TKR Experience with MUA?

[Nekocarlo]

Hello, I had tar 7 weeks ago and recovery is going well as far as pain control and sleep. I feel lucky in some ways. However I’ve been in pt for weeks, twice a week (following about 6 sessions with an at home pt weeks -3) and my range of motion seems to be stuck between 90 and 94 . These are the’ old, measurements, at begiining of pt before knee has been worked on, as that is the number my os
deems most accurate.

At my 6 week visit last week, he said this is not good enough and asked me to do nothing but knee bending exercises for next 2 weeks, when I see him again. (He is happy with my extension and strength. If I don’t reach 105-110 by then (which is now one week away) he’s going to recommend MUA. I know there is some controversy here regarding this procedure, but I’d like to hear from anyone who has actually had it. How is the recovery? How much did it help rom, if any, and for how long? Not sure how you go from MUA almost directly to intense pt for weeks, but I hear that is what is recommended. By the way, my pt was surprised by this, he knew I was a bit stalled with rom but didn’t think my numbers would result in a recommendation for MUA. Also, I have an excellent os, all he does is knee and hip replacements and he’s very well respected.

 

[Steveg63]

Sorry your 'stuck' on 94 degree bend, I am at week 11 post op and have only just hit 105 with some persuasion, I see my surgeon in 2 weeks and he informed me, at week 7 (I was 85 bend then), I needed to be at 110 by my 2nd visit, he has 'suggested' MUA, if I am not at this mark. I won't be taking his advice!

Iam seeing a weekly improvement with my mobility and functionality, as long as its getting easier week by week I believe the rom with also get better.

Good luck with what ever you decide.

 

[Layla]

Hello and Happy Friday Nekocarlo,

While your range of motion is currently limited at only seven weeks post op, it will naturally 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?

I will leave a couple accounts in regard to ROM in posts below.
Best Wishes! Have a wonderful weekend

 

[Layla]

Update from member VolLady-

"I want to tell everyone that has went though TKR that it is a long journey to heal. I am going this spring to have my other knee replaced.

Please do not get discouraged and I know you will because I did with my first one and cried more than I had in a life time. Scared mostly.... Surgeons will not tell you everything that you will experience during your healing. It took me 7 months actually to feel more normal but not 100%.

For the ROM I only got to 112 at 4 months and still cannot bend it all the way back to reach 130. But I can drive, sit at a table, put my shoes and clothes on great without a ROM of 130 or 120. There is no swelling at all at 8 months but I still have some stiffness at times but I deal with it and walk. I also still ride my bike with no trouble.

I am telling everyone this because your body will heal without PT and pushing your limit beyond to the point there is more swelling and pain. I have decided when I have my other knee fixed this spring, that I will do my own PT since I have all the equipment and items that they use anyway.

I had a MUA at almost 6 wks., and regretted it from day one. Simply because it did not help me anymore with my ROM but it did set me back on healing. The swelling was awful. I will not have another MUA even if my ROM was 95 at the time.

I will go in with open eyes on this other knee comparing on what I went though with the first one. So, with all that said, I wish everyone a happy healing and let your body decide with healing than someone trying to push you until you scream with pain. Also don't worry about the ROM, it will come -- it might take a year or more, but it will come. I am 67 years old and I don't expect to get past 120, but I do what I want to do at 67. Oh! and I can even bend down with the knee need to kneel on it..... Best wishes everyone!"

 

[Layla]

Update from member JusticeRider -

"I just want to add, for all those coming along, a note on ROM. I want to share this because nearly all of us have a tremendous amount pressure put on us to increase our ROM by certain deadlines, or else.

Mine has been extremely slow coming. First I had to wait out the swelling, which in my case took more than 5 months. Yes, months. At that point I began to see real progress. It has continued to this day. I have seen improvement in the last 2 weeks. It’s still going. A this point I think the limiting factor is tight muscles, ligaments, and tendons from 3 yrs of very limited ROM and actually about 25 yrs of somewhat limited ROM. Those tissues are slowly stretching.

I have had to be willing to let my flexion improve at a glacial pace, be very patient, and tune out the dire warnings of my surgeon, PA, previous PT, and some well meaning acquaintances. I refused painful PT and refused a MUA. I have absolutely no regrets. I know my body, and I believe those things would have caused a domino effect of swelling and pain that may have derailed my recovery long term and even possibly have torn soft tissue, etc. I now know I have the added challenges of hypermobility and an immune condition that causes an inflammatory reaction. I think a MUA would have been very harmful to me.

Instead of forcing it, I have relied on weekly massage and using my stationary bike as a stretching aid every single day. I have been very active, but I have ramped up really, really gradually. I have not measured my flexion, because honestly I feel almost a PTSD type of reaction around it. All I care about is function and what I can do. My knee is very functional now, and still improving. I love my new knee. I’m glad I let it heal on its own timeline even though it was so much longer than everyone (most of all me!) would have liked."

 

[Layla]

One more -

“At my six week appointment this is what my OS wrote in my visit summary: "She reads an online website called Bone Smart which states to not push through pain following knee replacement. If she were to follow this direction, she will have to learn to live with a knee that only reaches to 85 degrees of flexion. I believe this website is very misleading."

It has now been 20 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks (where I am today): 110
I am so thrilled it keeps improving and improving and I know now that I will get to my goal of 120 (or even better, dare I say!)
So, if a OS or PT bullies you into thinking your ROM will not improve over time they are wrong. By the way, I haven't been back to see the OS since that horrible appointment at 6 weeks, but I sure am going back when I reach 120 just to say, "Ha! You were wrong, BoneSmart was right!" “

And,

“Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better. “

 

[Jtmav]

Just a footnote, but my surgeon stopped by after surgery to see how I was and we chatted for a bit. Since this is my second TKR in 3 months I had questions about recovery. He said, and he is well thought of here in the Boston area, head Ortho at Mass General, that he has seen improvements as far as 3 years from surgery from his patients, always reinforced that this was a year long and maybe more recovery. Personally I would think long and hard about MUA with less than 6+ months of recovery.

 

[benne68]

my surgeon... head Ortho at Mass General, [said] that he has seen improvements as far as 3 years from surgery from his patients, always reinforced that this was a year long and maybe more recovery.

Thanks for sharing this, @Jtmav!

It's important for all our members to know that top surgeons confirm BoneSmart's mantra.

 

[Jockette]

Congratulations Steve, I’ve been following your progress lately because I’m also having problems with rom progression and I find out today if my surgeon is going to recommend muna. 110 rom is great, I would love to get there.
im stuck at 96 or so, can get to 105 during therapy after massage and riding bike for 5 minutes, but surgeon wants me at minimum of 105-110 cold (beginning of therapy) by now, which is 8 weeks post op; or he wants me to have muna.
im really encouraged by your progress. I do tons of knee bending exercises for 2 weeks and gain a few measly points, I do a couple of short bike exercises and gain 5 points during the pt session. Very strange. Bu next time I’m measured (cold) I’m back to 95

Also, having trouble finding people who can describe actual the recovery from mua. I’ve read it’s more painful than initial surgery and also that people drive to p therapy 2 days later and are walking without aids. also read that it helps 75 percent of the time, not good enough odds for me, and that most people do improve rom but the knee function never matches the function of people who did not need mua. . I’m in my late 60s, really think I could live with 110 rom.
I have had good luck with pain control and sleep,hate to go backwards.

@Nekocarlo
I’m sorry that your surgeon wants you to regain your ROM faster than your body will recover it on its own. Recovery time tables vary because we are all different.

Recovery after MUA varies, also, because we are all different.

We have learned from many members, me included, that there is no Window of Opportunity. My ROM contiuned to improve all through my second year, and even a bit more in my third. It actually made me kind of angry that they put so much pressure on us about our ROM, in the early weeks.

Yes, an MUA will set you back a bit, as it disrupts the soft tissue, due to the force of the procedure.

Just know that having an MUA is your decision. A ROM measurment is only one aspect of recovery. You are doing well in other areas. The increased ROM will come in time. Saying no to therapy - am I allowed to?

Let us know how your appointment goes today.

 

[Jockette]

Here are some members who have had an MUA:

Knee Surgery Recovery Area

For post-operative knee patients, on the "other side"

bonesmart.org

 

[volLady]

I had a MUA last year-23 with my first TKR at 6 weeks. My ROM was at 95. My surgeon is great. When he did my MUA I hurt so bad and was so sore afterwards, that I swore I would not have another with my second TKR in the future. The MUA set me back at least 2 weeks and had to go back on a walker where ia was so sore and stiff.

I quit PT since I had been going for 4 weeks anyway and let myself do the healing instead. I treated my knee with care, did what I could do, which was drive, go up and downstairs with rails, and let nature take its course. That was 15 months ago and my knee now is great. Took me 6 months to bend more once the swelling went down.

Now with my 2nd TKR right knee, my ROM is at 100 and my surgeon says that is great at 3 weeks. I don't do PT since I have all the equipment I need, even a bike that I ride now at 3 weeks. My surgeon is okay at that but told me to take it easy going up and downstairs at this stage. I know what my body can do and I plainly told him that I would not go though another MUA even if my ROM wasn't good. I am 67, slow healer and I will not let PT or any other person push me to the limit that it is painful! I know for sure that there is some PT people that are very aggressive and pushy and there is no need for that. Everyone heals different with time like me!

This surgery is going better than the first but I have some issues with thigh and hip muscles giving me fits but I have learned where I have walked bowed-legged for so long, that my body and bones are readjusting to the new gait.

Like I said, think hard before you do a MUA. It can help or it can set you back. Listen to your body. Believe me, surgeons don't tell you everything after surgery...... hugs to all out there!

 

[Nekocarlo]

Thank you Jockette and volLady. The Dr saw that I had made some progress and gave me 2 more weeks to hopefully get further but I’m still sort of stuck at 95 ( get to 105 at pt). The swelling/stiffness is still pronounced. The only exercises that seem to increase rom are the knee massage, followed by short bike ride ( I can finally do full rotations but it’s difficult at first ) and the total gym, but then at the next pt session im back to 95 at the beginning.
@volLady you did not go to any physical therapy sessions after your mua, and you eventually got full rom back? How long after your mua did you need to use your walker?
I was told some patients go back on percocet after the mua but not everyone needs it.
thanks for the info, it really helps not to have to make this decision in an information vacuum.

 

[Nekocarlo]

Hi Steve, i saw my surgeon Wednesday and he saw I had made some progress (only about 5 degrees) and said he’d see me in 2 moreweeks to see if I could make further progress. Problem: I went crazy trying to warm up/ loosen my knee the morning of my appointment so I could hopefully steer the conversation away from mua, and in doing so I set myself way back. It is now so swollen and painful ( even 4 days later) that I can’t really do my stretches/exercises, and I’m limping the way I did several weeks ago.
Beating myself up. I was at 93-97 rom ’cold’ and now I’m guessing it is back to low to mid 80s. My own fault, and not sure if I should go to pt this week. I’m probably going to have the mua due to this set back, but won’t make decision til May 29. I hope you find out what is wrong and
can ‘get it fixed’ . These bumps in the road now feel like boulders.

 

[mendogal]

@Nekocarlo
Since you have swelling due to a morning of overworking your knee there is no need to go for a MUA!

You have totally re-traumatized your new knee. If you skip PT, ice, elevate, and rest, just doing minimal stretching you'll regain the ROM you had.

 

[Jockette]

@Nekocarlo, I copied your recent post on @Steveg63 ’s thread, to your recovery thread, to maintain your history and so we could reply.

i saw my surgeon Wednesday and he saw I had made some progress (only about 5 degrees) and said he’d see me in 2 moreweeks to see if I could make further progress.

This is very good news!

Problem: I went crazy trying to warm up/ loosen my knee the morning of my appointment so I could hopefully steer the conversation away from mua, and in doing so I set myself way back. It is now so swollen and painful ( even 4 days later) that I can’t really do my stretches/exercises,

I’m probably going to have the mua due to this set back,

This is proof that your ROM number is directly related to swelling. An MUA does not address swelling. Your ROM will improve when your swelling goes down, as you heal.

not sure if I should go to pt this week

I would take time off this week from PT and rest, ice and elevate, to get this new swelling down.

At “only” 2 months post op, you are very early in this year long recovery. Try to relax and let your body heal. Your ROM will improves as a result.

 

[Jockette]

Here’s another example of swelling and ROM. I fell, at almost 6 years post op, and landed on my PKR leg. It swelled up quite a bit. I did get X-rays and see an OS, and it was all soft tissue damage, and I could hardly bend my knee at all. No one suggested PT and I babied it by resting, icing, and elevating. My ROM returned just fine, as it healed.

 

[volLady]

Thank you Jockette and volLady. The Dr saw that I had made some progress and gave me 2 more weeks to hopefully get further but I’m still sort of stuck at 95 ( get to 105 at pt). The swelling/stiffness is still pronounced. The only exercises that seem to increase rom are the knee massage, followed by short bike ride ( I can finally do full rotations but it’s difficult at first ) and the total gym, but then at the next pt session im back to 95 at the beginning.
@volLady you did not go to any physical therapy sessions after your mua, and you eventually got full rom back? How long after your mua did you need to use your walker?
I was told some patients go back on percocet after the mua but not everyone needs it.
thanks for the info, it really helps not to have to make this decision in an information vacuum.

My MUA just delayed more healing for me. It set me back another 2 weeks where I was so sore that I could barely walks I had to go back to my walker for another 2 weeks to use. I did not go back to PT after that and did my own and listened to my body. I could tell by the time I reached 4 to 5 months I could tell the swelling was going down but at times I still had stiffness if I stayed on my feet a lot or sit a lot. That is very normal for TKR is stiffness. You will always have that. Some days will be good and some days bad. My OS told me at the ROM of 110-115 at 12 weeks is okay for him, that is if you can go up and down stairs, drive, and put your shoes on. Your ADL'S so to speak. I started driving at 4 weeks with the LK but now since I had recently my RTKR done on 4-24-24,it will be a longer time because I will have to make sure I can apply pressure down on the brake and gas with this one. I am not a doctor, that is your decision to make on MUA,but I would think real hard before I would decide. People heal different. I am 67 and I don't heal as quick like I used to. I think doctors push the MUA'S to quick. Your knee is like a hose filled with water and you know when PT wants that certain bend, you know a hose want bend when it is filled with water just like your knee filled with fluid. It is 15 months now with my first and it took me at least 9 months for it to feel like a knee. Hugs to you and everyone else going though this horrible pain and gain because believe me surgeons don't tell you everything about what you have to go though with...God Bless to all!

 

[volLady]

I am also at 3 days being a month since my last surgery and my ROM now is at 113. My husband measures me in the mornings while I am not swelled and that is when I get my readings. The day of surgery I had a ROM of 118 with lots of swelling. Also I can ride my bike to especially when the swelling isn't bad. Most of the bruising and swelling is gone except around the incision itself and the enter side of knee but that is normal.

 

[mendogal]

@volLady I am a firm believer in ignoring the numbers and focusing on small incremental functional milestones.
My ortho team never measured my range of motion and didn't ask what it was. They wanted to see me move and they wanted to know what I could do.

 

[Jtmav]

Just my 2cents but this obsession with numbers seems to cause more harm than good In the end we choose this elective surgery to improve the quality of life not to please others with our ability, for a brief moment in time, to reach some number that signifies success. Most of us went years in pain and finally decided enough was enough. I’m trying to focus on healing and strengthening my body to achieve the goal of a better LESS painful life. However you chose to express your different opinion with these so called experts, most of whom have never personally experienced what we have, is your call. I’m just simply saying no to a PT who wants to force anything on me. YMMV