Thanks. I am debating either trying an arthroscopic surgery to remove the scar tissue or a revision. My doctor is afraid that the scar tissue will return in either case.

@rayreich3 Is the arthroscopic the same as lysis? If not, do you know what the difference is? I am considering lysis.
Please do keep us updated.
JK

Good afternoon Ray, exflyer, and all -

Ray - This is pretty much SOP for TKR recoveries when they "are stuck". As
you (and everyone else probably) already knows, this is because the inflammation
builds scar tissue faster than your PT can break it loose - and finally the patient's
progress halts - and often the flexion and extension numbers start to reverse. In
my case, it was like moving a pile of sand on the beach. By that I mean - the amount
of scar tissue (over an inch thick in places) removed was counter-balanced by the
inflammation resulting from the arthroscopy - the result being that I was back at
square one in a matter of a few weeks. That doesn't mean this is what will happen
in your case - but not that uncommon (once you've already had a problem). For me
this was followed by a partial revision surgery and another TKR about a year later
(because of "joint loosening" - which is often caused by persistent inflammation).
The reason you and your surgeon are talking about this - is because you are already
"stuck". BUT... I would recommend that you at least have a conversation with your
surgeon about WHY this recovery (this time from the arthroscopy) will "go" differently.
That's a legitimate question to ask (although not one that generally gets asked). The
problem (from a patient's standpoint) is that there is no downside for the surgeon to
perform additional surgical procedures. His only question to be answered is - will this
guy's insurance pay for this (and I can assure you - as the surgeon is already assured
or you wouldn't be having this conversation)... and of course, they will. Exflyer's doctor
has a legitimate concern.

I'm sure you all (or most) know that chronic inflammation as a response to surgery - and
especially in the case of an implanted prosthesis... is an immune system response. In our
case (or my case... anyway) this is basically too much of a good thing. The same thing
that helps your incision heal maybe a little more quickly - is what is (for now) causing you
problems with excess scar tissue formation. Part of the reason that cortisone (or most of
the steroids) "works" is because it suppresses the normal immune system response and
by doing that... disrupts the (in my case "excess" or "abnormal") formation of scar tissue.

And just further FYI - orthopedic surgeons (when they're being honest - typically after you've
had the TKR), really don't understand the "WHY" of all this persistent inflammation. Basically -
what they know is that you either DO or DO NOT have problems with inflammation/scar tissue
after a TKR. Logically (to me, anyway) - there should be a way to test in advance (which frankly,
surgeons have no interest in doing... just like they don't test for metal allergies - although they
realize this is potentially a VERY significant - as in high numbers of people - problem). It's an
unfortunate (for the patients) fact, that none of this will ever be a problem for the surgeons.

To everyone out there thinking about a revision TKR, arthroscopy, or other/additional surgeical
procedure on your knee. IF you've had a problem with persistent inflammaton and scar tissue,
PLEASE get yourself tested for a metal allergy. Seriously. Why have additional procedures
that potentially are never going to solve your problem (if you actually do have an allergy). Please
don't take my word for this - check out NIH studies under the heading of TKR's and metal allergies.
This is not an insignificant number of people. I recommend MELISA for blood testing. Believe it or
not - there is very little serum (blood) metal allergy testing done in the US (although this is pretty
common in Europe, Asia, Latin America - etc.). I'd hate to think this was being conciously ignored
(but these surgeons and doctors have access to the same NIH, NEJM, and etc information as I do -
and are still mainly... categorically denying that this could be a significant problem. For them - it isn't.

My best to all - and I genuinely hope that your experiences are much different than mine.

John