all you need to do.

You won't need to contemplate using that machine either - and it sounds as if it could be dangerous in unskilled hands.
I had kidney stones that were blasted and broken up using sound waves. I had to have an anaesthetic while they did it, and it was agony afterwards. You don't need that.

Just try to relax and don't let all the dire predictions get to you. PTs get obsessive about ROM numbers, because that's how the insurance companies judge their effectiveness - but you don't need to buy into that insanity. Your knee knows how to heal itself. All you need to do is help it, by reducing the swelling, with lots of rest, ice and elevation, and a little bit of very gentle exercise.

Here are a couple of articles that you might find appropriate:
TKR: work “smarter” and not “harder”
Life in the slow lane

 

[Josephine]

But I have to ask...has anyone ever heard of anyone's knee locking up?

Yes, but only because they have adhesions - which you don't!

They use acoustic wave technology. I don't know all the technology behind it but I contacted them to see they have used it to break up adhesions and they told me they have.

Can't say I feel comfortable with that. When doing revisions on infected hips that required removal of every scrap of bone cement deep within the femoral cavity, we used a sonic instrument called an Oscar to loosen it! Okay for things like ACL repair/grafts and such, but a replacement? Uh-uh

 

[kneeper]

I'm going to see my internist on Tuesday to see what he says. He recently told my husband and me that he's listening more to how his patients say they feel. If they feel good where they are at then he says great! That's oversimplified but you understand. .

Good point.
The key is that in the end, can you do the things you want to do? At 6 weeks you feel like recovery is endless, the swelling is taking forever to go down and you wonder what you will be able to do in the end.

But I can tell you for me as the months went by I found myself just doing stuff that used to be agony or that I'd have to plan for, very naturally. So long as I was able to do stuff it didn't matter what the measurement was.