← Return to Poor range of motion after TKR and manipulation: What to do?

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@jillybeanc57

I had my TKR on November 19th. The doctor arranged for home physical therapy which didn't even start for 8 days after my discharge from the hospital. I wish my doctor had arranged therapy at the Physical Therapy Center where his office is located. Home therapy didn't help and 2 months later, I asked my doctor to do a MUA. The furthest ROM I got was to 80. When I saw the doctor before the MUA, he measured me at 75 ROM. I had the procedure on February 10th and my doctor said he got me to 110! Yesterday, my PT measured me at 103. I am in excruciating pain every time my PT tries to get that next measurement. I'm so tired and I actually become frightened entering the PT office because I know the pain that is coming, It's only been almost 3 months since the TKR. I'm just so tired and no one seems to understand how I'm feeling. I'm not a "quitter", but I thought i'd be doing better! My spouse thinks I'm not trying hard enough, but believe me, I'm giving it everything I've got. I have to go to PT every day last week and next since the MUA, and it's affecting my mood and sleep. Any support much appreciated!

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Replies to "I had my TKR on November 19th. The doctor arranged for home physical therapy which didn't..."

Wow- the surgeon only went to 110*? Is that a functional joint? Mine showed me a picture of my knee totally bent, about 135*! And I did aggressive daily PT after, and with exercises, I start at about 115* before, and reach 125*.
Your story about in home PT and delay was exactly like mine, so I have always wondered if scar tissue was laid down early.
The memory of 2 therapists pushing and bending my knee where I would literally hit the wall backing off in pain. OMG. Couldn’t retain those numbers for anything.

Stairs are still a PIA going down. I’m not happy with my knee but it does walk and hike at least. Very limiting in so many ways though.

Sounds like me. My PT told me that he was hitting a “hard stop” in trying to bend my leg. He said that he could tell that he was not making progress and recommended suspending PT, to which multiple surgeon agreed. This was because of excessive scar tissue. After that, an MUA, arthroscopic Debridement of scar tissue and an open Debridement for the scarring, my surgeon turns me loose, saying that we are sorry for how it turned out. HSS in Manhattan (for second opinion) recommended revision to a hinged knee. Because of the scarring, they remove all tendons, which are a major area of scarring and the hinge takes on the function of the tendons. I couldn’t use HSS (#1 orthopedic hospital worldwide) because they do not accept insurance. I am trying to get into The Mayo Clinic but have been turned down, as they say that they have more requests than they can accommodate. I am appealing that. It’s a long, painful and frustrating road. I only wish that I knew that I would be one of the ones affected by Arthrofibrosis ( excessive scarring…genetic) and I never would have had the surgery to begin with. Hang in there. I just think of others who have problems a lot worse.

I understand and can relate. I've had a replacement, manipulation, scope and revision all in 2 yrs and I'm now only at 70 degrees and my knee is twice the size of my other. I'm being tested to see if I'm allergic to metals, nickle and the cement that used in surgery. Pt did nothing but cause me pain and discomfort. Your husband should be more sympathetic it's a pain you don't understand until you've experienced it.

First of all, hang in there! Has your knee condition been evaluated as having excessive scar tissue, or just poor ROM due to a less than ideal PT arrangement. Having the pain you’re experiencing sounds fairly normal , especially if your situation is caused by scar tissue. And having a lot of scar tissue causes a lot of pain in PT, walking, etc. You’re always stiff. Make sure you get an X-ray of the operative knee post MUA to make sure there is not a crack causing your pain. Speaking of excruciating pain, my femur got a crack in it after my 1st manip at 8 weeks post 1st TKR, but doc did not inform me it was. After I recovered from that, I found a new fabulous surgeon who did a TKR revision, & rod insert in femur, and surgical removal of scar tissue 7 months later (Nov 7) Unfortunately, even after immediate and frequent PT therapy, I didn’t go beyond 70 degrees. I reluctantly agreed to a manip on Feb 11 (yours Feb 10!). 3 hours later I was in PT, the beginning of a 10 consecutive day regimen to maintain what the dr. got during the 2nd MUA (a little over 90). Because of what happened in the first MUA and the thickness of my scar tissue, dr and i agreed he would bend my knee only as far as he thought would be “safe”, so he said he stopped somewhere past 90 when the scar tissue stopped “crunching” (🫢- I know!). It’s been a 10 month journey (to you know where and back). I measured 81 /90 after the first PT session, 86 on 2nd and 3rd and 90 on 4th and 5 th. The fact that I can ride a recumbent bike and walk almost normally is a true miracle for me. I will never be the “gym rat”- Spinner, 4 mile/day walker, active person I was before the TKR, but what I have makes me very grateful! You’re ahead of me at 110 - I think you’ll get there. Stick with the best therapist you can get. Don’t know what you have available, but I go to a PT facility associated with the research hospital where I had my surgery. SO MUCH more medically focused than many of the “commercial” PT “stores”. Be as strong and determined as you can, and figure it will take a year! Best of luck, prayers, and positive thoughts!