Scar tissue after knee replacement

Thank you! I am scheduled for the left arthroscopic lysis of adhesions, Thursday. I’m torn on recovery. CPM or not, aggressive PT or passive, etc. The last 2 1/2 years have been miserable and I’m holding onto this as possible help. I don’t want to mess it up.

I’m so sorry it has come back for you. I’m struggling with my post care. Aggressive PT or no, CPM or not, etc. The last 2 1/2 years have been miserable.

I would go very aggressive. CPM. Everything. Ice after all care. Let us know how it goes.

I had an arthroscopic lysis of adhesions a year ago. My knee now easily bends to 125. However, the PT was brutal. A 10 hour a day routine for a month starting the day after surgery. I would be at the PT office 3x a week for 2 hour sessions where he would force my leg to move to the number the surgeon gave him. I learned how to cry silently as he pushed. PT then went to 8 hours, then 6. I was discharged at 3 hours of PT a day and told keep it up - don’t loose it. I now go to a rowing gym and row an hour 4 days a week and do an hour of stretching at home 4-5 times a week now.

Thank you for your reply. I struggle because there are so many differing opinions on recovery. Some believe aggressive PT others say absolutely not. That’s why I’m so frustrated, I don’t know which direction to go. Both philosophies make sense to me.

To everyone confused about PT:

I was very lucky to come across this British site during the run-up to my revision. It's been my experience that aggressive PT just continues to traumatize an already very acute injury, the one cause by the surgery itself. Their views on post-op exercise and PT saved me this time around. I'm against aggressive PT and so is my surgeon:
https://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463/
https://bonesmart.org/forum/threads/bonesmart-philosophy-for-sensible-post-op-therapy.37103/

Hello @babette
As PT, I appreciate your comments and insight and you are right about PTs sometimes being too aggressive. I have seen PTs push way to hard and they wonder why things are worse (rebound effect). Sometimes other things need to occur (massage, soft tissue work, etc) before stretching. But there is the flip side in which some people are too passive and barely do anything and then blame the doctor or PT for their lack of progress. I do think there needs to be more education and explanation upfront about all the pros and cons before surgery. With my knee replacement surgery (and I am a PT) not one single person mentioned any risks other than infection or rejection including the lingering pain and scar tissue build up or sizing issue with the prosthesis (my issue). I never realized that a prosthesis could be too small or large! I'm not even sure how scar tissue is determined other than going back into the joint, which in itself is another traumatic event for the joint.

I do know from my experience- persistence and continuing your exercises daily, pushing a bit past your tolerance, is necessary.

I am now totally against being extremely aggressive- and even in clinic practice, I never saw the value to being over aggressive. It's the patient that leaves the clinic in agony, not the therapist. There is no literature or evidence to say this aggressive approach results in more desired outcomes. I do feel that you have to shove gently- push to your limit but then a bit further. For those that have a low or poor pain tolerance, you have to push through.

There is current evidence that indicates that CPM (continuous passive motion) machines are not effective in more desired outcomes in uncomplicated knee replacements. I haven't see any literature about the use of machines in more problematic knees. The biggest issue is that the machine is passive and active motion is always preferred over passive for lots of reasons.

Sigh...getting nervous as the procedure is tomorrow. I’ve dealt with this for 2 1/2 years and am nervous it won’t help. I’m trying to stay positive and hopeful, maybe just sullen because it’s Christmas and I was supposed to go home but can’t now that they’ve rescheduled the surgery for tomorrow. So, alone and anxious.

Merry Christmas everyone!