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Manual Manipulation after Total Knee Replacement
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jeanneinct posted:
My total knee replacement was on Dec 4th, 2012. So it's seven weeks tomorrow and I have just seen my orthopedic doctor for a follow up. He tells me that I'll need manual manipulation. I have been dreading to hear those words, but I have and I'll have to deal with it. I don't know if there's anyone else that has needed to have adhesions manually manipulated under anesthesia, and if so, what was your result.

I have been going to physical therapy 2 to 3 times a week, but since the second week post operative, I had felt as though I had a tight band along the side of my knee and beneath it. It felt stiff and even manipulation by my therapist couldn't break through that tightness despite getting it to an 85 degree flexion. I'm a bit concerned that after going through manipulation that it will again be riddled with adhesion despite going to therapy next week every day. Has anyone had this done? After all the pain these past weeks, I'm really not looking forward to any more.
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ocknees responded:
Well, I'm no medical expert for certain. My TKR was in Sept. of 2012. I do have a history of severe adhesions following other surgeries. My knee was no exception.

No, I never got to the point where I needed to consider manipulation under anesthesia. I went online to read about it (various sites) and found, in my own humble opinion, it didn't seem beneficial. Most people said it wasn't worth it. I'll permit you to find such commentaries online to see for yourself.

My physical therapist applied a lotion to my knee during our PT sessions and after a massage, he'd always place a soft towel over my knee and moderately to aggressively rub my knee back and forth, side to side and really manipulate the whole knee. It felt so good afterward, but let me tell you, it didn't at first. It was something that became comfortable over time because the adhesions were slowly breaking loose each time.

I did the same thing at home - first beginning with a warm shower and running warm water (hand held shower head) on the knee (yes PTs perfer icing it, but the warmth helped ease my pain and stiffness). I massaged it with lotion and warm water in the shower. I rubbed the very scar as well. After getting out, I placed a towel over the knee and really rubbed my knee aggressively in every direction to shake those adhesions loose.

In my opinion, and I'm female, I had a choice: not disturb the knee with constant rubbing and self manipulation; or wear the mederma scar cream and leave the knee alone to decrease the ugly adhesioned-filled keloid scar on my knee. I opted for going with the ugly scar and working my knee over.

It's helped immensely. I had trouble bending my knee before and after the replacement. When I started, I was at negative 22 degrees extension. I finished 3 months of PT and now I'm zero degrees extention (completely flat) and an amazing 139 degrees flexion.

It was worth doing all that manipulation work.

I wish you all the best in whatever you choose to do. And I'm no expert. This is just my own experience. Best wishes.
 
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ocknees replied to ocknees's response:
Sentence error: I meant that I could choose not to constantly manipulate my knee and just use the mederma cream to shrink the ugly keloid scar I'm left with (due to adhesions) or the other option was to forget the mederma and work on manipulation. I chose to live with the ugly keloid scar. I couldn't live with adhesions.
 
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gingerhaynes responded:
I had a total knee replacement (Left Knee) on October 9, 2012. Went home on October 11. My orthopedic doctor told me that the surgery went perfect. 2 days after being home my home therapy started. Nurse was great, but physical therapist did nothing but sit at my table and told me to do the exercises. That's where the problem started. On my 2 week follow up I was very concerned that my rom was the same as when I was in the hospital (70 degrees). Surgeon had me stop in home therapy and start therapy at Wagner's Physical Therapy. Went 3 times a week for 3 weeks. All the therapist could get was 87 degrees. I came out crying due to pain each time. I called the surgeon and went back to see what was wrong. He said that I would have to have a manipulation under anesthesia. I was scared to death cause my youngest son is a RN, and had worked in the operating room, and told me what happens. I cried until I was under for the manipulation. Out patient surgery that takes maybe 15 to 20 minutes. The surgeon manually bends and extends the leg. I had adhesion's / scar tissue so bad. He also injected cortisone. Came out / went home feeling nothing. The following day was the worst. The muscles around the knee hurt terribly. Dr. prescribed more Norco for pain. The day after manipulation you will be back in therapy, and very little pain. I was asked to go to the surgeons therapists. I went 4 times a week for 4 weeks. My leg is doing great. I still ride a bike at home to strengthen my left quad.
 
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jeanneinct replied to gingerhaynes's response:
I had my TKR on Dec 4th and adhesions formed almost right away, Physical therapy was excruciating and I feel a waste of time, money and pain since I ended up going to manual manipulation this past Monday, Jan. 28th. He said he got a 120 degree flexion in the operation room and sent me for P.T. that same day and every day this week. It still feels restricted but the therapist got it to 120 degrees yesterday with manipulation and a few loud screams from me. I do my exercises at home but it does not feel better. I wish I never had this knee replaced. Living with the pain I had before was much more tolerable than this and far less depressing.
 
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gingerhaynes replied to jeanneinct's response:
I probably would not have had my left leg replaced if I could have walked on it. After scope Dr. told me that my knee was all but gone. I walked around in terrible pain for Way to long. I lost my job of 13 yrs. cause I just couldn't take the pain any longer. Plus I had a right knee partial replacement done in July 2011. Now that is the depressing one. Hurts all the time. After 2 months my left knee feels better than my right. If I had it to do over again on the right knee I would have been better off using crutches. Dr. just can't seem to tell me what's wrong. Hang in there and give it some time.
 
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hockeyjohn responded:
I too have had the replacement surgery, and have had 14 sessions of PT. The gains originally were fantastic, 85 degrees of flexion to 112. It has now stalled out and I too am being told that manual manipulation is the only way to break up the scar tissue.
I have tried all forms of massage/heat/ice/stretching and the band at the midline of the knee continues to make bending any further impossible. It's scheduled for next Friday and I am wondering if you have moved forward and what your experience has been?
 
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jeanneinct replied to hockeyjohn's response:
It was two weeks ago that I had the MUA (manual manipulation under anesthesia) The most flexion he got under anesthesia was 120 degrees.I was ordered to go to therapy that same afternoon and it was painful (as usual) but I was able to bend it. At the fifth day post manipulation, the therapist bent it to 120 degrees but it was so painful that I was begging her to stop, which she didn't and let out a final scream when she got it to 120. It was embarrassing, but I couldn't help it. I was supposed to go back to the doctor yesterday for a 2 week follow up but the blizzard prevented me from getting there, and I haven't been to therapy since last Friday.

Essentially I'm trying to keep exercising on my own until I can make it back to therapy and bending my knee against the arm of my couch as far as I can. I have pain when I walk and I'm still not going down the stairs one-foot, one-step at a time. I had done that accidentally when I had adhesion and felt like my knee exploded, I cried for five minutes from that pain. I'm going to wait to get to that point in physical therapy which by the way costs me $40 co-pay every visit. I go 3 times a week, so it's expensive.

Basically I feel as though I'm a brand new post operative knee and beginning therapy all over again but this time with a much greater degree of flexion. I use heat and I also massage my knee and scar. There are no adhesions under the scar, my therapist told me it's nice and loose beneath it. But there's still swelling present especially after therapy and I ice it up right away. The rest of the time, I use heat. This is such a slow healing process that it becomes depressing. The progress happens in tiny increments that are barely noticeable. I can count the number of times on one hand that I can stand or walk with no pain at all.

This has to get better, or I'll curse the day I decided to do this knee replacement.
 
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hockeyjohn replied to jeanneinct's response:
Oh no!!! That is my greatest fear. My knee feels great and the only pain is when we try to force the flexion past the 110 mark. I can sit comfortably at 90 and have been walking, stretching, etc for a month with no pain. I worry that by having this manipulation that I will have to start back at the beginning. I only have 6 therapy sessions left and the "wise" insurance company is not allowing any additional. I can do the work on my own, but my experience at PT has been fantastic and their assistance is invaluable. Hope your's gets better and I guess I just cross my fingers for my proceedure on Friday.
 
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jeanneinct replied to hockeyjohn's response:
Good luck to you. It does feel much better afterwards and the procedure is very fast and painless. The doctor told me that he's satisfied with 120 degrees because that will be enough for most of the normal activities. I've read about people getting a lot more than 120, but I don't think I'll get there. As you said, it's almost like beginning therapy again only now there's more focus on strength training. I found out that my health insurance offers the 'silver sneakers' benefit. This will cost me $12 a month but I'll have access to any YMCA in my area and there are three of them that have pools and exercise rooms. That will be my plan for rehab after I get the green light to be discharged from physical therapy. It might be an option for you also if you check with your insurance. A woman at physical therapy let me know about that benefit.
Good luck to you on Friday, you'll do just great!
 
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arbob5 replied to jeanneinct's response:
If you have access to a pool, by all means, take advantage of it. It is the very best therapy and while you're exercising in the pool, there is no pain...really...no pain at all.

We have the "silver sneakers" with our insurance also, and while I had my first THR 8-1/2 years ago, TKR 8 years ago, and my latest THR on July 16, 2012, I still use the pool at our Y and it has made all the difference in the world. It was recommended by my physical therapist when I finished my pt right after the latest surgery.

Think positive, do your regular exercises as recommended by your therapist, and, water therapy is the greatest.
 
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hockeyjohn replied to jeanneinct's response:
That is great news. I will check with insurance. They are delivering the Passive Motion Machine today for use over the weekend before I go back to PT. I work at my flexion everyday and have been told that is the only way to ever get "it" to feel normal. I have a friend who had TKR 2 years ago and he has had numerous problems, but none are truly related to the knee. I was warned that true recovery is measured in 3 month intervals, 3 mo post surgery you should feel really good, 6 months you should be even better, etc.... I know from past ACL rehab that rebuilding the strength is a slow process, but is the most important. Keep at it!!!!!!
 
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ffman responded:
I had a knee replacement oct 30.... Had a manipulation just done on my knee almost 2 weeks. It's really not as bad as it sounds. You are gonna be sore but I have been sore all this time. The key is patience and work it. Everyday I work it. Yes it's soooooooooo frustrating but it will get better
 
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jeanneinct replied to ocknees's response:
Being a Registered Nurse, I can say that I AM a medical expert and know that some peoples bodies build adhesions more than others. Adhesions are fibrous bands that occur due to tissue trauma. It happens to some degree with ALL surgery. I had been going to physical therapy three times a week. On the days that I wasn't going to physical therapy, I did the exercises at home. I used Bio-oil on my surgical scar and it healed so well that it was barely noticeable. It's just a thin white line. I didn't have the thick keloid scar as some people have developed. My therapist did the manual manipulation after every session, trying to force my knee more than 80 degrees. It was impossible to do since the adhesions had restricted the muscles from bending. Manual manipulation under anesthesia was not a choice, my surgeon didn't ask "may I?" and it was NOT preventable in my case which it usually isn't in most cases. When I went for my follow up visit after 7 weeks of agony, the doctor knew in 3 minutes that it was absolutely necessary or I would not regain range of motion ever. He didn't give me options. Breaking of adhesions under anesthesia is similar to breaking a bone, there are audible 'snaps' heard when they're released. I left the surgical suite and went directly to therapy. I was finally able to be manually manipulated by the therapist to just a little over 90 degrees which was amazing.
Please don't judge people and assume they haven't worked hard at rehabilitating their knee post-op. Things like adhesions happen more in some than in others no matter how much lotion, creams or oils they apply or how much they are working at rehabilitating. People all heal differently, so consider yourself fortunate that you weren't one that required manipulation under anesthesia.
 
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designlady54 replied to jeanneinct's response:
I had my TKR on 11/16/11 and I worked my behind off in PT and did great, I was afraid to do the surgery because of my weight but had no choice so I did 150% of everything they ask me to do. My problem is within the last year I have been having pain in my knee and hips and today I heard and felt a creaking noise coming from the knee and a dull pain across the front of the knee and found it difficult to walk on it. Does anyone know what could be causing this pain?


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