1 month after tkr the top two inches under my scar feel rock hard

Go to both your surgeon & PT. It’s most likely scar tissue (Arthrofibrosis), which affects 6-10% of those having TKR. I had the bad luck of falling into that group, on the more severe end of the spectrum. I am about 1 1/2 yrs. out from TKR. Post surgery, I had a MUA, Arthroscopic Debridement and an Open Debridement. They were all aimed at getting rid of scar tissue but with each procedure, it got worse, due to my bodies propensity to “lay down scar tissue” (the 6-10%). I went to HSS (#1 Ortho. Worldwide) for second opinion. They recommended a Revision surgery to replace my implant with a “hinged knee”. The thought behind this is that a large % of the scar tissue that limits ROM is amongst the tendons. Revision to a hinged knee includes removal of the tendons with the hinge taking the place of the tendons. I don’t want to freak you out but this is important to know and this possible outcome should be explained prior to surgery. There is a test being developed at HSS to know in advance if you are prone to excessive scarring. My HSS doctor said that with the outcome of my initial TKR, (high level of inflammation, very limited ROM and bad pain) that he would not have proceeded with the extra surgeries, which made things worse. He said that 10 years ago, they might have done that. My intention now, since HSS does not accept Medicare, is to go to the Mayo Clinic, (#2 Ortho Hospital Worldwide) in Rochester, Mn., who accepts Medicare to get their opinion, which I expect will also be to revise to a hinged knee.

Go to both your surgeon & PT. It’s most likely scar tissue (Arthrofibrosis), which affects 6-10% of those having TKR. I had the bad luck of falling into that group, on the more severe end of the spectrum. I am about 1 1/2 yrs. out from TKR. Post surgery, I had a MUA, Arthroscopic Debridement and an Open Debridement. They were all aimed at getting rid of scar tissue but with each procedure, it got worse, due to my bodies propensity to “lay down scar tissue” (the 6-10%). I went to HSS (#1 Ortho. Worldwide) for second opinion. They recommended a Revision surgery to replace my implant with a “hinged knee”. The thought behind this is that a large % of the scar tissue that limits ROM is amongst the tendons. Revision to a hinged knee includes removal of the tendons with the hinge taking the place of the tendons. I don’t want to freak you out but this is important to know and this possible outcome should be explained prior to surgery. There is a test being developed at HSS to know in advance if you are prone to excessive scarring. My HSS doctor said that with the outcome of my initial TKR, (high level of inflammation, very limited ROM and bad pain) that he would not have proceeded with the extra surgeries, which made things worse. He said that 10 years ago, they might have done that. My intention now, since HSS does not accept Medicare, is to go to the Mayo Clinic, (#2 Ortho Hospital Worldwide) in Rochester, Mn., who accepts Medicare to get their opinion, which I expect will also be to revise to a hinged knee.

Your post was not what I would have liked to hear, but being 8 months out from original replacement, a failed MUA resulting in cracked femur, and a most recent (out 5 weeks from) revision, it confirms my suspicions that this is what happens to “ some” of us, and no one really knows how to address it properly. I spend my entire day doing some form of PT or therapy (i.e. icing, heat, dynasplint, etc). I’m exhausted and just decided to accept my fate, and not be too hard on myself. Most surely, not going through 45 minutes of physical pain in PT twice a week. I will never have another surgery to address this, much less the last one you described.

How long after arthroscopic debridement did you have the big open debridement? Was it because they were unable to see or get at all the places you had scarring because of the small space and limited viewing with the scope? Or did they consider the arthroscopic surgery a success at first and weeks or months later the abnormal tissue growth came back at which time they did the open procedure? Did they take before and after pics during arthroscopy? When you had the open procedure did they open the entire length of the original scar or just a portion of it. I'm asking because I have Patellar Clunk Syndrome and need surgery and wondering if I should just do the big open surgery to begin with since it's a better approach to be thorough than doing it arthroscopically only to to have it fail because of limited access. I appreciate you taking the time to describe your experience. It's very helpful.

I was in a similar situation with PT. My therapist would try to bend my knee without progress. He said “with most people, I can tell that I can make progress but with you, I hit a hard stop”. He advised me that I was wasting time and money by continuing PT. My surgeon concurred with this. Prior to these surgeries, I had been a sprinter in the Sr. Games and an ardent weight lifter. With my pain & immobility, I quit my gym. About 6 months passed as my body aches (74 yrs. Old) increased and the future looked dark. At my wife’s persuasion, I rejoined a gym and started doing what I could, mostly upper body, and am now feeling much better overall. I look forward to my next step with the Mayo Clinic. I have to wait until April to go, since I had to change my health insurance to be covered outside my area, which means that they won’t pay for a preexisting condition until a 3 month wait period expires. Never Give Up!!!

There was several months between each of my procedures. They never quantified the amount of scar tissue. The problem was, because of my body’s response, the scar tissue quickly returned. The open debridement was to recut the entire vertical length of the TKR scar. There was a brief period after the arthroscopic debridement that it had seemed like there had been progress, although very little.