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Scar tissue after knee replacement
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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@gutthookd John, you have given a lot of good and useful advice here. Thankfully most of us had better outcomes but there is a large percentage of people who are not happy after knee surgery, I have heard it to be as high as 30%.
Prior to my first TKR, I did not research as much as I should have, I was in extreme pain, 24/7, so I took a surgeon who sounded good and could do my knee sooner than some others could. I was more careful in choosing the surgeon for my second TKR, I was not as desperate. I had excellent recommendations, and he was rated five stars on the rating sites. That being said, you cannot rely on them at all, but if there are many reviews of a doctor it is more reliable. My first TKR was not bad, just not as good as my second one.
Exercising beforehand to strengthen the supporting muscles is a huge advantage, as is losing as much excess weight as you can.
I too would be interested in hearing more about the X10. I believe someone else mentioned on one of the discussions. I am planning to have a lysis done and the X10 may be helpful after that. My flex is under 120, so I am hoping to improve that.
JK
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1 ReactionThanks @gutthookd - I can understand why you haven't had the shoulder done yet. I agree with @contentandwell JK that there was a discussion of the X10 machine not too long ago and also a discussion of alternative treatments like acupuncture and myofascial release. I'm going to tag some people who may be able to shed some light on this @lkinny, @golfshrink and @melcpa86. Wishing you the best of luck with your recovery decisions.
I’m shocked at how much the myofascial release and Acupuncture has helped. Unfortunately, I started both of them at the same time, so I’m not sure which is helping the most. I feel that the acupuncture took most of my nighttime pain away after two sessions. Myofascial release probably would’ve been more effective earlier on in my rehab. Feels good but wears off rapidly.
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2 ReactionsHello all. I'm a healthy 62 yr old female who had total knee replacement. It didn't bend properly so I got a manipulation done. During the process the Dr broke my femur. An emergency surgery was done to remove the original apparatus and replace it with a different model. It's been over a year and the scar tissue will not go away. I want to try astym or arthroscopic surgery with hopes of less stiffness and more rom. Is there hope/help for me??
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2 Reactions@blessangela2019 Once scar tissue forms I don't believe it will go away without some surgical intervention. I cannot say that I am 100% sure, I could be wrong. I was not familiar with astym so I just googled it. It sounds very encouraging. To increase my flex in the knee done in October 2017 this is what the surgeon's NP said:
An arthroscopic lysis of adhesions is what the procedure is called. The doctor goes in with a small camera and a small tool that burns the scar tissue away. He doesn't use the long incision. He makes two small 1/2 inch incisions to get his tools in the knee. It's same day surgery. You go home after the procedure. You walk, fully weight bearing right away. You start using the bike the day after surgery. Treadmill would wait several weeks until you have minimal swelling and get good motion on the bike. Once we see you at your first post-op appointment approx 10-14 days after surgery we see how your incision is healing and will let you know when you can get back in the pool.
Is your doctor proposing the astym procedure? If you have confidence in him I would go with what he advises. If you are not sure you should get a second opinion.
I have no idea which procedure is the best, but if your doctor tells you more about the astym, I would be interested in it, if you could share it.
JK
Dear Angela -
I'm genuinely sorry to hear your story. My own is not "the same", but probably similar in a lot of aspects. There
is so much that we as patients do not know prior to surgery - and everyone I've ever talked to that ended up
having problems after... mostly trusted in their surgeons that "this was no big deal" and that they would be "well
taken care of". In reality, there mostly isn't a co-ordinated care plan of any kind (that includes your surgeon - or
anyone else). If you are lucky, you'll get a physical therapist who is empathetic - and who will try to do something
other than just telling you "how great your knee looks" (when it doesn't) and "how good you are going - how well
you are progressing (when you clearly aren't). Many of these physical therapist's (I can't say "most" - although
I suspect this) won't honestly communicate the difficulties you are having (physically), the pain you seem to be
experiencing and etc.) back to your surgical team. IF the physical therapist does this (and of course - they should),
they will potentially "cost themselves business" (because a lot of these surgical teams... want patients "encouraged",
don't want to be bothered with problems they probably do believe are temporary - and will eventually resolve over
time... and more importantly - to them, don't want their time wasted doing things which are NOT additional surgeries).
As a physical therapist -- if you "get a name for" being a patient advocate or honestly reporting problems when you
see them... there is a good potential for you to be "punished" with less referrals from surgeons (and less business,
period). This is another case of incentives pointing exactly the wrong way if you are a patient.
After you have a TKR surgery and experience problems with your recovery... while you are sitting around (elevating
and icing), you start to "get educated" on this subject. Most TKR surgical recoveries are a kind of "race" between
the inflammation and scar tissue formation - and getting the necessary flexion (bending) and extension (straightening).
Based on individual differences your inflammation and scar tissue formation may proceed faster than you can develop
much flexion and extension. Of these two - the extension is absolutely the most important (because if you can't "straighten"
the leg properly, your walking "gait" is negatively affected and it's more likely that you will just continue building scar tissue
to the point that all progress first "stops" and is then "reversed" (and you find that over time you are able to bend and straighten
the leg progressively less - as this is "blocked" by scar tissue accumulations... which just increase over time). The scar tissue
does not "go away" on its own... generally. ASTYM can reduce surface scar tissue, but not the scar tissue which accumulates
in the joint itself. Arthroscopy can remove the scar tissue but often (in my case) promotes exactly the same response (serious
inflammation - and massive scar tissue accumulation resulting almost immediately). This is a process which is well understood
by surgeons and PT providers, but they don't seem to have a good idea for how to avoid this. The most common complaint for
people who have problems with their TKRs is "a persistently stiff and painful knee". In some cases (maybe a lot of cases), this
may be due to a metal or in some cases I am aware of... an adhesive allergy... in my own case originally, this was an allergy to
components of the alloy used in what I believed was a "titanium" prosthetic, but was in fact... a titanium alloy). If you think about
how many women (I guess "men" too - these days) have an allergic reaction to an earring "post" that isn't sterling silver or a
certain kind of stainless steel... you begin to understand the potential numbers of people involved (especially when you are also
considering this is a metal device implanted in your body... AND that metal isotopes are regularly released as part of the normal
process of an articulating joint... moving). This process of metal isotopes being released in the bloodstream (and what negative
effects could be - or are being experienced) is not well understood. When you multiply the numbers 723,000 TKRs in 2017 in
the US by the fact that the Nationl Institute of Health (NIH) says that about 15% of the US population has some degree of allergy
to Nickel or Chromium (which are common in prosthetic alloys) then you start to understand the potential numbers of people who
may be experiencing long term problems.
I was almost a "poster child" of a 59 year old male who had dropped a bunch of excess weight (and kept it off). Now I am soon
to be 63 - and have had an original TKR, a MUA, an arthroscopy, a partial revision, and then (finally) a metals allergy test (with
me - it was Maganese and Molybdenum... which were both present in my first prosthetic alloy) and then another TKR - this with
hypoallergenic components. I still have problems with inflammation and scar tissue formation - and have had another MUA
after this latest surgery (12/17/18) - the only difference being this time with a cortisone injection... which has helped. Maybe... I
am starting to improve slowly (but still... have a ton of pain and inflammation).
Beware of... "pain clinic persons" who are typically "injection specialists" and will try to sell you on PRP, stem-cells, and you
name it (none of which can do much for an already replaced knee). Diet can help (some) with the inflammation. Other than
that, I'd say definitely get yourself tested for a metal allergy if you continue to have problems. Do your own research, but
I think you will find that the MELISA test is the "gold standard" as far as this is concerned (not a simple skin allergy "scratch
test" - which might work fine for a certain make-up applied to the skin, but NOT for an object to be implanted in your body).
I recommend reading up on the subject (of problems with TKRs - you'll find what you are describing is the most common
complaint). Personally... I'd rather have an honest answer than a bunch of blue sky and sunshine. I hope there is an
immediate "cure" for all of this - for you, but there may not be. Honestly, I have to admit that I have some level of outrage
that surgeons are actively promoting these surgeries - when they don't understand "how to make it all better" if problems
are experienced (and frankly, I don't see a lot of interest from the surgical community on this... even as they try to figure
out ways to do even more surgeries - in the shortest amount of time possible). It's a BIG MONEY making business - and
like I said previously (from the patient standpoint), all the incentives are pointed in the wrong direction as far as helping
you to achieve a full (or as much as possible) recovery.
But like I also said - I do believe "the answer" is out there... and I haven't given up looking for this. Who is properly
"incentivized" to find an answer... other than the people who are suffering from these "less than optimal outcomes".
My very best to you (and everyone). Please feel free to ask me any specific questions. I can point you toward reseach
I am aware of... and if I really just "don't know" - then I'll say "I don't know" and maybe we can both (or all) find out.
John
I believe that there is probably an answer that will work for you (and me, and others) out there (somewhere - maybe not in
this country... which as it turns out is very backward in certain areas as far as the practice of medicine goes).
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1 ReactionGood afternoon, Debora (and thanks for your response) -
My "timing" has not been good in many cases regarding the original TKR and follow-up procedures.
A little bit like how we all (or maybe it IS just me) learn "about" being married... AFTER we have been
married (joking... mostly). Knowing what I believe i understand now, it would've been most optimal to
have been immediately put on that X10 (the name was taken from "extension" - which the surgeon and
co-inventor Dr. Halley, felt like was the absolutely most important "thing" to develop as quickly as possible
after surgery (or an MUA). In my present state, it might work - and it might not.
I'd appreciate any further information from people who've actually used this (as a patient).
Thanks again (and good for you - helping as a vlunteer)
John
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1 ReactionI wish my surgeon would do that procedure for me but he says no it won't work have to open up the knee and do another replacement I told him I will not do that again he just said ok see ya later. I have tried for a second opinion but no o e will talk to me until 1 year is up. I am lost at what to do
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2 Reactions@gutthookd
I used the X10 pretty soon, maybe 3 1/2 weeks after surgery and had great results; I reached 127 - 130 comfortably and quickly -- but could not keep the machine (there is too much demand, too few machines to rent ) for as long as I wanted (to ensure the progress "stuck" ). PT was not very demanding and I was discharged MUCH sooner than I wanted bec I was allegedly doing well enough; also really NOT given at home program by my PT. Within 2 - 3 months I had severe back-side-of-knee tendon pain and was challenged with simple walking and shoes. Frequent charley-horse pain and night cramping. Consequently I didn't push hard enough I think, got spooked. I got the machine back a few months later (recently) and never returned to as good of flexion as before. I'm disheartened to have less flexion than I want, at 11 months, but with new PT, I do feel less pain. I was a tough TKR case, having been repeatedly injured for 30 years and thus, atrophied. I really recommend using the X10 as soon as possible and to push yourself with it -- it's so easy and comfortable. They have recently manufactured 50 more machines which they try to get to different states, mostly east coast. Covered by insurance in Michigan only. Well worth the cost.
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2 Reactions@blessangela2019 Don’t give up on finding a second opinion. I had the arthroscopic lysis of adhesions procedure done 8 weeks ago at 8.5 months. The PT routine afterwards is brutal - but seems to be working. My original surgeon offered it and my second opinion doc said no - revise. I went with original doc. I’m in Texas in a town of 100K people north of Houston.
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