Limited ROM after total knee replacement.

Posted by Ozziegee @ozziegee, Jul 7, 2017

Hi, I seem to be stuck around 90 degree ROM following tkr surgery 20 weeks ago. I went to PT for two months and have been doing post op stretches and exercises daily. I’ve had constant swelling ever since the surgery and recovery has been very slow because of it. I’ve also had several prior surgeries on the same knee so figure scar tissue is at least a big part of the problem. I was wondering what options are available to me without doing a MUA? Any thoughts or suggestions?

Where or how do I find the Mayo Clinic videos on rehab stretches?

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@nancylh

Hi Ozziegee.

Sounds like you’re stuck in a frustrating place. My TKA was 1-5-17. The swelling has never gone away completely. My knee, entire leg and ankle remain swollen. I’ve tried ice, compression socks (they helped a little) etc. but still swollen. My surgeon’s assistant just keeps telling me it is normal for up to a year. How encouraging. The scarier part is when something in there moves and then it pokes and hurts, but we’d better not go there.

Anyway, this is about you, not me. As gailfaith pointed out above, movement, bending, stretching, all of those exercises PT gave you are what make the difference. When i would go into PT my ROM would be like 94, coming out 104.

You indicated that you are doing all of the exercises and stretches (i was not very consistent with this) so i just wonder if they need to change which exercises you should do. Over the five months of PT, mine changed every week. I go back to PT next week to see if i kept the ROM and can quit therapy.l

My PTs used some stick thing to rub out the scar tissue. OUCH. Not sure if that works on previous scar tissue though. What is a MUA?

I’m not happy with the exercises the last PT gave me. The student PT i had gave more exercises—may resume those. He has moved on.

Sorry i don’t have better info for you. I guess at this point we need to just keep doing the exercises and walking. Or maybe check with a different PT to see what else can be done. And as always ask the guy upstairs to heal it.

Nancy

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Just to clarify, i was in no way was i making a negative assessment of the Mayo. Sometimes the continuity of a discussion gets lost. I think i remember mentioning about my morbid obesity in a previous post. However, just to clarify so that no one gets confused here is some information about medically complicated morbid obesity and TKAs.

There are risks that go with medically complicated morbid obesity. Some physicians won’t do over BMI 40. Some do 40-45
and some 45-50. Comes with the territory. The following paragraph explains why physicians decline to do the surgery on morbidly obese people.

Restricted access
Because of the increased risks of complications, it is common practice for some surgeons to restrict the use of TKA in patients with a BMI of 40 or higher. Based on the current available data, many surgeons and surgeon groups across the country withhold surgical intervention in morbidly obese patients until body weight is optimized and associated medical comorbidities are better controlled.3 There may always be exceptions to this type of policy, and opponents to this position do exist. Nevertheless, the medical and societal implications of withholding TKA in morbidly obese patients are unknown.

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@nancylh

Hi Ozziegee.

Sounds like you’re stuck in a frustrating place. My TKA was 1-5-17. The swelling has never gone away completely. My knee, entire leg and ankle remain swollen. I’ve tried ice, compression socks (they helped a little) etc. but still swollen. My surgeon’s assistant just keeps telling me it is normal for up to a year. How encouraging. The scarier part is when something in there moves and then it pokes and hurts, but we’d better not go there.

Anyway, this is about you, not me. As gailfaith pointed out above, movement, bending, stretching, all of those exercises PT gave you are what make the difference. When i would go into PT my ROM would be like 94, coming out 104.

You indicated that you are doing all of the exercises and stretches (i was not very consistent with this) so i just wonder if they need to change which exercises you should do. Over the five months of PT, mine changed every week. I go back to PT next week to see if i kept the ROM and can quit therapy.l

My PTs used some stick thing to rub out the scar tissue. OUCH. Not sure if that works on previous scar tissue though. What is a MUA?

I’m not happy with the exercises the last PT gave me. The student PT i had gave more exercises—may resume those. He has moved on.

Sorry i don’t have better info for you. I guess at this point we need to just keep doing the exercises and walking. Or maybe check with a different PT to see what else can be done. And as always ask the guy upstairs to heal it.

Nancy

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Hi, @niazumbanut. I’m wondering if you would mind posting the link to the particular video you saw and liked on post-knee replacement exercises? I think it might be of interest to various members who’ve been talking about knee replacement, and it would be great to be sure of finding the right one.

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@ozziegee

Yeah, I’ll try the rehab video as well. Think I’ve seen just about all the tretching, bending exercises but worth a shot. MUA is manipulation under anesthesia. They knock you out and then the surgeon bends your knee back attempting to break up the scar tissue.

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I'm sorry if I'm not writing in the proper place here. I'm a newbie ;o) Did you have the MUA? If so did help? I'm facing the same thing and scared to death!

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@ozziegee

Yeah, I’ll try the rehab video as well. Think I’ve seen just about all the tretching, bending exercises but worth a shot. MUA is manipulation under anesthesia. They knock you out and then the surgeon bends your knee back attempting to break up the scar tissue.

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Hello @barefoottwin, and welcome to Connect. You did post in the right place. We have multiple discussions on knee replacements here on Connect. Here is another one that is quite active, https://connect.mayoclinic.org/discussion/scar-tissue-after-knee-replacement/. That discussion has been a bit more active more recently, so you may be interested in clicking on the link and reading through some of the things the members have shared.

I had my right knee replaced in in 2006. I had aggressive scar tissue formation and had to have two manipulations to try and break up the scar tissue. Eventually, after a year plus, I achieved 0-110 ROM. It was not an easy road, but it has been worth it in the end. I was fighting years of bone damage, so my right knee had not been straightened to 0 for well over a decade. When I woke up for my manipulation they had my leg in a brace straightened to 0 degrees. As you can imagine, all of those muscles and tendons were screaming because they were being stretched in a way they had not been stretched in a decade. I can understand your fears, especially since we are all so different and our bodies react differently.

@barefoottwin, if you don't mind me asking, how is your range of motion right now?

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@ozziegee

Yeah, I’ll try the rehab video as well. Think I’ve seen just about all the tretching, bending exercises but worth a shot. MUA is manipulation under anesthesia. They knock you out and then the surgeon bends your knee back attempting to break up the scar tissue.

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Hello @JustinMcClanahan and thank you for allowing me to join and thank you for the link!
I'm 7 weeks out from my knee replacement. I had a lot of problems the first 4 weeks because I had a huge hematoma, which added to the swelling after surgery. My drain fell out, I don't even think it was even put in. It was just laying next to me on my bed.

At my first PT, two days after surgery, I had "Range of motion – Initially range of motion 20-86 degrees of the right knee. After interventions patient had range of motion 11-93°." That was a horrific experience with PT, not because of the therapist working on me. There was a PT over seeing a student and he was very hyperactive and annoying, pacing back and forth and playing with a ball, while watching me. He suddenly left the opposite side of the table from my PT, then turned towards me, leaned over, grabbed my ankle and pushed it as hard and a fast as he could towards my butt. I was in shock and the pain made me scream out. He was actually violent! That was the end of my PT.

That night my leg started to swell more, turned redish pink and hurt more than before. I took a picture with my phone and sent to my doctor because I thought it might be infected. I had an x-ray and saw the doctor the next morning. That's when I was told I had a large hematoma.

My range of motion never got back to 11-93° It had actually gotten worse when bending it. I don't know what AROM is or PROM means.
Knee extension: -8dg AROM
Knee extension: -4dg PROM
Knee flexion: 82dg

I saw my doctor again a few days later, the back of my knee turned black. At this point I was told not to go PT and just rest but do my home exercises, which I did.

At 4 weeks they finally aspirated it, it was full of blood. No, it didn't help the pain or swelling once the lidocaine wore off. The doctor was talking about a manipulation at the 4 week mark, and that scared me.

My last visit with my doctor was March 5th and my report reads "the patient has approximately-3 to 90°"

I've been going to a new PT and as of Saturday his report is -5 to 115°

I spent 4 weeks in a hotel because I live 1200 miles away. I've been visiting a relative for two weeks now and go back to see the doctor this week.

He wants to do a manual manipulation because I'm not making enough improvement.

Do you or anyone else know if there are there any other options besides a manipulation?

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@ozziegee

Yeah, I’ll try the rehab video as well. Think I’ve seen just about all the tretching, bending exercises but worth a shot. MUA is manipulation under anesthesia. They knock you out and then the surgeon bends your knee back attempting to break up the scar tissue.

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I am so sorry for your pain and mental anguish. I hope you reported it to the doctor and the society for physical therapists, or similar name.

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@ozziegee

Yeah, I’ll try the rehab video as well. Think I’ve seen just about all the tretching, bending exercises but worth a shot. MUA is manipulation under anesthesia. They knock you out and then the surgeon bends your knee back attempting to break up the scar tissue.

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Thank you, I did report him to the doctor. And I plan to report it to the head of the department. I never thought of the society or physical therapists, or similar name. Thanks for that idea!

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@ozziegee

Yeah, I’ll try the rehab video as well. Think I’ve seen just about all the tretching, bending exercises but worth a shot. MUA is manipulation under anesthesia. They knock you out and then the surgeon bends your knee back attempting to break up the scar tissue.

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@barefoottwin, I am not positive but I think this is what AROM & PROM mean: "Passive range of motion (or PROM) – Therapist or equipment moves the joint through the range of motion with no effort from the patient. … active range of motion (or AROM) – Patient performs the exercise to move the joint without any assistance to the muscles surrounding the joint."

Has your surgeon mentioned that scar tissue is playing a role in you inability to make progress? I was told that a manipulation is to break the scar tissue up. I was also told that there is a certain timeframe that a manipulation can be used, because eventually the scar tissue gets so strong that you would risk breaking the femur during a manipulation. As I said, I had two manipulations and ultimately I ended up breaking the scar tissue up on my own playing catch with a football with my friends. The only other option that was discussed was an additional surgery to cut the scar tissue out, but the risk of infection outweighed the benefit for me.

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@ozziegee

Yeah, I’ll try the rehab video as well. Think I’ve seen just about all the tretching, bending exercises but worth a shot. MUA is manipulation under anesthesia. They knock you out and then the surgeon bends your knee back attempting to break up the scar tissue.

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Yup, I think you're correct. I just read some of my PT reports and it all makes sense.

We did not talk much about scar tissue today but I do understand that's partly the cause of my lack in flection.

He is not thrilled that my bend on my own, is only 90°. But he was happy that it's almost straight. Today is 7 weeks so we talked about the manipulation again. He did tell me there is a time frame as when to do it safely. He thinks another week or two is about my limit to get it done safely.

I plan on doing as much PT as I can and really push myself to get past 90 on my own in the next week to 10 days. But to be honest, I don't have high hopes but I'm not a quitter so I will give it my best shot.

I have a friend who had the manipulation done and she said she's never gotten past 90°. Her knee looks like a basket ball but she has no pain. She seems content with that but I know I wouldn't be. I'm a photographer and I need to be able to move around.

My biggest fear, if I haven't mentioned it, is more pain.

I was in a bad accident in 2005 and I've been in chronic pain since, I've had a total of 9 surgeries so far. I was really hoping this would help me a lot. I imagined I'd be walking better which, would help some of that pain.

I will give this my best shot this coming week. Unfortunately we all know that nothing is guaranteed in medicine, that's why it's called "practicing medicine, right?

DG

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@ozziegee

Yeah, I’ll try the rehab video as well. Think I’ve seen just about all the tretching, bending exercises but worth a shot. MUA is manipulation under anesthesia. They knock you out and then the surgeon bends your knee back attempting to break up the scar tissue.

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I had tkr on January 29,2018. I had 10 therapy sessions with the Pt. I had my pt manipulate the scar tissue with her thumbs on every sessions, I did my exercises at the gym. She also did dry kneeling when ever she found a tigh spot on the thigh that was hindering the bend.

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@ozziegee

Yeah, I’ll try the rehab video as well. Think I’ve seen just about all the tretching, bending exercises but worth a shot. MUA is manipulation under anesthesia. They knock you out and then the surgeon bends your knee back attempting to break up the scar tissue.

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Sorry, I accidentally touched the post button.

I had tkr on January 29,2018. I had 10 therapy sessions with the Pt. I had my pt manipulate the scar tissue with her thumbs on every sessions, I did my exercises at the gym. She also did dry kneedling when ever she found a tight spot on the thigh that was hindering the bend. The last few days I was instructed to bend my knee every 30 minutes even if I was sitting in a chair. I had a steady progress with man6 hours of hard work. She finally discharged me yesterday. I was very fortunate to be able to measure at 142 degree bend. I owe my success to lots of scar tissue manipulation by the Pt and the spinning bike. I was also very religious do8ng all the exercises I was told to do. I still can feel little snapping of the scar tissue in the knee while I’m biking. I had my other knee replaced in 2011 and it has a bend 146 degrees. I just wanted to share my success story so it might be an inspiration for someone.

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@ozziegee

Yeah, I’ll try the rehab video as well. Think I’ve seen just about all the tretching, bending exercises but worth a shot. MUA is manipulation under anesthesia. They knock you out and then the surgeon bends your knee back attempting to break up the scar tissue.

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Thank you for sharing your story. It does help to hear when some gets through this. I’m going exactly what I’ve been told to do everyday but no one (except my doctor) has even mentioned scar tissue to me. I decided to call my massage therapist who did wonders for me a few years ago after my second back surgery. He said he can work on me to help break up the tissue but it wouldn’t be relaxing. LOL I went to see him directly after PT yesterday and I think between both, I over did it. I’m going to try every other day with both plus my exercises. I would love to know what you did at home to help the scar tissue.
I don’t even know where to begin. My whole knee is swollen and tight.

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@ozziegee

Yeah, I’ll try the rehab video as well. Think I’ve seen just about all the tretching, bending exercises but worth a shot. MUA is manipulation under anesthesia. They knock you out and then the surgeon bends your knee back attempting to break up the scar tissue.

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Well, I just followed my PT’s direction. Strength building exercises were the easy part, bending not so much. After warming up and massaging the scar tissue I’ll lie on my back, bring my thigh/knee in vertical position and take few deep breaths, with each exhale if you relax your body the the foot will come down a few mm. The key for me was to completly relax. Every morning the knee will be stuck let’s say at 80 degrees or so even though I’d have a knee bend of 110 or more at the therapist the day before. But I was able to loosen it up and match it pretty close to where the therapist had left me. Some times I’ll put my hiking boot on the foot to assist with the weight. I did the same with the therapist. I could never relax with her not knowing when she was going to push, so I followed my own procedure ther3. She just sat n3xt to me with measurement tool. Again, the key for me was to relax.

On a side note I’m pretty limber to start with which also helped me. I rarely sit on the couch at home, instead prefer sitt In on the carpet, that can amazingly make one more flexible.

I hope that it helps. Good luck to you!!!

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@ozziegee

Yeah, I’ll try the rehab video as well. Think I’ve seen just about all the tretching, bending exercises but worth a shot. MUA is manipulation under anesthesia. They knock you out and then the surgeon bends your knee back attempting to break up the scar tissue.

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Leg raises help with swelling. Legs up the wall pose, you can find that on line at yogajournal.com. I was asked to raise my leg at least four times a day.

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