Scar tissue after knee replacement

After reading so many posts about problems with scar tissue, I became very concerned. Had tkr 5 weeks ago, and generally doing remarkably well. Still lingering pain and swelling, but flexion 117 and extension 4 after 4 weeks, so great! However, PT remarked that there will/may be scar tissue forming at the very end (top 1” of incision) above the knee cap. Wondering how much and where the scar tissue is that is causing people so many problems..... I’m massaging daily, and so far it seems to be ok. On the other hand, some posts indicated that the problems can start much farther into the future. Any input?

My scar tissue started occurring at just under 3 weeks post TKR, certainly this was when a very observant physio noticed that things were not progressing as they should do. At this point my knee flexion was under 70 degrees, and then despite intensive physio this continued to worsen in between physio appointments. It felt like my knee was surrounded by concrete. I had a manipulation under anaesthetic at 11 weeks post TKR, I was then advised that I had arthrofibrosis. The scar tissue reformed at 2 weeks post manipulation despite more intensive physio, and I was unable to maintain by range of movement between physio sessions. 13 weeks after the manipulation I underwent arthroscopic arthrolysis and debridment of left knee for extensive fibrosis . It is a daily battle to keep my knee flexion at 90 degrees, it feels as though my knee is surrounded by Velcro.

You have described my situation almost except I haven’t had the arthroscopic surgery. I was scheduled for that surgery last week. At pre op appointment my surgeon didn’t give me much hope that I would be better so I canceled my surgery. I am now trying to get another opinion. I had one manipulation and the outcome was like yours . I am 16 months post op., still only 90 degrees. I am now wondering i getting a second opinion is worth it, I have started my own PT routine of my bike, lunges (doctor had me doing them daily after taking pain meds to try to betray scar tissue) medicine ball and long walks..
Do you feel the arthroscopic surgery was worth it? I am assuming you had intense PT after?

I also had similar problems. I had the arthroscopic surgery and it made a big difference. After the surgery, I biked for eight minutes and did lunges every three hours ( even through the night). I did not want to allow scar tissue to form again after the Dr. cut it out. I have much better ROM now, can go down the stairs, etc. Still a little stiff, but working much better.

WOW! I was just going to ask if others could respond about this surgery. My doctor didn’t give me much hope. I have worked very hard and am willing to do PT again at facility and at home.
How long ago was your surgery and what is your ROM now?

It is still early days, but I feel that the arthroscopic surgery was worth while. I have been off sick from work for nearly a year. My surgeon gave me 3 options back in late August:- 1. To leave things as they were and that things might get better in a year or so.2. Repeat manipulation under anaesthetic 3. Arthroscopic arthrolysis and debridment of left knee. Having offered me 3 choices he felt that the arthroscopic surgery was the best option in order to get me back to work. I saw occupational health earlier this week, and they are happy for me to return to work next month, I just need to convince my manager and HR.
Today for the first time I have managed to complete a full revolution on my excercise bike, and managed to cycle for 2 minutes.
In terms of physio I am having weekly hydrotherapy, and then doing my own physio regularly during the day. My physio at the operating hospital, has backed off, although still keeping an eye on things, as she believes that aggressive physio is or has triggered off the arthrofibrosis. What has also helped this time is baclofen and amitriptyline for neuropathic pain.

@gator1965

I'm interested in your comment about aggressive PT triggering scar tissue. Especially early on, my gut told me that PT was causing more inflammation and pain/problems than it was helping. I persevered, and still go (though to a new therapist) but I would have to be much better educated to understand how over-traumatizing a replaced body part repeatedly is really going to help things.

My understanding is that physiotherapy needs to be aggressive enough to restore movement in the joint, but not so aggressive that it triggers an inflammatory reaction. My physio explained that it is a fine balance. I am learning to listen to my knee after this surgery, and avoid the temptation to push it to the limit.
I believe that given time the arthrofibrosis tissue remodels itself, but this can take a year or longer.

I agree with gator . There is a balance . At first pt pushed so hard that my swelling increased and made everything worse.

I am considering arthroscopic surgery but today a new doc told me that I should get a special mri first. It is a metal suppression mri for tkr. And then he could see the amount of scar tissue and where it is, and perhaps see if the surgery would help.