1. < Joint Replacements

How do you treat excess scarring after TKR?

Posted by Jmacvol @jmacvol, Jul 29, 2016

I had TKR on my left knee Dec 2013. Had poor ROM performance with PT and had MUA after 3 months. Recovery from MUA was most painful experience ever and totally ineffective. As time went on ROM got worse as scar tissue took over knee. Sep 2014 I had left knee revision to remove scar tissue and had right kne TKR. 3 more months of PT and right knee recovered much better than left as left knee once again grew excessive scar tissue. Dec 2015 I had a 2nd revision on left knee to remove scar tissue and surgeon said if this didn't work he may have to replace remove appliance and start over. 3 more months of PT and ROM got worse with PT as scar tissue grew back again. ROM in left knee is about 70. As each day goes on pain increases with no improvement in site. Surgeon says that appliance is fine and there is no more he can do. Is there any solution to my problem. Contacted Mayo for help.

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heyjoe415 | @heyjoe415 | Sep 4, 2022
In reply to @gailfaith "Hi Jmacvol.....Do you live close to Mayo (which one?). I've been there twice for 2 different..." + (show)
@gailfaith

Hi Jmacvol.....Do you live close to Mayo (which one?). I've been there twice for 2 different issues and for me it takes 3 flights each way to get there. Well worth the effort. Not to make you jealsous but after my first TKR, when I went back to see the surgeon in 2 weeks for a check, I needed no cane, etc. The gal asked where my cane was and she said they were going to put me on a pedistal in the waiting room! However I went to a nursing home for post care for the first one as I live alone. The physiatrist there was nuts. This was back when they still used ths passive motion machine, and she got upset when I raised the angle to bend my knee over 90 degrees. That is what you go there for, to get as much bend as possible. When she wasn't around I'd raise it again, but the best I ever got to was about 124 degress of bend but after I got home and used my stationionary bike to help me with the bending by lowering the bike seat as much as possile. My second one is an even better story. gailfaith

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124 degrees of bend after a TKR is very good. 120 degrees is the target after most surgeries, so good for you. You must have done all that was recommended re: PT post-op.

I worked to get my whole body in shape for a year before my first TKR this March. It could nor have gone better and I? followed all post-op therapy instructions and still do some of them, and more, at the gym.

I had my other knee replaced this July. Pretty much the same results but it took two weeks longer (around 6 weeks) before I could use stairs. Still have some minor swelling 8 weeks out. No two operations are the same.

Joe

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lawman | @lawman | Sep 4, 2022
In reply to @gailfaith "Do I understand you correctly, that outside of the scarring, the rest of the TKR results..." + (show)
@gailfaith

Do I understand you correctly, that outside of the scarring, the rest of the TKR results were good? If so, I am happy for you. After my second TKR also on the machine before I left the hospital, I went to a different nursing home. I expected to use the machine there, but when the she saw my ROM already, she didn't order it. However on day 1 there, they measured my ROM at something in the mid 120's. But I was having calf pain and to be sure I didn't have a clot, I did no PT over the weekend until they could confirm there was no clot. So after lying in bed for 3 days, I was concerned that I had lost some of my good 120+ degrees of bend. So when I started PT again on Tuesday, I joking asked how much did I lose. His response: you're now up to 132 degrees! As far as I can ascertain, that is about where I was pre-surgery! Now that I have monotonic dystophy, I need that 132 degrees to get up from the floor though I still need help as the legs are weak, but I can at least get my R leg under me and get ready to stand.
When you fly to Mayo, where do you fly from and where is your plane change? I fly out of Lancaster airport which is just down the street (2 miles) to Dulles, then to Minneapolis and then Rochester. But coming home the last time, they cancelled the last flight back to Lancaster as they never told us that airline had changed hands and the FAA had not yet approved them flying into Lancaster. ! So instead of a 45 minute flight, they DROVE me and another passenger right to our front doors! But that was an hour wait at first then a 3 hr drive.

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Speaking for the people who STILL have pain and scar tissue, I can only wonder why people come on here and tell their success stories other than for attention and brag! Also, we are glad for you but frankly do NOT want to hear it. Just valuable insight and information to help.

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heyjoe415 | @heyjoe415 | Oct 16, 2022
In reply to @dawn_giacabazi "Hi @jmacvol, welcome to connect. I am not a doctor but understand your situation. I injured..." + (show)
@dawn_giacabazi

Hi @jmacvol, welcome to connect.
I am not a doctor but understand your situation. I injured my right knee. Tore my meniscus & ACL & broke a bone off my thigh (fell of silly tedmill) 6 years ago. I learned that the key to slowing down the process of scar tissue is continous exercise & stretching, even when therapy discharges. You may need to revisit therapy for some help breaking up some of that scar tissue. I actually still see therapy to keep mine feeling great, a maintenance program. This might be a great option for you.

Hope this helps.
Dawn

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Dawn,

I think you're right. The best way to avoid scar tissue after a TKR is to be diligent about stretches and then strengthening. It's too late once the scar tissue is there and it has to be removed surgically, I think, or the TKR needs to be done over. Neither option is good.

For those reading who are pondering TKR, strengthen your quads and hamstring as much as possible before the surgery, and be diligent about post-op exercises. And continue to make stretching and strengthening exercises part of your life.

Joe

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lawman | @lawman | Nov 23, 2022

I’m in Florida and need any recommendations for doctors or methods to remove scar tissue after TKR. Three years later and still have swelling, stiffness and pain

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jw14450 | @jw14450 | Jan 3, 2023

Hi,
I am posting here to see if I am in an exclusive club with my ongoing issues following knee replacement. My initial total replacement was a little over 3 years ago. Other than the typical PT experience with getting to full extension and 120 plus degree bend, all went as expected for the initial 3-4 months. At that point I started experiencing increased pain in the joint especially climbing and descending stairs. My surgeon recommended different PT and other exercises but I continually went downhill getting progressively worse. He had me do a wide range of imaging, infection and allergy tests all inconclusive. Other that hope it would remedy itself, he had no plan of action. After a year or more of increasing pain, I went for another opinion.

After another series of testing it was concluded that my replacement was loose and needing a complete revision. I did that 14 months ago and the new surgeon said that among other items he would have done differently, the first prosthesis just about fell out with zero effort required to remove it. The new implant is much more aggressive. This time around I had no flexibility issues and was over 110 degrees by my first visit to the PT facility. All was great for the first few months and then again, I started experiencing increasing joint pain. I have great stability, no flexibility issues, can walk miles but I have constant pain with simple knee bending movements and stairs. The diagnosis is excessive scar tissue or sinovitis. After another range of tests I had an arthroscopic “clean-up” about 8 weeks ago. I had immediate pain relief but 2 weeks later the pain returned and continues. I am having PT to break up scar tissue but my therapist says he has never felt a knee grinding like mine does. To me it is almost like I have a bag of marbles in the joint. So much so that at times you can hear the grinding.

Last part of my story is my older brother is a retired knee and hip replacement specialist. Both he and my current surgeon are somewhat stumped on why I continue to have excessive scar tissue. They are confident the scar tissue is the problem. I am considering a 4th procedure to inspect and remove the scar tissue but there is no promise that this would not happen all over again.

I am curious if anyone in this group has experienced anything similar and what you did or are doing. Although few, there must be others with an experience similar to mine as I am hoping to get ahead of the problem and start to experience life as I expected it to be when I had the initial replacement over 3 years ago. Any replies are greatly appreciated.

JW

REPLY
3 replies
noethewja | @noethewja | Jan 4, 2023
In reply to @jw14450 "Hi, I am posting here to see if I am in an exclusive club with my..." + (show)
@jw14450

Hi,
I am posting here to see if I am in an exclusive club with my ongoing issues following knee replacement. My initial total replacement was a little over 3 years ago. Other than the typical PT experience with getting to full extension and 120 plus degree bend, all went as expected for the initial 3-4 months. At that point I started experiencing increased pain in the joint especially climbing and descending stairs. My surgeon recommended different PT and other exercises but I continually went downhill getting progressively worse. He had me do a wide range of imaging, infection and allergy tests all inconclusive. Other that hope it would remedy itself, he had no plan of action. After a year or more of increasing pain, I went for another opinion.

After another series of testing it was concluded that my replacement was loose and needing a complete revision. I did that 14 months ago and the new surgeon said that among other items he would have done differently, the first prosthesis just about fell out with zero effort required to remove it. The new implant is much more aggressive. This time around I had no flexibility issues and was over 110 degrees by my first visit to the PT facility. All was great for the first few months and then again, I started experiencing increasing joint pain. I have great stability, no flexibility issues, can walk miles but I have constant pain with simple knee bending movements and stairs. The diagnosis is excessive scar tissue or sinovitis. After another range of tests I had an arthroscopic “clean-up” about 8 weeks ago. I had immediate pain relief but 2 weeks later the pain returned and continues. I am having PT to break up scar tissue but my therapist says he has never felt a knee grinding like mine does. To me it is almost like I have a bag of marbles in the joint. So much so that at times you can hear the grinding.

Last part of my story is my older brother is a retired knee and hip replacement specialist. Both he and my current surgeon are somewhat stumped on why I continue to have excessive scar tissue. They are confident the scar tissue is the problem. I am considering a 4th procedure to inspect and remove the scar tissue but there is no promise that this would not happen all over again.

I am curious if anyone in this group has experienced anything similar and what you did or are doing. Although few, there must be others with an experience similar to mine as I am hoping to get ahead of the problem and start to experience life as I expected it to be when I had the initial replacement over 3 years ago. Any replies are greatly appreciated.

JW

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I have excessive scar tissue. Had TKR Jan 2022. Had two manipulations to force scar tissue to break up. Feb 2022 and Apr 2022. Lot of PT. Still no good. Aug 2022 had scar tissue removal. Scar was 1 1/2 inches thick. Removed about 80% of scar tissue. 5-6 months later and extensive PT scar tissue has presumably grain back and preventing me from bending and straightening much. Very limited range of motion. Going to see a different surgeon next week for second opinion. I tried to get into Mayo and provided all my info reports X-rays. But received letter that they are experiencing appointment delays and put me on wait list. Feel I’m in limbo.

REPLY
Moderator
Colleen Young, Connect Director | @colleenyoung | Jan 4, 2023
In reply to @jw14450 "Hi, I am posting here to see if I am in an exclusive club with my..." + (show)
@jw14450

Hi,
I am posting here to see if I am in an exclusive club with my ongoing issues following knee replacement. My initial total replacement was a little over 3 years ago. Other than the typical PT experience with getting to full extension and 120 plus degree bend, all went as expected for the initial 3-4 months. At that point I started experiencing increased pain in the joint especially climbing and descending stairs. My surgeon recommended different PT and other exercises but I continually went downhill getting progressively worse. He had me do a wide range of imaging, infection and allergy tests all inconclusive. Other that hope it would remedy itself, he had no plan of action. After a year or more of increasing pain, I went for another opinion.

After another series of testing it was concluded that my replacement was loose and needing a complete revision. I did that 14 months ago and the new surgeon said that among other items he would have done differently, the first prosthesis just about fell out with zero effort required to remove it. The new implant is much more aggressive. This time around I had no flexibility issues and was over 110 degrees by my first visit to the PT facility. All was great for the first few months and then again, I started experiencing increasing joint pain. I have great stability, no flexibility issues, can walk miles but I have constant pain with simple knee bending movements and stairs. The diagnosis is excessive scar tissue or sinovitis. After another range of tests I had an arthroscopic “clean-up” about 8 weeks ago. I had immediate pain relief but 2 weeks later the pain returned and continues. I am having PT to break up scar tissue but my therapist says he has never felt a knee grinding like mine does. To me it is almost like I have a bag of marbles in the joint. So much so that at times you can hear the grinding.

Last part of my story is my older brother is a retired knee and hip replacement specialist. Both he and my current surgeon are somewhat stumped on why I continue to have excessive scar tissue. They are confident the scar tissue is the problem. I am considering a 4th procedure to inspect and remove the scar tissue but there is no promise that this would not happen all over again.

I am curious if anyone in this group has experienced anything similar and what you did or are doing. Although few, there must be others with an experience similar to mine as I am hoping to get ahead of the problem and start to experience life as I expected it to be when I had the initial replacement over 3 years ago. Any replies are greatly appreciated.

JW

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Hi @jw14450, I moved your question about removing scar tissue after TKR to this existing discussion in the Joint Replacements group:
– How do you treat excess scarring after TKR?: https://connect.mayoclinic.org/discussion/how-do-you-treat-excess-scarring-after-tkr/

I did this so that you can read previous helpful posts and connect with members like @heyjoe415 @lawman @ezas123 @xteach @artscaping and more. You may also be interested in these related discussions:

– Scar Tissue Around Knee After TKR https://connect.mayoclinic.org/discussion/scar-tissue-around-knee-after-tkr/
- Revision surgery because of scar tissue in knee https://connect.mayoclinic.org/discussion/knee-replacement-revision/
– Will MFR help with scar tissue build up? https://connect.mayoclinic.org/discussion/will-mfr-help-with-scar-tissue-build-up/
- 8 Months after TKR Serious Grinding: https://connect.mayoclinic.org/discussion/8-months-after-tkr-serious-grinding/

REPLY
Mentor
Chris Trout, Volunteer Mentor | @artscaping | Jan 4, 2023

Good evening @jw14450, and welcome to Connect. I have read your discussion of the post-surgery situation you have found yourself in several years after your TKR. I also had a three-year gap between my first TKR and the day when it gave up acting appropriately, complete with pain and stiffness, and swelling. Here is how I handled it.

https://connect.mayoclinic.org/discussion/will-mfr-help-with-scar-tissue-build-up/

A TKR surgery is quite complex......complete with severe handling of bones, connective tissues, muscles and nerves. So you can tell that I probably wasn't excited about having to undergo a second TKR last year. However, this time I was able to have a robotic surgery and one that was minimally invasive. And this time I was instructed to participate in pre-surgery exercises for six weeks before the actual surgery. In retrospect, I think those two items made a huge difference. Of course, I started PT right away and pushed myself to 137 degrees bend with zero extension relatively quickly.

And the new item.....my MFR therapist and my orthopedic PT got together and discussed how they could handle the scaring issue. My PT managed the movement exercises and my MFR therapist handled pain and discomfort until there wasn't any. In doing so, the scar tissue was eradicated before it could become a problem.

My question is this, surgery by its nature creates scar tissue. If for some reason, you get more than your share of it and it doesn't find its way out maybe you would profit from having some MFR sessions. You can find out more about MFR on this Connect link.

https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

May you be safe, protected, and free from inner and outer harm.
Chris

REPLY
jw14450 | @jw14450 | Jan 9, 2023
In reply to @dmk "At 15 months post op I still do all the exercises for my new knee as..." + (show)
@dmk

At 15 months post op I still do all the exercises for my new knee as prescribed by my physical therapist! Includes things like stationary bike, strengthening with exercise ankle weights one and two pounders. Rolling down right left of knee with rolling pin center knee done with hands. Other leg strengthening exercises, squats, balancing and endurance exercises 3 times a week. At 65 will keep them up as long as I can. My new knee is awesome!!!
My therapist made sure I didn’t develop and scar tissue using deep tissue massaging which is not fun but I know necessary and taught me the art of using rolling pin which I do to this day. A lot of time and work for me but to date my knee has been awesome!!!

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Hi DMK

Maybe you can share some details on your rolling pin therapy. I am trying to get ahead of my scar tissue issue to avoid a surgical tissue removal procedure. Even if I do Xbox ahead with it I want stay in front of the possibility of it returning.

Thanks

REPLY
1 reply
noethewja | @noethewja | Jan 10, 2023
In reply to @jw14450 "Hi, I am posting here to see if I am in an exclusive club with my..." + (show)
@jw14450

Hi,
I am posting here to see if I am in an exclusive club with my ongoing issues following knee replacement. My initial total replacement was a little over 3 years ago. Other than the typical PT experience with getting to full extension and 120 plus degree bend, all went as expected for the initial 3-4 months. At that point I started experiencing increased pain in the joint especially climbing and descending stairs. My surgeon recommended different PT and other exercises but I continually went downhill getting progressively worse. He had me do a wide range of imaging, infection and allergy tests all inconclusive. Other that hope it would remedy itself, he had no plan of action. After a year or more of increasing pain, I went for another opinion.

After another series of testing it was concluded that my replacement was loose and needing a complete revision. I did that 14 months ago and the new surgeon said that among other items he would have done differently, the first prosthesis just about fell out with zero effort required to remove it. The new implant is much more aggressive. This time around I had no flexibility issues and was over 110 degrees by my first visit to the PT facility. All was great for the first few months and then again, I started experiencing increasing joint pain. I have great stability, no flexibility issues, can walk miles but I have constant pain with simple knee bending movements and stairs. The diagnosis is excessive scar tissue or sinovitis. After another range of tests I had an arthroscopic “clean-up” about 8 weeks ago. I had immediate pain relief but 2 weeks later the pain returned and continues. I am having PT to break up scar tissue but my therapist says he has never felt a knee grinding like mine does. To me it is almost like I have a bag of marbles in the joint. So much so that at times you can hear the grinding.

Last part of my story is my older brother is a retired knee and hip replacement specialist. Both he and my current surgeon are somewhat stumped on why I continue to have excessive scar tissue. They are confident the scar tissue is the problem. I am considering a 4th procedure to inspect and remove the scar tissue but there is no promise that this would not happen all over again.

I am curious if anyone in this group has experienced anything similar and what you did or are doing. Although few, there must be others with an experience similar to mine as I am hoping to get ahead of the problem and start to experience life as I expected it to be when I had the initial replacement over 3 years ago. Any replies are greatly appreciated.

JW

Jump to this post

I have excessive scar tissue too. Had surgery to remove it Aug 2022. After months of PT scar tissue is back and very limiting my ROM. About 70 degrees. My surgeon is proposing a revision where remove implant, remove s at tissue again. On tibia and femur remove bone on both to make bigger gap for knee to bend. New implant. And more PT. Especially as scar reforms. He’s talked with several specialists around the country and all agree with this as next step. One of the places he talked to are two surgeons from Rothman Orthopedic institute in Philadelphia. Then others in LA, Chicago, Dallas. I’ll be meeting with another surgeon to discuss this procedure and go from there. . Sounds radical but could be option for you. Best wishes to you.
Wayne

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