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8 Months after TKR Serious Grinding
My TKR surgery, 3/3/22, was "unremarkable" Seems that everyone including the surgeon expected that I would be right back on my feet and would have no problems - because I am fit and healthy and active. There was slight crepitus early on that was deemed innocuous. The PT guy thought there might be patellar tracking issues, but after a while it seemed like there was a distinct catch upon straightening my leg from a flexed position. It seemed to fit the description of "patellar clunk" which the PT guy had never heard of!!!! At my 3 month appt, my surgeon, after feeling the grinding when I straightened my leg, almost winced and said something like - " it's too early to panic; only 3 months" etc. Let's see how things are at the 6 month appt". Meanwhile at around 4 months the PT guy noticing that the situation wasn't improving said that I should see the surgeon before the 6 months. Due to scheduling I only got in to see him a few weeks early. Nothing was decided except that it was an unusual or rare situation. Apparently out of 150 surgeries that Dr W had done this past year, I and one other person had a catch like this on straightening. The surgeon suggested that he could open the incision and clean out scar tissue, which is what he had done with the other patient with this problem. ( This fellow seems to be doing well several months after the corrective surgery; I spoke with him about it to find out what his experience was like)
I am very hesitant to have surgery again and of course there's no guarantee that the scar tissue won't recur ( assuming that is what it is) Plus I asked the surgeon about a less invasive procedure - such as a scope to correct the scar tissue. He feels that he prefers the open surgery. ( I'm thinking in his practice ( he does a LOT of TKRs) perhaps he doesn't do scopes very often? dunno) Anyway, he suggested seeing another surgeon. Made 2 referrals to guys who are supposed to be great. Neither would see me. đ My cousin, a nurse suggested I see a sports med guy who she says is brilliant and who helped her with her knees. That referral which I first initiated Oct 15 or so is in progress - and obviously is taking a while!! Meanwhile I am not even sure that it's an appropriate referral....but I guess I will find out - if the Doc says he won't see me. Then on to the next referral?
Meantime the knee is NOT getting better. I do have full ROM - but what good is it when every time I stand from a sitting position, walk down stairs, try to step up I get this terrible grinding- and it's painful, depending on how much pressure I am putting on the joint. I am still doing exercises that the PT guy gave me ( second PT guy) Trying to keep the muscles strong. (Also - I walk most days and swim and am pretty much on my feet and moving around a lot unless I am at my part time job which involves a lot of computer work. - can walk a few miles but it gets a bit stiff and sore. Have not been able to get back to hiking and biking. ) PT guy also tried dry needling to try to release the scar tissue - but some of it seems to be right between the kneecap and femur, so hard to get the needle in there. The first PT guy, btw also tried ultrasound to break up the scar tissue.
The knee is still often a bit warm to the touch compared to my other knee and a bit swollen - but not terribly. This is all really stressing me out. And is sometimes depressing. I wonder if my expectations were just too high? I thought I would get back to normal - which for me is a LOT of physical activity.
Something HAS to be done. I am willing to wait this out for a while - maybe get some more PT, keep working it to see if the grinding will lessen with time, but I can't live with this forever, for sure!!! At this point I feel like I am on my own. I know I have to advocate for myself. I know I may have to have another procedure, but I want to figure out the best approach - plus I want to have a clear diagnosis. Can MRI ever be helpful in visualizing what is happening with TKR?
I've been reading other people's posts in this forum for a while so I thought I'd see if anyone has had a similar experience or has any suggestions.
Thanks!
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I also had patella clunk syndrome. My surgeon was very hesitant to open the knee before 1 year for fear of infection and also sometimes it does correct itself. At 20 months and after more therapy he said we should scope the knee.
My knee was scoped on Sept 1 and is sooo much better. I did do about 4 weeks of therapy after.
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2 ReactionsI'm not familiar with this situation. I had success with having both knees replaced. Question - did you do all of the post-op stretching exercises - the ones that are boring, repetitive, and hurt somewhat? The only time I'm aware of scar tissue forming is if those exercises are not done. Anyway, you don't have to answer. Just be honest with yourself and your surgeon.
If you did all the post-op exercises, and I think you did because you say your ROM is good, this sounds like a one in one hundred problem where the patella prosthesis is not tracking in the groove in the femur or maybe the implant. I suppose that could cause scar tissue.
The last person to post seemed to have this problem and the scar tissue was removed with a scope. But if the underlying issue is an improperly aligned patella (or maybe a problem with the femoral prosthesis, then your surgeon is probably right and it's best to do another surgery to 1) remove the scar tissue and 2) fix the problem. I don't think this can be fixed with a scope.
Sorry, that's all I can think of. All the best to you in getting this fixed.
Joe
Yes - I was very religious about doing all of the exercises - and still at 10 months I do exercises that the last PT gave me and do a lot fo walking and some yoga.
Quite a few things have happened in thelast couple of months. I had some "cupping" and acupuncture. The acupuncturist also showed mehow to do Graston technique ( some call it muscle scraping) to help break up scar tissue. I have been doing that as well. My surgeon ordered an xray to rule out "malrotation of the femoral component". Thank goodness that was ruled out!! After the xray report indicated "small join effusion", I started using a knee wrap - just an old one that i had around the house. That seemed to finally get rid of the last bit of swelling - just from the compression. I also have been using a brace and that seems ot help. I walk several miles most days and it is getting easier. But the grinding is still a problem. I can feel the lumps - which I assume are scar tissue - along the scar and when I bend my knee ( I have full range of motion) I can feel them above the knee cap. Hard to tell if they are in the patellar tendon - but that seems to be where it's really bumpy. And when I staighten my leg or stand up from seated position it really grinds and hurts!
Seeing another surgeon next week just to see if he has any insights. Also planning to go back to my orginal PT guy and see if he has suggestions. At my 1 year appointment Mar 3, we'll assess.
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1 ReactionInterested to hear more about your patellar clunk! Did it hurt when you straightened your leg? Did it make it difficult to stand up from a seated position? Could you see your knee cap "jump" a little when straightening your leg from a flexed position? Do you know if you had a posterior stabilized implant? It seems like patellar clunk is a pretty rare complication and I have read that it is more commmon with that type of implant. Hope you are still doing well!
All of those descriptions fit my situation. I am at about a year and a half out from the surgery. I was advised a few months ago to give it until two years. I understand that the troublesome tissue can be removed with arthroscopy or by opening up the original incision. In any case, it seems unlikely that this scar tissue would resolve without intervention. I am starting to try to find a surgeon who could scope it. As well, I think I should make an appointment with my surgeon. He has been helpful - but apparently has not seen this complication and says that he would open the knee. Would really like to avoid that!
My primary care physician suggested that I look in Boston (I am in Maine) And of course she also told me that orthopedic surgeons don't like working on other surgeons patients....
Suggestions about how to find the right surgeon would be appreciated. Or for that matter, any other suggestions.
Oh that is good to hear. Where are you located? My surgeon does not want to scope - but open up the knee so I am looking for someone who would scope it.
bonnie if you're looking for a new surgeon, I suggest finding one who specializes in revisions. They are out there and are experienced in either redoing or otherwise fixing a problem with earlier procedures.
My criteria for ortho surgeons in addition to exp with revisions - a Dr in his/her mid 30s to mid 40s with a solid med school/residency pedigree.
All the best!
bonnie....this is me. I feel a pulling above my knee and sometimes over the knee. I'm sure that it's scar tissue and don't know what to do about it. I can feel lumps as well and have done some MFR but it did nothing. I have also done some scraping as well and am 14 months out. I'm so tired of soreness and stiffness and the pulling. Stretching does not see to help either. I'd love to know what you find out. I do have a ROM of 120 and can straighten with no issues and the surgeon says all is well and some people just have soreness after doing to much. I do not want to slow down either. Right above the scar above my knee is pulls and sometimes more than others. Please let me know what they say. If I could get rid of this I'd be good.
It sounds like you don't have the problem on extension that I have. That is really the main issue for me - and like you said - getting rid of this one issue - well I would be very happy! I will let you know what I find out.
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1 ReactionI had my TKR June 2023. After 3 months of pt, things were great. Continued exercises after pt. But about a month after last pt, knee cap started âshiftingâ when I straightened it. And got worse. Doctor did a scope in November and cleaned out a large amount of scar tissue that the patella was catching on. Insurance informed me I had done enough pt for the year so since I couldnât afford it, no pt after but did exercises. And started swimming again after healing. In January, pain and extreme grinding caused me to go back to doctor. Tendinitis and would keep an eye on the crepitus since it seems to be back. After resting the knee except for swimming exercises, taking anti-inflammatory meds and using lidocaine gel, the tendinitis is better. But the crepitus is still there and the kneecap is popping around again like it was before. We will see today what they say to do now. The doctor was shocked at my last appointment by the crepitus as it was so much better after the last clean out scope.