TKR Update on Slower Recovery

[Mar]

Can you change my title to “When and if I should do MUA”

Well saw my OS yesterday. He feels I do need the MUA. I’m feeling like I do as well. Only because I’m 10 weeks out and my heel slides on my back only get me to about 75 bend. I have not progressed in any way. I was 87 at PT initially a day after surgery. It’s just a block wall that doesn’t want to give. I can slide down a wall to 90. So very weird!

I’m worried about just waiting it out what if I’m one of a few who will never gain? So far everyone’s chart has shown at least slight progression. My leg is much less swollen then it was so shouldn’t something have changed by now just with that, I would think?

I’m getting lymphatic massage literally 4 days a week. Twice at my knee PT. I’m also doing Pelvic PT. Where she does it as well. I get electrical stim 2 days a week and while I’m doing the pelvic PT she puts infrared on my knee.

No one has tried to bend my knee past what is comfortable, haven’t let them. For the last 6 weeks they really just do massage. So I seriously don’t think there’s much more that could be done to help it. Also I ice and elevate though I’m getting a bit tired of it.

They can’t get me in until the 26th. I will be 12 weeks out. Although I can now do a rotation on my recumbent bike at home I can’t do it on the one at PT, which is weird. So some how I can move my hips enough to do it on mine so still showing me I am not a true 90 degrees. But I have been that for sometime with no progression as well.

Weird how the hip can trick you into thinking you have more flexion then you really do. My uncertainty is I leave August 8-18 for vacation. Should I wait till I return? But they can’t get me in until the 30th of August. That will put me at 16 weeks. Do you think it is safer to do earlier then later?

My idea is it does give my body more time to hopefully increase flexion during that waiting period. But could it be more dangerous that far out? This is all very frustrating and full of uncertainty as to what I should do? I am completely confused. If I had some inkling things are improving I wouldn’t even be thinking of this. I did need the MUA with my other knee 8 years ago but problem is I can’t remember much about it.

 

[Mar]

Well I answered my own question . I finally was able to locate my old posts from my first TKR. Wow, 8 years ago I sure forgot a whole lot of what went on back then. I actually had better flexion with it but apparently my gait was very off! The MUA was done at 5 weeks because if I waited any longer I would have had more deductible to pay. Other then a few issues that I haven’t experienced with this one I really was doing ok until after the MUA. Took months to recover. I’ve now decided I will schedule it at 16 weeks but don’t think I really plan to go through with it unless my flexion doesn’t increase at all by then.

 

[Jockette]

An MUA can be done at any time, so try not to worry about the “when.” Some of us just really take a lot longer than some others to regain ROM. That was me.

My early ROM numbers that were recorded by my PT and my surgeon are “great” so MUA was never discussed with me. But they were false numbers in my opinion, because they were all “encouraged“ (basically forced) by the person measuring, I couldn’t get that bend myself. I also never had the function that those numbers were supposed to give me, again, because I couldn’t do them myself. My functional ROM was poor my whole first year, even though my “numbers were great”

My ROM improved a lot in my second year, as my whole leg continued to relax and heal, which made me angry that my medical team stressed me out so much about the ROM, when it did come in, in its own time, and not theirs. They had me worrying about it the whole first year.

You have been very sensible in your rehab, not constantly overdoing either activity or exercises, and resting well and icing, so my guess is that you probably don’t have any adhesions, which is what an MUA is supposed to address. An MUA doesn’t just give us our ROM faster, it is intended to break up adhesions, which are tissues that are literally stuck together. Overworking the rehab, especially too early, can make those inner tissues inflamed, hot and dry and cause them to stick together. That’s what an MUA fixes.

If there are no adhesions, then it doesn’t really help anything. It might loosen things up initially, but then our knee goes back to its own rate of healing.

Try to relax about the ROM. You are currently about 25% healed, in this year long recovery. Where you are now is not where you will end up.

Go on your trip, relax, be reasonable with your activity, and enjoy yourself! It will all work out fine.

 

[Mar]

Jockette, that’s good to know, I’m going to stop my PT except the pelvic one which I still need. She does all kinds of PT so I can address any concerns I have. Will continue to do stretches. Just going to do ADL’s and ride my recumbent bike. Pretend like I never had it. Will ice and elevate 4 x day. Just need to move on and try to ignore it. I think my swelling is under control and they have taught me how to do the lymphatic drainage. Hopefully when the time comes to make a final decision I will have made some kind of progress and just cancel the MUA.

 

[Celle]

I’m 10 weeks out and my heel slides on my back only get me to about 75 bend. I have not progressed in any way. I was 87 at PT initially a day after surgery. It’s just a block wall that doesn’t want to give. I can slide down a wall to 90. So very weird!

If your flexion when sliding down the wall is 90 degrees, that's what it is. Doing flexion lying flat on your back is often more difficult.

As Jockette says, go on your holiday and enjoy yourself. Stop worrying about exercises and ROM while you're away.

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your knee has the potential to achieve good ROM right from the start, but it's prevented from doing so by swelling and pain. As it heals and the swelling goes down, your ROM (both flexion and extension) will increase spontaneously, whether you do formal PT or just let your normal Activities of Daily Living (ADLs) be your exercise.

We know, from people's experiences here on BoneSmart, that ROM can continue to increase for a year, or even longer. There's no need to rush, no deadline you have to meet.

 

[BBCG]

Hi Mar,

After my first TKR in 2016 I was also “threatened” with a MUA. I say “threatened”, because that’s how they said it: if you don’t get to 120 degrees by 12 weeks, we will have to do a Manipulation Under Anesthesia! It was very scary to me, but partly that’s because I had only just found Bonesmart, and had been misled about a lot regarding recovery. I reacted badly to the opioids and they didn’t touch the pain for me. So I had had weeks of misery and wanted the pain to stop! Certainly didn’t want to undergo it all over again!

But, I found Bonesmart, backed off from overdoing things, cut back on PT, stopped letting them force my knee, found better pain relief, and said no to the MUA at my 2nd appointment at 3 months. I told my OS,
“I plan to wait a while and see how well I can do getting to 120 on my own without a MUA.”

So, I didn’t do a MUA, canceled my 6 month appointment (I felt they might push me to do it again!), and went back at 9 months when I had plenty of bend!

The reality is that lots of us who have been through this surgery have had our ROM return far more slowly than the folks who propose the interventions say is the case. I can’t guess as to why. But they haven’t been there, perhaps?

At any rate, it sounds like you are taking control of your knee’s recovery and will do better and better as time goes on…

Hope you are having a relaxing weekend and where I am, ice in my knee feels great; it’s hot out!

 

[liam2015]

I agree with the others. Go and enjoy your vacation. You never know, you might just gain enough r.o.m. that you won't need the m.u.a.

 

[Mar]

That’s what I’m hoping for. Well if I’m really at 90 then I’m not as worried. Being only 75 after 10 weeks is a bit of a worry especially since I have been rather careful to avoid anything that will increase swelling. I have probably over iced then under iced and mostly with elevation except when in the car. My PT only does massage if they do bend it it which is rare it is never aggressive. I’ve prayed so much over this knee. I prayed for a sign to tell me all will be ok, but all I really heard was no improvement. Sort of depressingBut then last night I read my past messages on my other knee and after what I wrote after that MUA, I’m now leaning toward not doing that again . So maybe that was the answer to prayer I needed to smack some sense into my head, lol.

 

[Sisterpat]

Mar, if you can achieve 90 degrees in any fashion, then you’ve achieved 90 degrees! Go on vacation and relax. Forget the numbers while you are away!

 

[Mar]

Well I was able to do a full rotation on the PT recumbent bike todayslight progress but I’m excited. Now I’m not scheduled for the MUA until Sept. 1. I see them August 26 to see if it’s still needed.. I’m pretty confident I will have enough improvement to cancel it.

 

[Sisterpat]

 

[Mar]

So today I went to PT today and she showed me some new stretches to do, nothing crazy, massaged my leg then she said I want to tape it. Said it helps with moving the facia so it can drain the fluid better. Well I don’t know if it was that or just time but later I noticed it was bending better so I let my leg slide down the wall took a measurement and it said 105. Man if this keeps up I don’t think I will need the manipulation. Anyone had their leg taped to reduce swelling? Just curious if it helped you as well. Going from 90 to 105, so exciting

 

[GiantFinnegan]

That is so great, Mar! I'm struggling with my ROM due to continued swelling. Do you know what kind of tape it is?

I really can't imagine you'll need the MUA!

 

[70somethingsusa]

mar: Physio taught me to tape my leg as a treatment for Osteoarthritis, a couple of years b4 knee replacement. It increased mobility and decreased swelling.I found it to be very effective.

 

[Mar]

Giant Finnegan, I’m not sure what type of tape. It is tan but I assume some type of athletic tape that trainers use support injuries. I can ask but don’t see her again until Monday.

 

[GiantFinnegan]

Thanks Mar. I've been looking around and found some videos of PTs putting kinesio (KT) tape on knee replacement patients to help with swelling. I'm going to ask my PT (also on Monday).

 

[beesknee]

So I think I am going to go head and and do the MUA. I only go to PT and have massage treatment to try and decrease swelling. I never really did the exercises they wanted me to do. Just heal slides and back and forth on my bike. I ice and elevate all the time, but nothing has changed. If I had just an inkling of improvement I would continue on.

This is what motivates me to push though PT. I think most can get back ROM with ADL, but if you happen to have a stubborn knee (like I seem to have), I believe you need to push a little bit and feel some pain of stretching though some the scar tissue.

That being said, I am a whisker from canceling all my in person PT sessions. My PT has the personality of a tree stump - instead of making things interesting or enjoyable, I dread dealing with him.

Anyway anything I do with the PT I can do myself at home. I have worked out 3 times a week on average since I was 15 years old so I am comfortable with self guided exercise. I realize many people have never done structured worked outs their entire life so that is when PT guidance is probably most important.

I hope you have continued your small improvements following your path and avoid another MAU.

 

[Mar]

I’ve been getting mild vertigo and balance issues lately so had some labs done. I possibly have Meniere’s Disease. Had a possible attack 3 years ago and nothing since till possibly now. My labs prior to my LTKR all normal. I don’t have high blood pressure or diabetes. So was surprised when they said I may have some kidney issues. My GFR is 56, and urea nitrogen slightly elevated. I’ve been taking 2 Tylenol and 2 ibuprofen 3 x day. Obviously going to stop the Ibuprofen but dang do you think that will move it back to normal. I did take Celebrex just one bottle about 4-5 weeks ago to see if it would help the swelling. I stopped the Ibuprofen during that time. Anyone else have this happen? Did it improve once you stopped Ibuprofen or Celebrex?

 

[kneeper]

This sounds like a question for your doctor.

 

[Irongirl56]

@Mar, my BUN has been elevated for my last 2 surgeries and my GFR was 56 prior to this surgery. I dont take a ton of ibuprofen but have certainly taken my fair share over the years as a runner and Ironman triathlete. And having had 4 knee surgeries in the last 3 years has led to an increased intake as well. I dont have any BP or diabetic issues either.
I talk to my doc and she thinks maybe I was dehydrated when those labs were drawn but I will be rechecking them in a few weeks now that I am post op. if kidney damage is there unlikely it will get back to normal so hoping was a fluke.
I also have had vertigo spells many times over the years. Meniers is often ruled out and been diagnosed with vestibular dysfunction. I have tried to pinpoint my spells to time of year, allergy season, too much time in the pool etc but cant find a cause. They just show up and can last for several weeks. Makes it really touch to go to the dentist! But they are a benign nuisance to deal with at this point.
Definitely get your labs rechecked once you are off the NSaids and keep us posted.