My TKR journey at 7 weeks: Should I get manipulation (MUA)?

Posted by knittygirl @knittygirl, Jun 5 3:14pm

Hi all,
I underwent TKR on April 18th. I’m a 50 year old female. My knee before surgery had 3 meniscus tears (lived in England for 3 years and the only tool in their box was PT, which didn’t fix the problem). I incurred another tear in October and was told that my knee was so riddled with osteoarthritis that the only option was TKR. My leg was deformed by my surgery date.
Fast forward to today. Due to insurance I had to delay PT for a week, then only was able to have outpatient PT 2x a week. I’m currently at 100 degrees ROM and my Dr. Is extremely upset with me. He says I should be at 120 or further. He’s threatening an MUA and I’m just trying to get a feeling for if that is normal at this point. I’m off pain meds. I push myself past the pain 5 times a day. My insurance is currently reviewing whether or not to give me more sessions (2 weeks wait), but in the meantime I’m pushing myself up to 6 times a day. Is this enough? What else can I do? Thanks for reading. KG

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Hello @knittygirl and welcome to Mayo Connect. I'm sorry that you have had such a difficult time getting treatment for your knee. Your tears in the meniscus along with the delayed TKR seem to have put you in a difficult situation. You said that you lived in the UK for three years. Was your TKR done in the States?

We have a number of members who have had a TKR and might address your concerns about the ROM numbers. You said that your doctor is threatening an MUA. I'm not familiar with that term. Could you explain?

In the meantime, I would like to invite members of our TKR discussion group to this conversation such as @johnbishop, @contentandwell, @ralph13, and @bob22.

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@hopeful33250

Hello @knittygirl and welcome to Mayo Connect. I'm sorry that you have had such a difficult time getting treatment for your knee. Your tears in the meniscus along with the delayed TKR seem to have put you in a difficult situation. You said that you lived in the UK for three years. Was your TKR done in the States?

We have a number of members who have had a TKR and might address your concerns about the ROM numbers. You said that your doctor is threatening an MUA. I'm not familiar with that term. Could you explain?

In the meantime, I would like to invite members of our TKR discussion group to this conversation such as @johnbishop, @contentandwell, @ralph13, and @bob22.

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Thank you for the reply!

I lived in the UK for three years, but moved back here to the states a couple of years ago. When I went into the doctor for knee pain and swelling in January they found that I had 2 old tears and a new tear. I had significant discomfort in my knee while living in England, but diagnosis and treatment there are not rapid. As long as you can walk, you get PT as treatment.
MUA is manipulation under anesthesia. They put you to sleep and manually break up the scar tissue in your knee by forcing it. I’ve been told that by 6 weeks you have all of the range of motion you will get and there is no changing it without an MUA. Since my PT sessions have run out and I’m only at 100, I’m wondering if there is anything that I can do from home to help further my progress. I’m pushing myself past the pain 5 times a day for a good 20 minutes at a time and all it seems to be doing is making the knee swollen and painful. For pain I only take Tylenol and Advil.
Thanks again for the response. KG

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Hi @knittygirl, I would like to add my welcome to Connect along with Teresa @hopeful33250. The only PT I had was at the hospital and then they sent me home with exercises and instructions to do multiple times a day. At 2 months it still may be a little early. I had a follow up with my surgeon to see how I was doing at about month after the TKR and he chewed me out for not icing and elevating enough. Basically told me anytime I was sitting down I should have the leg elevated which I wasn't doing enough. I also wasn't icing the knee enough to keep the swelling down. So I went back and worked on the exercises the told me to do. If you didn't receive any from the surgeon or care team, here is a list you can print out – Total Knee Replacement Exercise Guide: https://orthoinfo.aaos.org/en/recovery/total-knee-replacement-exercise-guide/

Also, I really these helpful videos from Bob and Brad – https://www.bobandbrad.com/total-knee-replacement-program. Here's the one on total knee bending that might be helpful:
https://www.bobandbrad.com/total-knee-replacement-program/8.-guidelines-to-achieve-maximal-knee-flexion-(bending)-range-of-motion–total-knee-replacement-
If you are having a lot of pain and swelling, are you icing and elevating the knee after you do the exercises?

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Wow! You had a nice surgeon. My surgeon chewed me out for not pushing hard enough through the pain and then called my PT and chewed her out. Yes, I rest and elevate when in pain after exercises . I have a little under the desk cycle that I use. It’s the only one I have access to.
Basically he told me that if I don’t improve 20 more degrees in 2 more weeks, I’m getting an MUA. I’ll try these exercises and just cross my fingers they work. I’m not having much hope.
Thanks for responding!

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@knittygirl

Wow! You had a nice surgeon. My surgeon chewed me out for not pushing hard enough through the pain and then called my PT and chewed her out. Yes, I rest and elevate when in pain after exercises . I have a little under the desk cycle that I use. It’s the only one I have access to.
Basically he told me that if I don’t improve 20 more degrees in 2 more weeks, I’m getting an MUA. I’ll try these exercises and just cross my fingers they work. I’m not having much hope.
Thanks for responding!

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Are you icing the knee along with elevating? It really helps. I used one similar to this and then gave it to a friend who had a TKR a year later – https://www.amazon.com/Large-Cold-Therapy-Pack-Cureve/dp/B07B8C7ZGQ/ref=sr_1_19_sspa

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Yes! I have tons of ice packs. I rotate them out throughout the day after exercise. Less now that I’m 7 weeks in and not in as much pain. I’m trying to get in as much ADL and exercises as possible before this next critical appointment, so I’m exercising about 6-7 times a day and icing/elevating 30 min all day.
Thanks for the response! KG

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@knittygirl

Wow! You had a nice surgeon. My surgeon chewed me out for not pushing hard enough through the pain and then called my PT and chewed her out. Yes, I rest and elevate when in pain after exercises . I have a little under the desk cycle that I use. It’s the only one I have access to.
Basically he told me that if I don’t improve 20 more degrees in 2 more weeks, I’m getting an MUA. I’ll try these exercises and just cross my fingers they work. I’m not having much hope.
Thanks for responding!

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I'm quite surprised by your surgeon's reaction, and insistence on MUA this soon after surgery.

In your position, I would have a lot of questions for him before I let him proceed.
Why is he pushing for more surgery this early? What does he see that indicates there is a risk to waiting and trying more conservative therapy for another month or two? Are there other more conservative therapies to try first?

For you, I have other questions –
Is there any way you can borrow or rent a stationery cycle for a month or two? Or, if you have a bicycle, you can buy a device at the bike shop (or on line) to make it a stationery cycle. This was the very best therapy tool I had when recovering from a bad knee injury & repair surgery, and it was what got my Mom's knees moving after TKR.

Are you following John's advice to keep that knee elevated and iced? How many hours a day?

Finally, remember that YOU are in charge of your body & your care. Not the doctor. You are not obligated to submit to a surgical procedure before you are ready. However, this can be a delicate negotiation. Outright refusal may lead the doctor to dismiss you as a patient, whereas making a specific plan with the PT and presenting it might get him to agree to waiting a while.

What will be your next steps?
Sue

I wish you the best

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Thank you, Sue. You are a wise woman and a voice of reason.

I am icing and elevating for 20 minutes every hour. I was told not to leave the ice pack on for longer. The rest of the time I’m doing ADL and exercising.

When PT told me that was the end of my therapy and I was only at 100 I basically went into a tailspin. They said it will take insurance up to 2 weeks to approve, and I will be seeing the doc before then. I will make him a list of questions to ask him and we’ll see what happens from there.

Thanks again.

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I think you are doing awesome for 7 weeks ..,..what I would give to be in your place at 100 and I am over 10 months out……I pushed and pushed for me all I got was swollen and whole lot of pain, if I were you I would try myofascial release or mfr as you will here people refer to it …. Breaks up scar tissue might get you your last 20 you need….I had mua at 6-7 weeks for me did not help dr was able to get me to 120 while I was under but unfortunately did not retain any of it …..just got pain and swelling that took weeks to go away..,,, when all said and done did not help at all…. So that is why I would try mfr first ….good luck

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I had an MUA at 10 weeks followed by 10continuous days of PT and then PT 3 times a week. It was painful but necessary. I was stuck at 100 as well. I am now 10 months out and easily bend to 125. MUA has best results done within 12 weeks. After that success rates diminish. It is not an automatic cure. You will need to work and bend beyond your comfort zone following. I hope your insurance approves you for more PT. It really is key in your recovery. I don’t know your financial situation but if possible pay for your extra PT visits. The investment you make will be worth it giving yourself a full functioning knee.

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