Brescher, I am not an MD, but have struggled for 10 months to understand what happened after my 6/2022 TKR. I have no idea when the scar tissue began to form but the arthroscopy surgery I had in 12/2022 revealed (and removed) lots of it. Attached is a photo of what the doc found. After arthro, my patellar tendon still clicked & hurt every time I bent the TKR knee. That contributed to my inflammation. My knee would heat up and get very stiff. The arthro surgery revealed that my patellar tendon was badly abraded from normal movement and exercise, to the point where the tendon might rupture (IMO). An ultrasound confirmed the patellar damage. Concerning the relentless nerve pain, I received numbing injections in 9/2022 as part of the Genicular Nerve Ablation procedure. I got "lucky" therein, the numbing injections reduced the nerve pain so I didn't follow thru with the ablation.

I conclude the following and it's important to remind u that I am not an md. Mayo's website discusses "tuck the saphenous" nerve. To a mechanic like me, that means the nerve is "tucked" out of the way during surgery and that's done to reduce subsequent nerve pain which, in my case, radiated down the leg and was most persistent. Radiating, relentless nerve pain prevented sleep. It felt like a bare 110 volt wire touched my leg and the pain radiated down to my ankle.

My saphenous nerve was NOT tucked during surgery.

Some practitioners (I have heard) move the patellar tendon aside to install the prosthesis. My tendon was cut and that lead (IMO) to "severe tendinosis" according to the MRI procedure I demanded. My next step is Myofascial Release injections under the guidance of an ultrasound machine. Hopefully, my tendon will repair itself (heal) after the abrided portion is removed but at my advanced age, it may not heal properly. If MFR with ultrasound and injections doesn't work, I will try "tenex" which means I will need crutches. If that doesn't work I may have to be content with limited function until some other procedure comes along. The single best idea was losing weight so the TKR knee has less of a load.

I apologize for the jargon. It was not my intent to study knee surgery so thoroughly, but with most doc visits reduced to 11 minutes (I am not a Mayo patient), it's difficult to learn very much. Internet research on Mayo & Cleveland were the best way I could find to reduce the pain and increase knee function. If I was able to roll back the clock, I would have found a doc who tucked the saphenous nerve and did not cut the patellar tendon. BEFORE surgery, I would have fully exhausted the alternatives which include Hyaluronic acid (which is helping my other knee), prp and stem cell (there may be others I am not aware of). Cortisone produced very short term relief for me. If TKR produced any problems, I would adamantly insist upon an MRI & an ultrasound to help diagnose what's going on. I would also agree to the numbing portion associated with the Genicular Nerve Block procedure but I'm not an md so I can only speak to my personal experience.

God knows this was a real challenge. Hope I've helped.