It looks like I may need manipulation as my range of motion after TKR is not what my doc wants. Can someone who has had this give me some info? I know it's done outpatient and under anesthesia, but where are you at after the procedure? Does the flex improve immediately? Are you in as much pain as after the original surgery? I imagine you still need PT for a period of time. Any info will be helpful. Thanks.
I am really interested in any replys you might get on your post. I am almost 3 months po, and have only gotten up to 97 degrees bending. I am somewhat concerned because I seem to have really good days then feel as though I am back to square one with the tightness and painfull bending of the knee. My physical therapist has mentioned manipulation because of the scar tissue, but has only described it as you have, as an outpatient procedure with anethisia. My Dr. hasn't mentioned it, he seems to think since I've gotten past 90 degrees, I will walk just fine in time. I guess I am just very impatient. I told my husband that my Dr. and PO's all say "it's just been 3 months" while I am saying "it's already been 3 MONTHS!!!". Looking forward when it's all better and I can say, "I'm glad I did it!".
Good luck to you, and really hope someone responds to your questions! Staranew
My TKR was Aug 23, 2010, and I had MUA on Nov 1. I had been stuck at -10 and 100 for about 3 weeks, despite aggressive stretching at pt and a disciplined home exercise program. The surgeon got me to 125 flexion under anesthesia but when I went to pt the following day I could only get to 105 and have been stuck there ever since. My knee is still hot and my scar red, and while I appreciate the extra 5 degrees, it is clear that I need to make more progress in flexion to be able to live a normal life. I went back to the surgeon on Nov 19 and was injected with cortisone followed by a stretching session immediately afterwards at pt. With overpressure I could get to almost 110, but within 3 days I was back to a max of 105, despite a long weekend of home exercise. My other problem is that I am still in a lot of pain, despite taking norco and anti-inflammatories and frequent icing. I am really afraid that this level of pain is a permanent state and this really freaks me out. I won't say that I am worse off than before surgery--I was not able to sleep for 8 months before surgery and I was in a lot of pain--but I don't know how I can live with the pain and restriction in activity over the long run.
The following user gives a hug of support to stuckinplace:
Hi. I had RTKR 7/28 and due to pre existing damage, 5 weeks out was only at about 68 degrees flexion. I had MUA on 8/31. It was outpatient in surgery center. Under for about 30 minutes. Everyone is different but I experienced extreme pain upon wakening and it took about 90 minutes, 3 doses in IV of Morphine, 1 of Demerol, and Deloden to get pain under control so they could release for therapy an hour later. Doc was able to get flexion to 120 during MUA. A few days before I had starting using cane but had to go back to walker. My first PT day of MUA provided a flexion of 84 degrees. Started daily therapy and the first 3 were very painful. However, pain eased and PT continued on until 2 weeks ago, when I was released. I am at 95 degrees which is about 10 better than where I was before my TKR.
Would I recommend TKR? Absolutely, as it will increase flexion. Would I go through it again. Even though it was very uncomfortable, if doc recommended it I would bite the bullet and do it again.
On a side note, I had just quit using cane a couple of weeks ago, made my first long drive for a business trip, and started feeling like I had turned a corner. No pain with extension and flexion continuing to improve. Then - this past Monday I went to close patio door during a major downpour, slipped on the wet floor, went down and lay on the floor is extreme pain in my right leg. Head popping sounds as I went down. Laid on the floor, fortuneatly had my phone with me, called my wife, and then 911. Long story short, ride to hospital with EMT's, admitted for 2 days and sent home with fractured femur just below the knee implant. No surgery needed but now have to stay off leg for 6 weeks and get to spend the holidays in a splint. I'm hoping for better 2011.
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Morider, am so sorry to hear about your fall and your subsequent down time over the holidays because of it. It will most likely put you back into a lot more pt time because of it, all the best!
To all of you who have posted, I failed to mention in my last post that my PO assertained that I would most likely benefit from using a dyna splint to help my felxion. I am to wear it anywhere from 1 to 8 hours a day, either sitting in a chair with my leg hanging free or lying on my left side in bed. I have tried both ways, and they both hurt my hips and my lower back, but I find I can stand more hours lying in bed than sitting. I am now up to no less than 4 and more often 5 hours per day (night) wearing the splint. My sleep is consistently interrupted because I have to take it off and put it back on to get my total hours in (no way can I keep it on for 4 or 5 hours at one time, it just hurts too much), but I have to say that it is making a real difference in being able to bend my knee. (The gal who fitted me for it explained that it didn't matter how you put the time in, a little here and a little there, would be just fine as long as you get in as many hours as possible up to 8, it all counts the same because it is constantly bending the knee and streaching tissue).
You might ask you PO's and Dr's about trying one before going back under sedation. It might be worth a try! I just got up after 2 hours wearing it in bed and got on my exercise bike for 5 minutes to stretch my knee when I remembered I wanted to check this site. That's another thing I try to do several times a day, short but frequent turns on my bike, it really seems to help loosen things up. Also, I tightened the tension setting before using it tonight and was really proud that I got through 2 hours before having to take it off for a bit. Making progress (I hope).
Good luck to all, and hope to hear good things from you soon!
I am really impressed with your disciplined approach to the dynasplint. After my MUA I asked the ortho about splinting, but she didn't seem to want to go there. It occurs to me that the whole TKR is about self torture.
Thanks to everyone who replied! I am at 80 degrees now and need to get to 90 by 12/20 to avoid the MUA. PT (4x/week) is aggressive (and painful), and while I can achieve 80 there, it does not last. I am religiously doing the home exercises, but nothing seems to maintain. It is discouraging not to see progress and to be in pain so much when I thought I had a fairly high tolerence for it.
Maybe MUA is what I need.
Sorry to vent here - trying to avoid doing so much with my family.
Ask your Dr. or PT about the Dynasplint system before getting the manipulation. It could be just what you need to get you past 80. I was stuck between 80 and 90 before getting mine, and now I have hit 97 and hoping for better.
Startanew - I ckecked with my PT who seemed to feel it is better for extension than stretching. I am now at 85 and have a week and a half to go before my doctor appt. I am still in a great deal of pain, but am making slow progress and my PT says i will improve, but it will be slow, probably because I waited too long. I think I will opt out of the MUA, but my doc will not be happy!
I am already walking more than twice what I could do before and without pain. Nights are the hardest!
Sorry it's been so long since I checked in on the boards, but its that busy time of year. I saw my Dr. on the 29th of last month, told him I had reached 97 degrees and asked him if I would need manipulation. He said "absolutely not", that I was coming along exactly as expected and that in time I would be able to bend my knee more and more and a whole lot easier. I only hope he's right!! I have been doing just fine in therapy, some days are better than others, but for the most part it keeps me moving and gives me more energy. Since cold weather has started up, it seems I am more lethargic than usual, but if I get to moving around and working out, it gets better.
Last night I went to a friends house for Christmas get together, sat on a couch that was low to the ground, and when getting up, renched my knee. I have been in a great deal of pain (almost like right out of surgery) ever since. I decided to take the day off from the splint and from my home exercises, and use ice and heat to see if I could get the swelling to go down. It seems to have worked some, but I am still experiencing more pain than I have in quite a while. My PT told me that when I tweek my knee, that I need to rest and take it easy for a day or so, I think maybe it has helped, I'm not hurting quite a bad as I was last night. Still, even after more than 3 months, I am still experiencing that old extremely tight feeling that completely envelopes my knee. Can't wait for that to go away!!
How did your Dr. appt. go? I hope you didn't have to have the manipulation, and I also hope that you are getting a better flexation than you were the last time you posted. Let me know how you are doing, and I won't take so long to respond this time.
Sorry this is such a late reply! I saw my doc on 12/20 and had achieved 90 by then. He did not even mention MUA, just wanted me to keep on with the 4x weekly PT sessions for another month.
I don't think I will gain much more flex, but I am walking without pain which was my main goal. At 10 weeks, I am still not sleeping well but am only taking one pain pill before each PT session because it allows for more stretching. I wonder when it will get to the point of not "pulling" when I bend, or of not thinking about it so much! I am not so discouraged, which is good!
Again, thanks for all the comments and replies - hope everyone else is making progress as well.
Good going, Conliz! I am into a new phase with my alien knee, too. Less pain, although I have been cranking on the knee daily. The doc has me on a big dose of prednisone for the inflammation, and that isn't very comfortable, but I hope it will allow me to push the exercises a little harder so that I can avoid a surgery to remove scar tissue. When measured last week I was still at 105 flexion, but I notice that small things, like getting out of the car are a little less awkward, so either I'm adjusting to the new normal, or I'm getting to my max without quite so much overpressure. I have taken to adding a stretch in the jacuzzi at the end of my workout, and I kneel on the seat and try to sit back on my heels. Ouch! But the jets make it bearable for a couple minutes. I have also lower the seat on the exercise bike so that I get a little more stretch--it takes time to get round the first time, but I have been able to do it eventually. What I need for the new year is a big ole dose of patience--a quality I sorely lack!
Hope your sleep quality improves--I notice that I am able to do much more if I can get at least 4 good hours. Good luck!
Hi guys, just thought I would put in my two cents worth here. I am the same way as you guys are, concerned about the numbers. Not to say they aren't important, they definately are. But I think what's more important is your quality of life. Can you do things better that you could before TKR? Does taking that step hurt as much as it did before? I had a tendency to compare my right leg to my left leg as they were done 13 weeks apart. My right leg reached good numbers pretty quickly -5 and 124. My left leg seemed to be my problem child and despite agressive PT for 5 months my best left numbers are -10 and 105. I went back to work Nov 10th and I think that was one of the best decisions I made for my recovery. My job does require a lot of walking and some stairs, but I do have the option of an elevator. I find myself more and more using the stairs, my strength has improved and continues to do so. Before left surgery I was at -5 and 130, so I still have a long way to get to that point, and I may never get to it. But despite that my overall quality of life has improved dramatically. You know they say it takes a full year to heal and I'm not there on either leg yet. So I say hang in there and over time you will see that things do improve Thanks for listening.
C5-C6 Diskectomy & Fusion 9-15-98
Right Torn Medial Menicus 5-10-99
Right TKR 3-31-10
Left TKR 7-7-10
Left Revision 7-28-14
Right Revision 9-30-14
Jerseyboy--you are correct in that what counts is function, and not being completely undone by chronic pain. Glad to hear of your progress, although I sympathize with your frustration with the 2nd tkr recovery being less satisfactory. No fair!
It just goes to show that although there are treatment protocols, recovery is individual and unpredictable. No one wants to hear that, but if a manipulation helps, it helps, and you can't decide in advance whether it will help you, you can only take advice.
In the meantime, everyone is in my heart as we try to keep up the work of recovery.
My doctor has always told me that "Every knee is different" and I don't think there is a more true statement
I remember seeing the doctor the day after my second knee and him saying that "This one came out better than the first one". LOL, maybe it did, I don't know. What I do know is the recovery was.....more challanging....
MUA was not mentioned to me by the doctor or pt for that matter. There was a guy in PT when I was there with my first knee "Vinnie" who was I guess 5 weeks ahead of me with about 85 flex at the time. I remember the day he came in after and got 110 un-assisted. He ended up leaving PT at 125, so MUA for him was a very good thing.
I still have some pain in both legs ocassionally but compared to what I had!!!! I'll take this pain any day
Who knows, maybe I would have benefited from MUA, but like you said:
Originally Posted by stuckinplace
I notice that small things, like getting out of the car are a little less awkward, so either I'm adjusting to the new normal, or I'm getting to my max without quite so much overpressure.
I notice the same types of things, and in my eyes, that's hugh improvement
C5-C6 Diskectomy & Fusion 9-15-98
Right Torn Medial Menicus 5-10-99
Right TKR 3-31-10
Left TKR 7-7-10
Left Revision 7-28-14
Right Revision 9-30-14