scar tissue after knee replacement

Posted by leithlane @leithlane, Jan 31, 2017

I had knee replacement surgery 6 weeks ago . Through PT I have been working on breaking up the scar tissue only for it to regrow by the time I get back to PT two days later. I have been massaging at home, using a hand held massager and roller. It is painful and swollen. I am getting very disheartened. Any suggestions as to what else I can do. Has anyone had laser treatments to break up scar tissue? Were they effective?

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@contentandwell

@melcpa86 The flex they want you to achieve is generally 120, anything more than that is gravy. Mine is not at that in either leg but I do very well walking in most things, just cannot bend it enough for ease in getting up and down from the floor. I would give anything to have 125! When we were on vacation in October I walked about 37 miles in four days!

@klouis I am going to be having that surgery soon, I think it is probably the same thing. It's good to know that someone else found it did help.
JK

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I think the surgery you and @klouis mentioned is the one I had 5 weeks ago. If so, it has helped. But be prepared for the workload after surgery if you want the results.

At 5 weeks post op My passive motion is now at 132 with less of a push from PT and fewer tears and I am walking normally and no longer limping constantly.

I am by no means at the end of this journey. PT won’t tell me my active ROM (probably for fear of discouraging me). It still hurts to stand and after walking about 15 mins.

The journey after the surgery has been intense. Starting at 10 hours of PT a day – I’m now down to 6 hours a day. That might be because My surgeon and PT are the orthos for a major university football & soccer team and their job is to get folks back on the field fast. I don’t know.

I was supposed to head back to work tomorrow- but PT asked me to wait one more week – I think to try and get me to where he is comfortable reducing the PT to 4 hours so I can try and manage.

Just letting you know my journey for reference.

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@melcpa86

I think the surgery you and @klouis mentioned is the one I had 5 weeks ago. If so, it has helped. But be prepared for the workload after surgery if you want the results.

At 5 weeks post op My passive motion is now at 132 with less of a push from PT and fewer tears and I am walking normally and no longer limping constantly.

I am by no means at the end of this journey. PT won’t tell me my active ROM (probably for fear of discouraging me). It still hurts to stand and after walking about 15 mins.

The journey after the surgery has been intense. Starting at 10 hours of PT a day – I’m now down to 6 hours a day. That might be because My surgeon and PT are the orthos for a major university football & soccer team and their job is to get folks back on the field fast. I don’t know.

I was supposed to head back to work tomorrow- but PT asked me to wait one more week – I think to try and get me to where he is comfortable reducing the PT to 4 hours so I can try and manage.

Just letting you know my journey for reference.

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@melcpa86 Hi, I'm not sure I understand your figures. What are you referring to when you say "My passive motion is now at 132" if not ROM?
It sounds as if for you the PT after this minor surgery was more intense than after the initial TKR. Am I reading that correctly? I cannot imagine doing 10 hours a day, or even 6. I think the surgery I will be having is more minor than what you had, but I will know soon.
Thanks for the info and heads up.
JK

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@contentandwell

@melcpa86 Hi, I'm not sure I understand your figures. What are you referring to when you say "My passive motion is now at 132" if not ROM?
It sounds as if for you the PT after this minor surgery was more intense than after the initial TKR. Am I reading that correctly? I cannot imagine doing 10 hours a day, or even 6. I think the surgery I will be having is more minor than what you had, but I will know soon.
Thanks for the info and heads up.
JK

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My understanding is there are two types of range of motion. Passive – which is assisted (an MUA, or PT moving or you forcing with a strap) and Active – which is totally on your own with no help. What my PT has told me is that your passive range of motion is your personal max. If you can maintain your passive range of motion farther out from the surgery – it should convert to an active range of motion if you stick with the program.

After my initial knee replacement, I developed arthofibrosis, which is an official diagnosis painful restriction of joint motion, with scar tissue forming within the joint and surrounding soft tissue spaces and persisting DESPITE aggressive rehabilitation. My initial PT was considered medically aggressive since for 4 months and 3 hours per day. They started me at this level because I had a documented history of excessive scar tissue from two other surgeries. However, despite PT both my passive and range of motion would decrease weekly. My PT identified that I had arthofibrosis at about 2 months post op – but after a knee replacement, they won't do a lysis until you are at least 6 months post replacement.

What my surgeon explained to me is that anytime you damage your body with trauma or surgery – your body heals with scar tissue. When a joint is involved, you are in a race between the scar tissue and your motion. The lysis surgery allows the race to restart when the surgeon removes the excessive scar tissue – but you have to race to prevent the NEW scar tissue from preventing any gains in your motion. Hence the aggressive PT again – but at a higher level.

My PT tells me the passive number at each session. As long as I'm hitting what the surgeon had me at coming out of the lysis surgery – I'm winning the race.

Hope that explains it

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@melcpa86

My understanding is there are two types of range of motion. Passive – which is assisted (an MUA, or PT moving or you forcing with a strap) and Active – which is totally on your own with no help. What my PT has told me is that your passive range of motion is your personal max. If you can maintain your passive range of motion farther out from the surgery – it should convert to an active range of motion if you stick with the program.

After my initial knee replacement, I developed arthofibrosis, which is an official diagnosis painful restriction of joint motion, with scar tissue forming within the joint and surrounding soft tissue spaces and persisting DESPITE aggressive rehabilitation. My initial PT was considered medically aggressive since for 4 months and 3 hours per day. They started me at this level because I had a documented history of excessive scar tissue from two other surgeries. However, despite PT both my passive and range of motion would decrease weekly. My PT identified that I had arthofibrosis at about 2 months post op – but after a knee replacement, they won't do a lysis until you are at least 6 months post replacement.

What my surgeon explained to me is that anytime you damage your body with trauma or surgery – your body heals with scar tissue. When a joint is involved, you are in a race between the scar tissue and your motion. The lysis surgery allows the race to restart when the surgeon removes the excessive scar tissue – but you have to race to prevent the NEW scar tissue from preventing any gains in your motion. Hence the aggressive PT again – but at a higher level.

My PT tells me the passive number at each session. As long as I'm hitting what the surgeon had me at coming out of the lysis surgery – I'm winning the race.

Hope that explains it

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@melcpa86 Thank you for the explanation. It makes sense for sure, and I wonder why this was never explained to me by either of the two doctors or by my physical therapist. I have a real aversion to medical jargon so it is possible that it was explained and did not register, but I honestly do not think so.
I hope that you continue to win the race.
JK

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@contentandwell

@melcpa86 Thank you for the explanation. It makes sense for sure, and I wonder why this was never explained to me by either of the two doctors or by my physical therapist. I have a real aversion to medical jargon so it is possible that it was explained and did not register, but I honestly do not think so.
I hope that you continue to win the race.
JK

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Yes thanks for your message it’s been very helpful

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@dduke

I also had it done. It is called: arthroscopic lysis and debridement of the knee. https://www.arthroscopytechniques.org/article/S2212-6287(17)30061-0/fulltext

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Going in for a 2nd opinion this week- knee seems to be getting worse as in more pain and -is it possible?- more scar tissue building around tkr-quite sad- original surgeon said only a 50% chance of relief after doing All the pt etc after the lysis/debridement. i am frightened and looking at shelling at least 12 k for the experiment…

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So you had the scar tissue removal? If so, extensive PT afterward is crucial. I could not get a knee flexion tool for months, so, I built a boat winch attached to my pull strap to force my knee. I am 15 months post knee replacement. Two MUA and Lysis. Now at 130 degrees at the gym (not comfortable, but doable). How many times a day do you exercise, stair lunge, bike, etc.? I find, if I do not do stationary bike at least three times a day, it stiffens up.

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@dduke

So you had the scar tissue removal? If so, extensive PT afterward is crucial. I could not get a knee flexion tool for months, so, I built a boat winch attached to my pull strap to force my knee. I am 15 months post knee replacement. Two MUA and Lysis. Now at 130 degrees at the gym (not comfortable, but doable). How many times a day do you exercise, stair lunge, bike, etc.? I find, if I do not do stationary bike at least three times a day, it stiffens up.

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@dduke I had a lysis of adhesions for scar tissue removal 7 weeks ago. I’m at 130-132 flexion since the surgery but not without pain and a lot of effort

You are absolutely correct that the PT is essential. It is also brutal. My PT started me with a 10 hour per day routine (1 hour stretching / 1 hour rest) for the first 2 weeks. Then moved to a 90 min routine 3x a day for the next month. That occupied about 6 hours a day and includes about 4.5 hours of stretching/ walking and 1.5 hours icing. Last week he moved me to 3.5 hour routine because I had to go back to work. Dr limited my hours at work to 6 so I could try and get in all the PT.

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@contentandwell : I am also an old woman, 70 in a few months, and have been fairly active all of my life. Which probably helped me sail through 2 arthroscopic shoulder surgeries in the past. 3 months and 29 days – I was counting – after right shoulder I was back playing tennis with a full service motion. No OOMPH behind it, but still. The TKR has been more of a slog. However, yesterday morning when I lifted my hands from the usual routine of pushing the knee flat, it stayed down! Yeah! Will keep at it. Regarding gyms: I have a hate-hate relationship with them, even though I have used them on and off in the past. Much prefer outdoor or “real-life” exercises: walking, swimming, gardening, hiking+tennis to be resumed soon.
I am not sure I would have the guts to undergo surgery again to gain more flex since otherwise you seem to be doing great. How you can sit way up at the recumbent bike with limited flex I can’t imagine. Not officially measured, but I improvised with protractor and iPad display of angles to compare, and I’m probably around 135 flex, and would not even consider getting up close on the machine.
Lastly, life is not fair! Just heard from a friend of mine that her college buddy, age 77, moderately overweight, mostly couch potato, had TKR, never needed a single prescription pain pill, and was walking normally at 10 days. Aargh!!!!

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@damewocane

Going in for a 2nd opinion this week- knee seems to be getting worse as in more pain and -is it possible?- more scar tissue building around tkr-quite sad- original surgeon said only a 50% chance of relief after doing All the pt etc after the lysis/debridement. i am frightened and looking at shelling at least 12 k for the experiment…

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@damewocane I hope the second opinion will be more hopeful than your original surgeon's opinion. Have you had the lysis, or is he just saying that he doesn't think it will help that much? I sure hope when I have it that it will be helpful, but I am not expecting anything more than 125, tops.
JK

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@dduke

So you had the scar tissue removal? If so, extensive PT afterward is crucial. I could not get a knee flexion tool for months, so, I built a boat winch attached to my pull strap to force my knee. I am 15 months post knee replacement. Two MUA and Lysis. Now at 130 degrees at the gym (not comfortable, but doable). How many times a day do you exercise, stair lunge, bike, etc.? I find, if I do not do stationary bike at least three times a day, it stiffens up.

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@dduke what is a knee flexion tool? I am beginning to wonder if I want to bother with this surgery or just be satisfied with what I have.
JK

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@ellerbracke

@contentandwell : I am also an old woman, 70 in a few months, and have been fairly active all of my life. Which probably helped me sail through 2 arthroscopic shoulder surgeries in the past. 3 months and 29 days – I was counting – after right shoulder I was back playing tennis with a full service motion. No OOMPH behind it, but still. The TKR has been more of a slog. However, yesterday morning when I lifted my hands from the usual routine of pushing the knee flat, it stayed down! Yeah! Will keep at it. Regarding gyms: I have a hate-hate relationship with them, even though I have used them on and off in the past. Much prefer outdoor or “real-life” exercises: walking, swimming, gardening, hiking+tennis to be resumed soon.
I am not sure I would have the guts to undergo surgery again to gain more flex since otherwise you seem to be doing great. How you can sit way up at the recumbent bike with limited flex I can’t imagine. Not officially measured, but I improvised with protractor and iPad display of angles to compare, and I’m probably around 135 flex, and would not even consider getting up close on the machine.
Lastly, life is not fair! Just heard from a friend of mine that her college buddy, age 77, moderately overweight, mostly couch potato, had TKR, never needed a single prescription pain pill, and was walking normally at 10 days. Aargh!!!!

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@ellerbracke I can probably put the bike far forward because I am short, just under 5'3".
Oh my, your friend is very fortunate.
JK

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@ellerbracke; @contentandwell I don't visit site often — but am puzzled by recent comments about flexion limitations of "only 130" or 135. That's better than 90% of the population who don't need TKR!! What a miracle it would be to get to 130; to not revert back 15 degrees (every day is like starting over due to the stiffness). Question: How are you able to measure at the gym that you are at 130+ ? On a machine? What machines most helpful besides bike? For those closer to surgery date, I can recommend machine called X-10 — if you can get it for 3 -weeks, it's great. Unfortunately I wish I could have rented it much longer. Later, I had a setback at 5-6 months which I'm not pulling out of , so stiff still. Also: wasn't 6-10 hours a day of PT too much?

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@lkinny

@ellerbracke; @contentandwell I don't visit site often — but am puzzled by recent comments about flexion limitations of "only 130" or 135. That's better than 90% of the population who don't need TKR!! What a miracle it would be to get to 130; to not revert back 15 degrees (every day is like starting over due to the stiffness). Question: How are you able to measure at the gym that you are at 130+ ? On a machine? What machines most helpful besides bike? For those closer to surgery date, I can recommend machine called X-10 — if you can get it for 3 -weeks, it's great. Unfortunately I wish I could have rented it much longer. Later, I had a setback at 5-6 months which I'm not pulling out of , so stiff still. Also: wasn't 6-10 hours a day of PT too much?

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@lkinny I will be thrilled if I reach 125° flex. A woman in my water class had a TKR recently and claimed she had 145! I doubt it. The aim generally is to get to 120° minimum, which I am not at. I have not been measured since I had PT. The NP at the ortho just looked at it and knew it was under 120°.

My ortho loves recumbent bikes and water jogging. I don't suppose the water jogging pushes the flex like you can on the bike but it does help to build strength. He is also opposed to overly aggressive PT.

I googled the X-10 and here is the website on it: https://x10therapy.com/. It sounds interesting. I will check with my ortho before I have the lysis. I did not see where it gave the cost on the website. Do you recall what it cost to rent it? Thanks.
JK

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