MUA UPDATE - MUA determined today...ugh!

[skigirl]

i myself gasped when you mentioned that the pt was bearing down on your knee!!! No wonder you have swelling. That is the worst thing that they can do. For one thing, it takes more than 8 weeks for scar tissue to form, so really, the excess swelling is what is holding you up.

I would recommend that you keep your leg elevated as much as possible. How much are you walking around and doing chores? Second, don't let them push on your knee. And yes I think someone at the PT is not such a great measurer!! If you can do a full rotation on the bike, it is likely that your rom is around 100, which is perfectly normal for your stage of recovery. I also wonder about the 35 for extension.

If you are walking and doing a full rotation, I seriously doubt that number too. I struggled a little with extension myself with my second knee. I just hung my leg off the bed while lying on my stomach for a few minutes a day. By 12 weeks, it was normal.

 

[Josephine]

I've never heard the whole wait 'til 12 weeks thing, but would love to know more.

There is nothing to know. There is no hard and fast rule about it, despite many US surgeons insisting otherwise. We had this member who had an MUA ONE YEAR after the surgery and got a good result!
ROM: it's worth the wait for ROM

those wicked physical therapists bore down on me today pushing to get extension and then flexion. It actually took me by surprise as I thought I was going to be doing all the work, so wasn't enough time to stop them. And, of course, I've been extremely stiff and sore all day because of it!

That is entirely the point - they abuse your knee, it swells and gets stiff and your ROM is affected negatively. But my dear, it's never too late to stop the doing that. Why would you think it is? If you read this article - CONSENT: what it means and how it can be used - you will find this comment

If they (the patient) change their mind at any point before (or during the procedure where appropriate), the person is entitled to withdraw their previous consent..

naturally I got the whole "the sooner we break up that scar tissue, the better" spiel from the OS.

Well that's kind of true except in most cases, patients actually don't have any 'scar tissue' (more correctly called adhesions) and this will be very adequately proved if, after the MUA is done, the patient has no after pain. I've attended numerous MUAs in my career and noted almost without exception, that if there were adhesions, which would be demonstrated during the procedure by sounds like Velcro ripping apart, the patient would require pain meds in recovery. However, if a good ROM was easily achieved with none of that noise, then there would be NO afterpain and no requirement for pain meds immediately they woke up though perhaps there might be a little aching. The patient would invariably be told that the ROM was 'easily' achieved which meant much the same thing - the MUA was unnecessary. As per this quote below.

The horror stories about pain and screaming (you have seen them, I'm sure! Scared me to death beforehand.) didn't happen to me.

 

[Polkadot]

Just to clarify: I did have pain management after the MUA. I had a dose of steroids, plus they renewed my prescription for narcotics that I had gotten after the original surgery. I don't know how it would have felt without these measures.

 

[RadioGal]

@pumpkin Thank you for merging the threads. Makes sense to keep it all on one. I stayed up way past "normal" bedtime last night reading each and every MUA link you attached. Worth it! Thank you, good stuff in there and I feel so much better informed now.

@KarriB Thank you as well. And everything that I've read here regarding "assisting" one in getting more ROM has manifested itself big time today as I have not been this sore, stiff or in this much pain in weeks! Just a day after the PT went to town on my knee, really going for that extra little bit of measurement I have been paying the price all day long. Until y'day I was feeling so much better having backed off the exercises, even earlier convincing my PT to change their aggressive approach, moving better, less pain and, as I said earlier, doing full rotations on the bike for the first time ever when they decided not to leave well enough alone. I have been so miserable today! So your reply was right on, thank you again. I'm a walking, hobbling really, testimony to exactly what you wrote.

@Polkadot I have been following your story and reading all the updates on your thread. You've given me so much hope. Maybe I'm being a bit too anxious, but I'm actually glad they want to do this MUA in the next couple of weeks as I just want to get it over with! I'm ready to get out of this rut and see some improvement. Wondering if that's the wrong approach ... but I will say I'm very hopeful now after reading your and other's posts. Thank you!

 

[RadioGal]

@skigirl I'm doing, I'd say, moderate housework and "some" walking. Housework doesn't bother me terribly, but I do find that if I'm on my feet a bit too long, let's say 15-20 minutes, while grocery shopping I get anxious to wrap it up and head to the cashier so I can get out of there. As for anything else, well besides stretching with a strap I'm really not doing any @ home exercises. Once I found this site and started reading like crazy I backed off them immediately. Subsequently I saw an immediate improvement. OH, and as for elevating, well I finally got my Lounge Doctor delivered today!! So happy about that and already using it. To be honest, before now I have been a bit lazy about elevating or doing it improperly with too much bend.

Thank you @Josephine for your thoroughness. And you're right, I should've stopped them! Lesson, sadly, learned.

 

[KarriB]

I actually didn't even remember what my ROM number was when I was released from PT. It cam up on a FB post a few months ago, so I know now that it was 109. But I continued to gain ROM over a year later. It honestly is about what you can do and not about the number. If you're able to get full revolutions on a bike that's fabulous!

 

[sistersinhim]

It most definitely what your knee can do and not those numbers. PT seems to be the only ones concerned about that. Not even my OS cares about numbers, just ability!

 

[RadioGal]

Considering 2nd opinion from another OS now ... before I do an MUA with my current doc. Any thoughts on this? I'm quite confused @ this point. My scar is very warm to the touch (doc says no problem, that's normal) my knee is visibly valgus (no problem there as well) I have an excruciating pain that runs down my calf on the outer side if I move a certain way, straight to the bone kind of pain. I'm not moving well, so doc says, once again, no problem that's what an MUA is for. Cripes, one conflicting message after another, so thinking a 2nd opinion may be in order.

Yes, this is quite confusing. Any thoughts, experience with this or advice? I thank you!

 

[Pumpkin]

thinking a 2nd opinion may be in order.

I agree, a second opinion is in order.
You will want to look for a surgeon specializing in Revisions, they have the education and background to determine what is happening with troubled knees. Look for a surgeon specializing in complex joint reconstruction or revisions. They should have no relationship with your present OS, not even golf buddies.

 

[KarriB]

You are still very early in recovery and your knee is probably still reacting to the aggressive therapy from last week. While you're looking for a 2nd opinion give your knee a rest, limit your activity and ice/elevate as much as possible. You may just see some additional ROM from doing that for a week or so.

 

[RadioGal]

@becticu Just picked up your post, reading all the way through to the end, post MUA. Feeling much better now about the scheduled MUA I have for Sep. 7th.

With much reluctance and serious trepidation, I have concurred with my doc that I need it! I have attached a recent pic of my knee (if anyone wants to comment or see why I'm going forward with the MUA) and yes, it's "stuck" in that bent position despite that I'm doing my utmost to straighten it. So, I've made the decision to have it done. The pain is pretty rough most days, but I've read time and time again on here that post MUA pain is not much different. Having said that, I'm a realist and know this can be very difficult and that my outcome and pain may be different.

I just wanted to say thanks for the thoroughness of this post. It definitely gave me some hope.

 

[Celle]

HI @RadioGal - I've copied the post above from becticu's thread into your own thread, because it contains an important update about your own knee.

I hope the MUA works for you but, unfortunately, MUAs sometimes don't work to help with extension. You may find that you are able to bend your knee better, though.

You'll still have the problem of your leg being aligned incorrectly and I think it's still a good idea to look for a second opinion about that.

Best wishes!

 

[RadioGal]

@Celle Oh boy, that's something I've never heard before. Okay, I'll run that by the doc.

One thing I will say is that my knee was sort of in this position before TKR. I have even asked (PT, OS, PA) if muscle memory has played a part here. No one seems to have an answer for that, just a "could have" sort of reply. Confusing.

Other than adding a 20 lb. weight to knee (ouch, I'm kidding) how does one go about getting more extension?

Thank you.

 

[KarriB]

I wouldn't add a 20lb weight for extension, but you can try what shown in the link below. Letting my leg bridge between the ottoman and my chair helped my extension. It will happen over a period of time, however gravity will do its thing. Walking also helps with extension.

https://bonesmart.org/forum/threads/extension-how-to-estimate-it-and-ways-to-improve-it.9529/

 

[Celle]

@Celle Oh boy, that's something I've never heard before. Okay, I'll run that by the doc.

One thing I will say is that my knee was sort of in this position before TKR. I have even asked (PT, OS, PA) if muscle memory has played a part here. No one seems to have an answer for that, just a "could have" sort of reply. Confusing.

I think you'd better go back to Post #17, where Josephine illustrated on your photo how your leg was misaligned. She suggested you seek a second opinion. You also said this, in Post #1, which is why Josephine asked for photos.

So, my knee, to my knowledge, was not off this much before surgery. In fact, I'm not even sure valgus was an issue, but my doc has said it's common for women to be 7-8 degrees valgus, so I imagine it was off some. But now, 5 weeks post LTKR, I can visibly see my knee turning inward in the mirror.

Now, to address your other question:

Other than adding a 20 lb. weight to knee (ouch, I'm kidding) how does one go about getting more extension?

It's not unusual for extension to take longer to achieve than flexion. There's no need to worry about that, because ROM, both flexion and extension, can continue to increase for a year, or even longer. There's no deadline you have to meet. It's not even 3 months since your surgery, so you still have plenty of time.
Myth busting: the "window of opportunity" in TKR

There are lots of ways in which you can help to improve your extension, some of which are suggested in this article: Extension: how to estimate it and ways to improve it
Don't use weights until at least 4 months post-surgery, and then only use light weights.
It takes time and gentle treatment for the muscles and ligaments at the back of your leg to lengthen again, from the slight shrinkage they have at the moment.

 

[MyTest]

@RadioGal

Hoping the MUA goes well. My knee is sticking out like yours and I am also stuck so I truly understand. Did the doctor confirm it's scar tissue??

Good luck and please keep us posted.

 

[Pheebs52]

Have you found a revision specialist @RadioGal? If so, is it he/she suggesting the MUA? Your knee looks as though it would be quite painful, so I hope this is the right solution for you.

 

[RadioGal]

Here's (pictures) why I've made the decision to have an MUA. In these pics I'm seriously pushing my knee down as much as I can.

According to @Josephine and her link on measuring extension, if I've read it right, I am somewhere below 45 degrees.

I did not seek a second opinion after all because I just want to get this knee moving! I'm tired of the pain, frustration and annoying my boss with all my requests for time off. @Celle now has me concerned that an MUA will not help with extension. Doc (who says I definitely have adhesions) says it will. This is terribly confusing.

The upside, hopefully, will be that my ROM will improve. I've been (nearly) perpetually stuck at 85 ROM and I don't believe I'm being too hasty by wanting more out of my knee. Then again, perhaps I am. My daughter-in-law, we just found out, is pregnant with twins, plus they already have a 5 year old. I've already been asked to help out with my grandson and the new little ones on the way come Spring. I want to be healthy and moving when that time comes.
I'm prepared to be raked over the BoneSmart coals, I can take it so have it if you think I'm being too hasty. After all, an MUA can only help, yes? Or have I not searched the BS archives enough to read the downside stories? Thank you again.

 

[RadioGal]

@MyTest Thank you for your reply and I'd love to know what you're doing, or thinking about doing, regarding your situation.

 

[RadioGal]

@Pheebs52 Have not sought a second opinion, well, take that back for a sec. I called a couple of places within 10-20 mile range of home and both said it would take months to get in. Likely another reason I'm going with my doc's recommendation? Yeah, likely.