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Scar tissue after knee replacement

Posted by leithlane @leithlane, Jan 31, 2017

I had knee replacement surgery 6 weeks ago . Through PT I have been working on breaking up the scar tissue only for it to regrow by the time I get back to PT two days later. I have been massaging at home, using a hand held massager and roller. It is painful and swollen. I am getting very disheartened. Any suggestions as to what else I can do. Has anyone had laser treatments to break up scar tissue? Were they effective?

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babette | @babette | Nov 6, 2018

@sdhkkhmz Having had this surgery reminds me a lot of the conspiracy of silence around childbirth. No one tells you how much pain is involved in the recovery. At just over 3 months out I'm only now beginning to turn a corner. Those early weeks were really really bad and even opiates didn't help.

I'm seeing an acupuncturist who shared with me the Chinese view on no icing. Inflammation, swelling and tenderness are part of the healing process and are respected as such. Not to overwhelm or confuse you but there are some mainstream YouTube videos that explain why ice is not a good idea beyond the first day or so of an injury ...

Just my .02.

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gator1965 | @gator1965 | Nov 7, 2018
In reply to @sdhkkjmz "I’m 3 weeks out from knee replacement and have experienced the same issues you have with..." + (show)
@sdhkkjmz

I’m 3 weeks out from knee replacement and have experienced the same issues you have with the scar tissue. It is very painful and nobody told me about this part of the process. I began outpatient therapy yesterday with a new therapist. She elevated my feet out the e-stem machine on the 4 corners of the knee, avoiding the incision. She then out cold packs right out of the freezer in it and set it for 15 minutes as high as I could tolerate the electric stimulus. At first it seemed comfortable but the last about 4-5 minutes is almost more than I could handle. Next time I’ll ask that she not out the ice packs directly on skin as it burns. Afterward I had leased pain and could move the knee a little more.

I think if I were you, have dr write a script for an at home tens unit and try to duplicate something like this at home. My insurance bobs did pay for it 100% - maybe your wil to. If the dr is aware of your situation see if you can get therapy 5 days a week for awhile. The pt I go to is also going to use hydro therapy in the pool once my incision is completely healed in about a month. Said it would help in movement but also in breaking scar tissue. Maybe find someplace near you with a pt with a pool- they are out there and I can’t wait to get started in moving again.

Until then I feel your pain and nobody that hasn’t experienced this cannot imagine the intense pain that comes with it. I’m sick of the almost constant pain and discomfort. Hang in there, I know it’s hard. Find a way. Rad about therapies online and ask a lot of questions and don’t take no for an answer!

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My physio at the Royal Orthopaedic Hospital, advises that they put patients straight in the hydrotherapy pool following a TKR, certainly I would have benefited from this in my case. They simply apply a waterproof dressing. They advised me that there is little chance of infection as the water is highly chlorinated. After my arthroscopic arthrolysis and debridment of the knee I was in the pool within 36 hours of the surgery.

Like you I did not like icing my knee as it caused a burning type of pain, and still does 7 months following my TKR. I prefer a gel heat pad, it provides pain relief for me.

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2 replies
dduke | @dduke | Nov 7, 2018
In reply to @gator1965 "My physio at the Royal Orthopaedic Hospital, advises that they put patients straight in the hydrotherapy..." + (show)
@gator1965

My physio at the Royal Orthopaedic Hospital, advises that they put patients straight in the hydrotherapy pool following a TKR, certainly I would have benefited from this in my case. They simply apply a waterproof dressing. They advised me that there is little chance of infection as the water is highly chlorinated. After my arthroscopic arthrolysis and debridment of the knee I was in the pool within 36 hours of the surgery.

Like you I did not like icing my knee as it caused a burning type of pain, and still does 7 months following my TKR. I prefer a gel heat pad, it provides pain relief for me.

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Make sure the ice pack in covered with a pillowcase or t-shirt before applying to your skin. Another method is to get the Ossur ice machine. You can adjust the level of cold and leave it on for hours if necessary. Moist heat pad also works well (designed to be a moist heat pad, not just getting a heating pad wet).

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turbo1 | @turbo1 | Nov 8, 2018

It has been exactly one month since replacement of my left knee. My right one was done 17 months ago, with no problems at all.
This time, although I've far exceeded the expected range of mobility, I've had a recurring problem with the scar splitting open about a quarter of an inch, through which clear to slightly pink fluid gushes forth. It started 11 days ago. It is odorless, and the tissue does not appear to be infected. However, as a precautionary measure, I've been placed on an antibiotic. If I avoid over-flexing my knee, when sitting down, for example, and keep a dressing on the site, it eventually closes. But, if I later forget and sit or rise quickly, it happens again, sometimes a half-inch or so from the last point of rupture.
This has me extremely frustrated, as my physical therapy has now been delayed. I am very anxious to finish my PT and get on with life, and am having a hard time remaining immobile.
Can anything be applied to the scar area to make it less prone to a breach?

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mylynn | @mylynn | Nov 8, 2018
In reply to @gator1965 "It has worked for me.i can now resume my career as a nurse in full clinical..." + (show)
@gator1965

It has worked for me.i can now resume my career as a nurse in full clinical capacity. I read my operation notes and it was not a pretty read. In 4 weeks following arthroscopic arthrolysis and debridment of left knee I feel fabulous. Yes I still have pain (Neuropathic pain)but better than I have done

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Sorry haven’t replied, but thank u for your response. I am getting different opinions Re arthroscopic debridment . 2 docs said they would do it and have had success in some cases , no way to know if it comes back. My doc does not do this procedure as he feels I may end up with worse scar tissue. So I’m really confused,

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mylynn | @mylynn | Nov 8, 2018
In reply to @dduke "There is something wrong. Arthrofibrosis. You have massive scar tissue surrounding your knee. You need arthroscopic..." + (show)
@dduke

There is something wrong. Arthrofibrosis. You have massive scar tissue surrounding your knee. You need arthroscopic lysis. I had the procedure as did several on this site. It made all the difference.
Arthrofibrosis
From Wikipedia, the free encyclopedia
Arthrofibrosis (from Greek: arthro- joint, fibr- fibrous and -osis abnormality) is a complication of injury or trauma where an excessive scar tissue response leads to painful restriction of joint motion, with scar tissue forming within the joint and surrounding soft tissue spaces and persisting despite rehabilitation exercises and stretches. Scarring adhesions has been described in most major joints, including knees, shoulders, hips, ankles, and wrists as well as spinal vertebrae.[1][2]
Arthrofibrosis of the knee[edit]
Arthrofibrosis of the knee has been one of the more studied joints as a result of its frequency of occurrence.[3][4] Beyond origins such as knee injury and trauma, arthrofibrosis of the knee has been associated with degenerative arthritis.[5] Scar tissues can cause structures of the knee to become contracted, restricting normal motion. Depending on the site of scarring, knee cap mobility and/or joint range of motion (i.e. flexion, extension, or both) may be affected.[6] Symptoms experienced as a result of arthrofibrosis of the knee include stiffness, pain, limping, heat, swelling, crepitus, and/or weakness.[4] Clinical diagnosis may also include the use of magnetic resonance imaging (or MRI) to visualize the knee compartments affected.[7]
The consequent pain may lead to the cascade of quadriceps weakness, patellar tendon adaptive shortening and scarring in the tissues around the knee cap—with an end stage of permanent patella infera—where the knee cap is pulled down into an abnormal position where it becomes vulnerable to joint surface damage.[8]
Patients who are recognized as developing arthrofibrosis may improve motion with appropriately directed physical therapy, corticosteroid injections, non-steroidal anti-inflammatory drugs, and cryotherapy. In many instances, however, as fibrosis has set in, surgical intervention is necessary.
Specialized arthroscopic lysis of adhesions knee procedures such as anterior interval releases may be indicated and utilized to great success, in the hands of an appropriately trained specialist.[5]

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As I wrote to gator 1965, 2 orthopedic surgeons suggested I have this surgery to remove scar tissue. They have had success with this, but not always, my original doc, who did the replacement does not do this procedure as he feels u run the risk of getting more scar tissue. Anyone have any data or thoughts on this ? Thanx!!!

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2 replies
mylynn | @mylynn | Nov 8, 2018
In reply to @bevinauburn "This is very helpful information. I have wondered how much and location of my scar tissue...." + (show)
@bevinauburn

This is very helpful information. I have wondered how much and location of my scar tissue. This was not an option offered to me. Was this office visit with a new doctor? I am trying to get an appointment with two doctors that were highly recommended to me. I have been working on this for two weeks and am still waiting for a call back to book appointment. I believe I need to be more aggressive instead of waiting for a call back. They have my referral from my GP. Dry frustrating.

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Sorry haven’t been following , but yes the mri was with a new doctor, not the doc who did my knee replace. I’m told the mri (M A R S- metal , artifact, reduction, system] is not fool proof, but does give them some of the story, My original doctor doesn’t use this and also will not do arthroscopic surgery for this as he feels it mite grow back even worse, so for now I’m doing my own PT , hoping with time it will loosen up, and he is suggesting a third manipulation as it is harmless,

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mylynn | @mylynn | Nov 9, 2018
In reply to @JustinMcClanahan "@kibe75, I had a right TKR in 2006. My recovery was awful. It was a combination..." + (show)
@JustinMcClanahan

@kibe75,

I had a right TKR in 2006. My recovery was awful. It was a combination of many factors: I wasn't aggressive enough on my rehab, the pain was intense and made rehab difficult, and I had really aggressive scar tissue growth. I ended up having to have two manipulations because my range-of-motion post replacement was a dismal 15-60 or so. Eventually I "popped" the scar tissue loose on my own, on accident, and my range-of-motion has been 0-105/110 ever since.

I learned then, and especially now on these threads, that we are all so much different. We heal differently, we react to medications differently, our bodies grow scar tissue at different rates. All I can say for certain is stick with it and keep pushing yourself. Try not to get too discouraged and quit. In total, my recovery was well over a year, but I got there. I have had no setbacks and virtually no pain in my right knee for the past 12 years.

@kibe75, how is your mobility on the knee? Are you able to use a stationary bike?

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Hi
It seems u know quite a bit ab this scar tissue, was wondering if u have any knowledge of why some people are more prone to get it? I’ve been trying to look up some info but very little seems to be know about it. I myself have mild psoriasis and now thinking this may be related , any thoughts on this?
Thanx

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1 reply
gator1965 | @gator1965 | Nov 9, 2018
In reply to @mylynn "As I wrote to gator 1965, 2 orthopedic surgeons suggested I have this surgery to remove..." + (show)
@mylynn

As I wrote to gator 1965, 2 orthopedic surgeons suggested I have this surgery to remove scar tissue. They have had success with this, but not always, my original doc, who did the replacement does not do this procedure as he feels u run the risk of getting more scar tissue. Anyone have any data or thoughts on this ? Thanx!!!

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I found a useful article on line "Stiffness following total knee arthroplasty "(2014). It discusses arthroscopic removal of scar tissue and range of motion improvement following the surgery. I certainly improved from 70 degrees to 107 in 6 weeks. It has been very hard work but I am getting there. I return back to work on Monday, which would not have been possible 6 weeks ago. Pain is still a problem, in particular neuropathic pain.

In terms of developing arthrofibrosis, my surgeon and physio advised that there are risk factors:- age of the individual ( younger people are more prone ), history of infection after the knee replacement, and being more genetically prone to producing excessive scar tissue.

My surgeon did not advocate a 2nd manipulation as he said the scar tissue would reaccumulate, the only viable options were to wait and see if it resolved by itself (This could take longer than a year, returning to work was my priority and not be retired on the grounds of ill health) or go in surgically and remove it. He felt the surgery was the only way, a risk that paid off thankfully. I had and have total trust in his surgical capabilities, I just hope he is not retired when I need my hip replacing!

REPLY
melcpa86 | @melcpa86 | Nov 9, 2018
In reply to @mylynn "As I wrote to gator 1965, 2 orthopedic surgeons suggested I have this surgery to remove..." + (show)
@mylynn

As I wrote to gator 1965, 2 orthopedic surgeons suggested I have this surgery to remove scar tissue. They have had success with this, but not always, my original doc, who did the replacement does not do this procedure as he feels u run the risk of getting more scar tissue. Anyone have any data or thoughts on this ? Thanx!!!

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I am 8 months out from my TKR and am having the scar tissue removal surgery on 11/28. I have a history of generating too much scar tissue so I suspect my issue is genetic. Ive been researching since August I’ve have one surgeon recommend the arthroscopic removal and one say to to a total revision. From the tons of research I’ve done, if you choose the arthroscopic procedure you have to also know that the PT will be immediate and intense to prevent more scar tissue. The revision is a last resort.

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