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?

@gator1965

I too would be delighted with a flexion of 120 degrees, I am 9 months post TKR , one MUA and arthroscopic arthrolysis and debridment of left knee. I am still around 96 degrees. My surgeon has discharged me, I still have monthly physio

Jump to this post

Dear Gator –

There are still surgeons who sort of "declare victory" (reminiescent of that banner on the carrier deck) at anything over 90 degrees.
In my own case… it's been a process of lowered expectations based on a "self-educating process" over the last 3 years. Not all
expensive educations are "ivy league"… (and in my case discounting the about $1,000 a month for medical insurance – I'm at about
$90+K out of pocket… and counting). When I talk about "expense" – it would be worth it if I could have less daily pain and inflammation
(but you do finally "get educated"). IF… I could ever go back and put that genie back in the bottle… I would NEVER have done this
surgery (knowing what I know now – and continue to experience). I'm still still looking for "a way out", "a way back", … something and
am determined to NOT give up (although I personally know local people in my situation or nearly who have basically done that). There
is no doubt that all this pain, stress, sleeplessness, medications, etc… does take a toll. It's a question of how long the money holds out
and how long my health does (because who knows what else becomes collateral damage – or when ?). It would be a little idealistic to
assume 3+ years of this would have NO effect to my health.

My situation (of the inflammation, stiffness, etc.) is not the situation that most of you will ever face, but some of you will. If anyone out
there is considering a TKR and wanted my advice (and I don't blame you of you don't), I'd say to get a 2nd opinion from a well regarded surgeon who knew he wasn't going to do the surgery (and maybe better if they are a little outside your local area), then…
I'd at least explore what regenerative medicine has to offer (this is improving all the time, but unfortunately can not do much for you
AFTER you've had a TKR… before…maybe yes, after… most likely not). THEN if you feel like you have educated yourself to the extent
possible (and still want the TKR surgery)… DEFINITELY get yourself metal allergy tested (MELISA… there are links online) and then
maybe talk to the surgeon you've chosen (and maybe this should be someone who you have multiple recommendations from people
you know who've been a patient) and have discussions with this surgeon (and also who you're thinking about being your PT provider)
about how engaged they are going to be – in case things DON'T go as well as expected. Then if you're determined to have the surgery,
maybe a VERY good idea to prepare yourself (physically) – and by that I mean exercise daily (or as often as possible – especially your
legs, back, and core (you'll need those stomach muscles to get yourself "up and down" to reach for things you need when you are
largely incapacitated and etc. If you are carrying significant extra weight – consider dropping at least some of this (it just makes your
recovery more difficult). People who tell you "this is no big deal" and is just "minor surgery" are nearly always people who haven't had
a TKR surgery themselves. I had a friend (joking) ask me if I knew what "minor surgery" was ? Answer: That's surgery done on some
one ELSE.
———————————————————————————————————————————————————————————
I appreciate everyone who responded to what i wrote. My intentio is not to be "alarmist" or some sort of "prophet of doom", but to
hopefully help others potentially avoid some (maybe all ?) of what I've been through. I know there are people (and this is a majority)
who are helped 9and some of these helped greatly) by having this TKR surgery. BUT… I also know (now) that this joint implant
surgery "buisness" has become a giant industry and unfortunately we as older folks represent to them (maybe First) "a cash cow"
like no other. I grew up instinctively trusting doctors (even growing up around a family doctor who had treated multiple generations,
knew the family history, and in urgent cases… made "house call". My mother was a single parent teacher in Tennessse – with (4) kids… so that shoulfd tell about how much extra money we had. At that time, I never doubted that my doctor's primary interest and
motivation was my health. I can not honestly say I believe that to be "mostly true" now. What i do believ – is that in many cases that
"First do no harm" has been replaced by answering two questions – which are: Is this proposed procedure on this patient legally defensible ? (yes – in nearly all cases) and Can I get paid for this ? ( which is "yes" – that in most cases… if an orthopedic surgeon
recommends it, your insurance will pay at least a majority of the costs). Despite what you hear about "frivolous medical lawsuits",
these are nearly impossible to win (yes – you do hear about class action cases occasionally, but in the case of an individual "less
than optimal outsome" – these are common and as long as the surgeons stay within the broad confines of "the local standard of care"
which does differ area-to-area… they almost have to perform surgery on the "wrong" leg for you to get a favorable judgement (and
I can guarantee you'll be signing some sort "aggreement to arbitration" – which means you are going in front of their arbiter even in
thevery worst case scenarios… not a judge and jury). No, I never sued anyone in my life and have no intention now… but never
doubt that surgeons have looked at this from all angles "upfront" nd covered themselves completely… the only one suffering any
negative consequences (if any) – will be the patient. That's not "spinning this" any certain way… that's just the way it is (and no
accident that it's that way).
————————————————————————————————————————————————————————–
For the people who have unresolved issues of disability and pain as a result of this surgery (or really, as a consequence of any surgery, illness, accident, etc.) all I can say is "keep fighting" and most of all – don't give up on yourself. BUT… also be advised
that (as a group) we are vulnerable to every possible kind of "questionable medical" scam… most of these very expensive – and
nearly all of these are absolutely NOT covered by anyone's medical insurance. What wouldn't you pay to be able to walk (even
with limited pain – if you can't now) ? I guess the obvious answer is – Anything, nearly (and that's what makes us so vulnerable).
————————————————————————————————————————————————————————
In answer to Debbra (thanks for your question) – No, I've never had the shoulder surgery (yet) which is (also) in constant pain.
I've been trying to get over the knee first (idealistic me). This has deteriorated to the point of needing the "reverse type" replacement
surgery… and one problem for me being that there aren't a whole lot of options for hypoallergenic shoulder replacement joints in
the US (elsewhere – there is Ceramtec and others… although supposedly there is a carbon-fiber one of these coming out soon…
I hope). Thanks again for the question – and certainly am interested in any suggestions other may have,

Just FYI. I am weight size proportional, exercise vigorously (what I can) daily, and am on a fairly restricted diet gluten-free
generally, but also as anti-inflammatory as I can get (which is not "inexpensive").

I have had ASTYM therapy, but this deals only with surface scar tissue accumulations – not scar tissue literally "in the joint"
which seems to be my problem.

I understand that – my "joint" will not rotate properly (maybe – at all) which prevents the leg from straightening (extending)
fully. Per my previous, I am at about 11 degrees short of full extension (on my own – this can be "forced" closer).

Has anyone out there heard or better yet experienced "The X10 Knee Recovery Syetem" ? Sounds Elon Musk "Space
Shippy" named and no doubt terribly expensive. But… has anyone heard of this or better yet – any direct experience ?

Obviously… my options are pretty limited at this point – and I do appreciate any ideas from others.

And i wish you all – the very best,

John

REPLY
@gutthookd

Dear Gator –

There are still surgeons who sort of "declare victory" (reminiescent of that banner on the carrier deck) at anything over 90 degrees.
In my own case… it's been a process of lowered expectations based on a "self-educating process" over the last 3 years. Not all
expensive educations are "ivy league"… (and in my case discounting the about $1,000 a month for medical insurance – I'm at about
$90+K out of pocket… and counting). When I talk about "expense" – it would be worth it if I could have less daily pain and inflammation
(but you do finally "get educated"). IF… I could ever go back and put that genie back in the bottle… I would NEVER have done this
surgery (knowing what I know now – and continue to experience). I'm still still looking for "a way out", "a way back", … something and
am determined to NOT give up (although I personally know local people in my situation or nearly who have basically done that). There
is no doubt that all this pain, stress, sleeplessness, medications, etc… does take a toll. It's a question of how long the money holds out
and how long my health does (because who knows what else becomes collateral damage – or when ?). It would be a little idealistic to
assume 3+ years of this would have NO effect to my health.

My situation (of the inflammation, stiffness, etc.) is not the situation that most of you will ever face, but some of you will. If anyone out
there is considering a TKR and wanted my advice (and I don't blame you of you don't), I'd say to get a 2nd opinion from a well regarded surgeon who knew he wasn't going to do the surgery (and maybe better if they are a little outside your local area), then…
I'd at least explore what regenerative medicine has to offer (this is improving all the time, but unfortunately can not do much for you
AFTER you've had a TKR… before…maybe yes, after… most likely not). THEN if you feel like you have educated yourself to the extent
possible (and still want the TKR surgery)… DEFINITELY get yourself metal allergy tested (MELISA… there are links online) and then
maybe talk to the surgeon you've chosen (and maybe this should be someone who you have multiple recommendations from people
you know who've been a patient) and have discussions with this surgeon (and also who you're thinking about being your PT provider)
about how engaged they are going to be – in case things DON'T go as well as expected. Then if you're determined to have the surgery,
maybe a VERY good idea to prepare yourself (physically) – and by that I mean exercise daily (or as often as possible – especially your
legs, back, and core (you'll need those stomach muscles to get yourself "up and down" to reach for things you need when you are
largely incapacitated and etc. If you are carrying significant extra weight – consider dropping at least some of this (it just makes your
recovery more difficult). People who tell you "this is no big deal" and is just "minor surgery" are nearly always people who haven't had
a TKR surgery themselves. I had a friend (joking) ask me if I knew what "minor surgery" was ? Answer: That's surgery done on some
one ELSE.
———————————————————————————————————————————————————————————
I appreciate everyone who responded to what i wrote. My intentio is not to be "alarmist" or some sort of "prophet of doom", but to
hopefully help others potentially avoid some (maybe all ?) of what I've been through. I know there are people (and this is a majority)
who are helped 9and some of these helped greatly) by having this TKR surgery. BUT… I also know (now) that this joint implant
surgery "buisness" has become a giant industry and unfortunately we as older folks represent to them (maybe First) "a cash cow"
like no other. I grew up instinctively trusting doctors (even growing up around a family doctor who had treated multiple generations,
knew the family history, and in urgent cases… made "house call". My mother was a single parent teacher in Tennessse – with (4) kids… so that shoulfd tell about how much extra money we had. At that time, I never doubted that my doctor's primary interest and
motivation was my health. I can not honestly say I believe that to be "mostly true" now. What i do believ – is that in many cases that
"First do no harm" has been replaced by answering two questions – which are: Is this proposed procedure on this patient legally defensible ? (yes – in nearly all cases) and Can I get paid for this ? ( which is "yes" – that in most cases… if an orthopedic surgeon
recommends it, your insurance will pay at least a majority of the costs). Despite what you hear about "frivolous medical lawsuits",
these are nearly impossible to win (yes – you do hear about class action cases occasionally, but in the case of an individual "less
than optimal outsome" – these are common and as long as the surgeons stay within the broad confines of "the local standard of care"
which does differ area-to-area… they almost have to perform surgery on the "wrong" leg for you to get a favorable judgement (and
I can guarantee you'll be signing some sort "aggreement to arbitration" – which means you are going in front of their arbiter even in
thevery worst case scenarios… not a judge and jury). No, I never sued anyone in my life and have no intention now… but never
doubt that surgeons have looked at this from all angles "upfront" nd covered themselves completely… the only one suffering any
negative consequences (if any) – will be the patient. That's not "spinning this" any certain way… that's just the way it is (and no
accident that it's that way).
————————————————————————————————————————————————————————–
For the people who have unresolved issues of disability and pain as a result of this surgery (or really, as a consequence of any surgery, illness, accident, etc.) all I can say is "keep fighting" and most of all – don't give up on yourself. BUT… also be advised
that (as a group) we are vulnerable to every possible kind of "questionable medical" scam… most of these very expensive – and
nearly all of these are absolutely NOT covered by anyone's medical insurance. What wouldn't you pay to be able to walk (even
with limited pain – if you can't now) ? I guess the obvious answer is – Anything, nearly (and that's what makes us so vulnerable).
————————————————————————————————————————————————————————
In answer to Debbra (thanks for your question) – No, I've never had the shoulder surgery (yet) which is (also) in constant pain.
I've been trying to get over the knee first (idealistic me). This has deteriorated to the point of needing the "reverse type" replacement
surgery… and one problem for me being that there aren't a whole lot of options for hypoallergenic shoulder replacement joints in
the US (elsewhere – there is Ceramtec and others… although supposedly there is a carbon-fiber one of these coming out soon…
I hope). Thanks again for the question – and certainly am interested in any suggestions other may have,

Just FYI. I am weight size proportional, exercise vigorously (what I can) daily, and am on a fairly restricted diet gluten-free
generally, but also as anti-inflammatory as I can get (which is not "inexpensive").

I have had ASTYM therapy, but this deals only with surface scar tissue accumulations – not scar tissue literally "in the joint"
which seems to be my problem.

I understand that – my "joint" will not rotate properly (maybe – at all) which prevents the leg from straightening (extending)
fully. Per my previous, I am at about 11 degrees short of full extension (on my own – this can be "forced" closer).

Has anyone out there heard or better yet experienced "The X10 Knee Recovery Syetem" ? Sounds Elon Musk "Space
Shippy" named and no doubt terribly expensive. But… has anyone heard of this or better yet – any direct experience ?

Obviously… my options are pretty limited at this point – and I do appreciate any ideas from others.

And i wish you all – the very best,

John

Jump to this post

@gutthookd John, you have given a lot of good and useful advice here. Thankfully most of us had better outcomes but there is a large percentage of people who are not happy after knee surgery, I have heard it to be as high as 30%.
Prior to my first TKR, I did not research as much as I should have, I was in extreme pain, 24/7, so I took a surgeon who sounded good and could do my knee sooner than some others could. I was more careful in choosing the surgeon for my second TKR, I was not as desperate. I had excellent recommendations, and he was rated five stars on the rating sites. That being said, you cannot rely on them at all, but if there are many reviews of a doctor it is more reliable. My first TKR was not bad, just not as good as my second one.
Exercising beforehand to strengthen the supporting muscles is a huge advantage, as is losing as much excess weight as you can.
I too would be interested in hearing more about the X10. I believe someone else mentioned on one of the discussions. I am planning to have a lysis done and the X10 may be helpful after that. My flex is under 120, so I am hoping to improve that.
JK

REPLY
@gutthookd

Dear Gator –

There are still surgeons who sort of "declare victory" (reminiescent of that banner on the carrier deck) at anything over 90 degrees.
In my own case… it's been a process of lowered expectations based on a "self-educating process" over the last 3 years. Not all
expensive educations are "ivy league"… (and in my case discounting the about $1,000 a month for medical insurance – I'm at about
$90+K out of pocket… and counting). When I talk about "expense" – it would be worth it if I could have less daily pain and inflammation
(but you do finally "get educated"). IF… I could ever go back and put that genie back in the bottle… I would NEVER have done this
surgery (knowing what I know now – and continue to experience). I'm still still looking for "a way out", "a way back", … something and
am determined to NOT give up (although I personally know local people in my situation or nearly who have basically done that). There
is no doubt that all this pain, stress, sleeplessness, medications, etc… does take a toll. It's a question of how long the money holds out
and how long my health does (because who knows what else becomes collateral damage – or when ?). It would be a little idealistic to
assume 3+ years of this would have NO effect to my health.

My situation (of the inflammation, stiffness, etc.) is not the situation that most of you will ever face, but some of you will. If anyone out
there is considering a TKR and wanted my advice (and I don't blame you of you don't), I'd say to get a 2nd opinion from a well regarded surgeon who knew he wasn't going to do the surgery (and maybe better if they are a little outside your local area), then…
I'd at least explore what regenerative medicine has to offer (this is improving all the time, but unfortunately can not do much for you
AFTER you've had a TKR… before…maybe yes, after… most likely not). THEN if you feel like you have educated yourself to the extent
possible (and still want the TKR surgery)… DEFINITELY get yourself metal allergy tested (MELISA… there are links online) and then
maybe talk to the surgeon you've chosen (and maybe this should be someone who you have multiple recommendations from people
you know who've been a patient) and have discussions with this surgeon (and also who you're thinking about being your PT provider)
about how engaged they are going to be – in case things DON'T go as well as expected. Then if you're determined to have the surgery,
maybe a VERY good idea to prepare yourself (physically) – and by that I mean exercise daily (or as often as possible – especially your
legs, back, and core (you'll need those stomach muscles to get yourself "up and down" to reach for things you need when you are
largely incapacitated and etc. If you are carrying significant extra weight – consider dropping at least some of this (it just makes your
recovery more difficult). People who tell you "this is no big deal" and is just "minor surgery" are nearly always people who haven't had
a TKR surgery themselves. I had a friend (joking) ask me if I knew what "minor surgery" was ? Answer: That's surgery done on some
one ELSE.
———————————————————————————————————————————————————————————
I appreciate everyone who responded to what i wrote. My intentio is not to be "alarmist" or some sort of "prophet of doom", but to
hopefully help others potentially avoid some (maybe all ?) of what I've been through. I know there are people (and this is a majority)
who are helped 9and some of these helped greatly) by having this TKR surgery. BUT… I also know (now) that this joint implant
surgery "buisness" has become a giant industry and unfortunately we as older folks represent to them (maybe First) "a cash cow"
like no other. I grew up instinctively trusting doctors (even growing up around a family doctor who had treated multiple generations,
knew the family history, and in urgent cases… made "house call". My mother was a single parent teacher in Tennessse – with (4) kids… so that shoulfd tell about how much extra money we had. At that time, I never doubted that my doctor's primary interest and
motivation was my health. I can not honestly say I believe that to be "mostly true" now. What i do believ – is that in many cases that
"First do no harm" has been replaced by answering two questions – which are: Is this proposed procedure on this patient legally defensible ? (yes – in nearly all cases) and Can I get paid for this ? ( which is "yes" – that in most cases… if an orthopedic surgeon
recommends it, your insurance will pay at least a majority of the costs). Despite what you hear about "frivolous medical lawsuits",
these are nearly impossible to win (yes – you do hear about class action cases occasionally, but in the case of an individual "less
than optimal outsome" – these are common and as long as the surgeons stay within the broad confines of "the local standard of care"
which does differ area-to-area… they almost have to perform surgery on the "wrong" leg for you to get a favorable judgement (and
I can guarantee you'll be signing some sort "aggreement to arbitration" – which means you are going in front of their arbiter even in
thevery worst case scenarios… not a judge and jury). No, I never sued anyone in my life and have no intention now… but never
doubt that surgeons have looked at this from all angles "upfront" nd covered themselves completely… the only one suffering any
negative consequences (if any) – will be the patient. That's not "spinning this" any certain way… that's just the way it is (and no
accident that it's that way).
————————————————————————————————————————————————————————–
For the people who have unresolved issues of disability and pain as a result of this surgery (or really, as a consequence of any surgery, illness, accident, etc.) all I can say is "keep fighting" and most of all – don't give up on yourself. BUT… also be advised
that (as a group) we are vulnerable to every possible kind of "questionable medical" scam… most of these very expensive – and
nearly all of these are absolutely NOT covered by anyone's medical insurance. What wouldn't you pay to be able to walk (even
with limited pain – if you can't now) ? I guess the obvious answer is – Anything, nearly (and that's what makes us so vulnerable).
————————————————————————————————————————————————————————
In answer to Debbra (thanks for your question) – No, I've never had the shoulder surgery (yet) which is (also) in constant pain.
I've been trying to get over the knee first (idealistic me). This has deteriorated to the point of needing the "reverse type" replacement
surgery… and one problem for me being that there aren't a whole lot of options for hypoallergenic shoulder replacement joints in
the US (elsewhere – there is Ceramtec and others… although supposedly there is a carbon-fiber one of these coming out soon…
I hope). Thanks again for the question – and certainly am interested in any suggestions other may have,

Just FYI. I am weight size proportional, exercise vigorously (what I can) daily, and am on a fairly restricted diet gluten-free
generally, but also as anti-inflammatory as I can get (which is not "inexpensive").

I have had ASTYM therapy, but this deals only with surface scar tissue accumulations – not scar tissue literally "in the joint"
which seems to be my problem.

I understand that – my "joint" will not rotate properly (maybe – at all) which prevents the leg from straightening (extending)
fully. Per my previous, I am at about 11 degrees short of full extension (on my own – this can be "forced" closer).

Has anyone out there heard or better yet experienced "The X10 Knee Recovery Syetem" ? Sounds Elon Musk "Space
Shippy" named and no doubt terribly expensive. But… has anyone heard of this or better yet – any direct experience ?

Obviously… my options are pretty limited at this point – and I do appreciate any ideas from others.

And i wish you all – the very best,

John

Jump to this post

Thanks @gutthookd – I can understand why you haven't had the shoulder done yet. I agree with @contentandwell JK that there was a discussion of the X10 machine not too long ago and also a discussion of alternative treatments like acupuncture and myofascial release. I'm going to tag some people who may be able to shed some light on this @lkinny, @golfshrink and @melcpa86. Wishing you the best of luck with your recovery decisions.

REPLY

I’m shocked at how much the myofascial release and Acupuncture has helped. Unfortunately, I started both of them at the same time, so I’m not sure which is helping the most. I feel that the acupuncture took most of my nighttime pain away after two sessions. Myofascial release probably would’ve been more effective earlier on in my rehab. Feels good but wears off rapidly.

REPLY

Hello all. I'm a healthy 62 yr old female who had total knee replacement. It didn't bend properly so I got a manipulation done. During the process the Dr broke my femur. An emergency surgery was done to remove the original apparatus and replace it with a different model. It's been over a year and the scar tissue will not go away. I want to try astym or arthroscopic surgery with hopes of less stiffness and more rom. Is there hope/help for me??

REPLY
@blessangela2019

Hello all. I'm a healthy 62 yr old female who had total knee replacement. It didn't bend properly so I got a manipulation done. During the process the Dr broke my femur. An emergency surgery was done to remove the original apparatus and replace it with a different model. It's been over a year and the scar tissue will not go away. I want to try astym or arthroscopic surgery with hopes of less stiffness and more rom. Is there hope/help for me??

Jump to this post

@blessangela2019 Once scar tissue forms I don't believe it will go away without some surgical intervention. I cannot say that I am 100% sure, I could be wrong. I was not familiar with astym so I just googled it. It sounds very encouraging. To increase my flex in the knee done in October 2017 this is what the surgeon's NP said:

An arthroscopic lysis of adhesions is what the procedure is called. The doctor goes in with a small camera and a small tool that burns the scar tissue away. He doesn't use the long incision. He makes two small 1/2 inch incisions to get his tools in the knee. It's same day surgery. You go home after the procedure. You walk, fully weight bearing right away. You start using the bike the day after surgery. Treadmill would wait several weeks until you have minimal swelling and get good motion on the bike. Once we see you at your first post-op appointment approx 10-14 days after surgery we see how your incision is healing and will let you know when you can get back in the pool.

Is your doctor proposing the astym procedure? If you have confidence in him I would go with what he advises. If you are not sure you should get a second opinion.
I have no idea which procedure is the best, but if your doctor tells you more about the astym, I would be interested in it, if you could share it.
JK

REPLY
@blessangela2019

Hello all. I'm a healthy 62 yr old female who had total knee replacement. It didn't bend properly so I got a manipulation done. During the process the Dr broke my femur. An emergency surgery was done to remove the original apparatus and replace it with a different model. It's been over a year and the scar tissue will not go away. I want to try astym or arthroscopic surgery with hopes of less stiffness and more rom. Is there hope/help for me??

Jump to this post

Dear Angela –

I'm genuinely sorry to hear your story. My own is not "the same", but probably similar in a lot of aspects. There
is so much that we as patients do not know prior to surgery – and everyone I've ever talked to that ended up
having problems after… mostly trusted in their surgeons that "this was no big deal" and that they would be "well
taken care of". In reality, there mostly isn't a co-ordinated care plan of any kind (that includes your surgeon – or
anyone else). If you are lucky, you'll get a physical therapist who is empathetic – and who will try to do something
other than just telling you "how great your knee looks" (when it doesn't) and "how good you are going – how well
you are progressing (when you clearly aren't). Many of these physical therapist's (I can't say "most" – although
I suspect this) won't honestly communicate the difficulties you are having (physically), the pain you seem to be
experiencing and etc.) back to your surgical team. IF the physical therapist does this (and of course – they should),
they will potentially "cost themselves business" (because a lot of these surgical teams… want patients "encouraged",
don't want to be bothered with problems they probably do believe are temporary – and will eventually resolve over
time… and more importantly – to them, don't want their time wasted doing things which are NOT additional surgeries).
As a physical therapist — if you "get a name for" being a patient advocate or honestly reporting problems when you
see them… there is a good potential for you to be "punished" with less referrals from surgeons (and less business,
period). This is another case of incentives pointing exactly the wrong way if you are a patient.

After you have a TKR surgery and experience problems with your recovery… while you are sitting around (elevating
and icing), you start to "get educated" on this subject. Most TKR surgical recoveries are a kind of "race" between
the inflammation and scar tissue formation – and getting the necessary flexion (bending) and extension (straightening).
Based on individual differences your inflammation and scar tissue formation may proceed faster than you can develop
much flexion and extension. Of these two – the extension is absolutely the most important (because if you can't "straighten"
the leg properly, your walking "gait" is negatively affected and it's more likely that you will just continue building scar tissue
to the point that all progress first "stops" and is then "reversed" (and you find that over time you are able to bend and straighten
the leg progressively less – as this is "blocked" by scar tissue accumulations… which just increase over time). The scar tissue
does not "go away" on its own… generally. ASTYM can reduce surface scar tissue, but not the scar tissue which accumulates
in the joint itself. Arthroscopy can remove the scar tissue but often (in my case) promotes exactly the same response (serious
inflammation – and massive scar tissue accumulation resulting almost immediately). This is a process which is well understood
by surgeons and PT providers, but they don't seem to have a good idea for how to avoid this. The most common complaint for
people who have problems with their TKRs is "a persistently stiff and painful knee". In some cases (maybe a lot of cases), this
may be due to a metal or in some cases I am aware of… an adhesive allergy… in my own case originally, this was an allergy to
components of the alloy used in what I believed was a "titanium" prosthetic, but was in fact… a titanium alloy). If you think about
how many women (I guess "men" too – these days) have an allergic reaction to an earring "post" that isn't sterling silver or a
certain kind of stainless steel… you begin to understand the potential numbers of people involved (especially when you are also
considering this is a metal device implanted in your body… AND that metal isotopes are regularly released as part of the normal
process of an articulating joint… moving). This process of metal isotopes being released in the bloodstream (and what negative
effects could be – or are being experienced) is not well understood. When you multiply the numbers 723,000 TKRs in 2017 in
the US by the fact that the Nationl Institute of Health (NIH) says that about 15% of the US population has some degree of allergy
to Nickel or Chromium (which are common in prosthetic alloys) then you start to understand the potential numbers of people who
may be experiencing long term problems.

I was almost a "poster child" of a 59 year old male who had dropped a bunch of excess weight (and kept it off). Now I am soon
to be 63 – and have had an original TKR, a MUA, an arthroscopy, a partial revision, and then (finally) a metals allergy test (with
me – it was Maganese and Molybdenum… which were both present in my first prosthetic alloy) and then another TKR – this with
hypoallergenic components. I still have problems with inflammation and scar tissue formation – and have had another MUA
after this latest surgery (12/17/18) – the only difference being this time with a cortisone injection… which has helped. Maybe… I
am starting to improve slowly (but still… have a ton of pain and inflammation).

Beware of… "pain clinic persons" who are typically "injection specialists" and will try to sell you on PRP, stem-cells, and you
name it (none of which can do much for an already replaced knee). Diet can help (some) with the inflammation. Other than
that, I'd say definitely get yourself tested for a metal allergy if you continue to have problems. Do your own research, but
I think you will find that the MELISA test is the "gold standard" as far as this is concerned (not a simple skin allergy "scratch
test" – which might work fine for a certain make-up applied to the skin, but NOT for an object to be implanted in your body).

I recommend reading up on the subject (of problems with TKRs – you'll find what you are describing is the most common
complaint). Personally… I'd rather have an honest answer than a bunch of blue sky and sunshine. I hope there is an
immediate "cure" for all of this – for you, but there may not be. Honestly, I have to admit that I have some level of outrage
that surgeons are actively promoting these surgeries – when they don't understand "how to make it all better" if problems
are experienced (and frankly, I don't see a lot of interest from the surgical community on this… even as they try to figure
out ways to do even more surgeries – in the shortest amount of time possible). It's a BIG MONEY making business – and
like I said previously (from the patient standpoint), all the incentives are pointed in the wrong direction as far as helping
you to achieve a full (or as much as possible) recovery.

But like I also said – I do believe "the answer" is out there… and I haven't given up looking for this. Who is properly
"incentivized" to find an answer… other than the people who are suffering from these "less than optimal outcomes".

My very best to you (and everyone). Please feel free to ask me any specific questions. I can point you toward reseach
I am aware of… and if I really just "don't know" – then I'll say "I don't know" and maybe we can both (or all) find out.

John

I believe that there is probably an answer that will work for you (and me, and others) out there (somewhere – maybe not in
this country… which as it turns out is very backward in certain areas as far as the practice of medicine goes).

REPLY
@debbraw

Thanks @gutthookd – I can understand why you haven't had the shoulder done yet. I agree with @contentandwell JK that there was a discussion of the X10 machine not too long ago and also a discussion of alternative treatments like acupuncture and myofascial release. I'm going to tag some people who may be able to shed some light on this @lkinny, @golfshrink and @melcpa86. Wishing you the best of luck with your recovery decisions.

Jump to this post

Good afternoon, Debora (and thanks for your response) –

My "timing" has not been good in many cases regarding the original TKR and follow-up procedures.
A little bit like how we all (or maybe it IS just me) learn "about" being married… AFTER we have been
married (joking… mostly). Knowing what I believe i understand now, it would've been most optimal to
have been immediately put on that X10 (the name was taken from "extension" – which the surgeon and
co-inventor Dr. Halley, felt like was the absolutely most important "thing" to develop as quickly as possible
after surgery (or an MUA). In my present state, it might work – and it might not.

I'd appreciate any further information from people who've actually used this (as a patient).

Thanks again (and good for you – helping as a vlunteer)

John

REPLY
@contentandwell

@blessangela2019 Once scar tissue forms I don't believe it will go away without some surgical intervention. I cannot say that I am 100% sure, I could be wrong. I was not familiar with astym so I just googled it. It sounds very encouraging. To increase my flex in the knee done in October 2017 this is what the surgeon's NP said:

An arthroscopic lysis of adhesions is what the procedure is called. The doctor goes in with a small camera and a small tool that burns the scar tissue away. He doesn't use the long incision. He makes two small 1/2 inch incisions to get his tools in the knee. It's same day surgery. You go home after the procedure. You walk, fully weight bearing right away. You start using the bike the day after surgery. Treadmill would wait several weeks until you have minimal swelling and get good motion on the bike. Once we see you at your first post-op appointment approx 10-14 days after surgery we see how your incision is healing and will let you know when you can get back in the pool.

Is your doctor proposing the astym procedure? If you have confidence in him I would go with what he advises. If you are not sure you should get a second opinion.
I have no idea which procedure is the best, but if your doctor tells you more about the astym, I would be interested in it, if you could share it.
JK

Jump to this post

I wish my surgeon would do that procedure for me but he says no it won't work have to open up the knee and do another replacement I told him I will not do that again he just said ok see ya later. I have tried for a second opinion but no o e will talk to me until 1 year is up. I am lost at what to do

REPLY
@gutthookd

Good afternoon, Debora (and thanks for your response) –

My "timing" has not been good in many cases regarding the original TKR and follow-up procedures.
A little bit like how we all (or maybe it IS just me) learn "about" being married… AFTER we have been
married (joking… mostly). Knowing what I believe i understand now, it would've been most optimal to
have been immediately put on that X10 (the name was taken from "extension" – which the surgeon and
co-inventor Dr. Halley, felt like was the absolutely most important "thing" to develop as quickly as possible
after surgery (or an MUA). In my present state, it might work – and it might not.

I'd appreciate any further information from people who've actually used this (as a patient).

Thanks again (and good for you – helping as a vlunteer)

John

Jump to this post

@gutthookd
I used the X10 pretty soon, maybe 3 1/2 weeks after surgery and had great results; I reached 127 – 130 comfortably and quickly — but could not keep the machine (there is too much demand, too few machines to rent ) for as long as I wanted (to ensure the progress "stuck" ). PT was not very demanding and I was discharged MUCH sooner than I wanted bec I was allegedly doing well enough; also really NOT given at home program by my PT. Within 2 – 3 months I had severe back-side-of-knee tendon pain and was challenged with simple walking and shoes. Frequent charley-horse pain and night cramping. Consequently I didn't push hard enough I think, got spooked. I got the machine back a few months later (recently) and never returned to as good of flexion as before. I'm disheartened to have less flexion than I want, at 11 months, but with new PT, I do feel less pain. I was a tough TKR case, having been repeatedly injured for 30 years and thus, atrophied. I really recommend using the X10 as soon as possible and to push yourself with it — it's so easy and comfortable. They have recently manufactured 50 more machines which they try to get to different states, mostly east coast. Covered by insurance in Michigan only. Well worth the cost.

REPLY
@kneeproblem

I wish my surgeon would do that procedure for me but he says no it won't work have to open up the knee and do another replacement I told him I will not do that again he just said ok see ya later. I have tried for a second opinion but no o e will talk to me until 1 year is up. I am lost at what to do

Jump to this post

@blessangela2019 Don’t give up on finding a second opinion. I had the arthroscopic lysis of adhesions procedure done 8 weeks ago at 8.5 months. The PT routine afterwards is brutal – but seems to be working. My original surgeon offered it and my second opinion doc said no – revise. I went with original doc. I’m in Texas in a town of 100K people north of Houston.

REPLY
@kneeproblem

I wish my surgeon would do that procedure for me but he says no it won't work have to open up the knee and do another replacement I told him I will not do that again he just said ok see ya later. I have tried for a second opinion but no o e will talk to me until 1 year is up. I am lost at what to do

Jump to this post

Dear knee problem (and all) –

I am starting to believe that there are basically two kinds of people with post TKR problems. The minority (unfortunately) are those
who either don't talk about it with others or who have stopped out of frustration. In the course of over 3 years of my own struggles
(which are not over), I've been inplaces of dark despair – including times I thought this was some sort of "fate" I just needed to "accept"
(and I've actually gotten "that talk" from two of the three surgeons – not the latest, but I'm expecting that pretty soon). You'll all hear
something similar at the point your current surgeon is looking to "cut you loose" (not wanting toinvest any further time in something he
doesn't see paying off for him). It mostly goes… "there are times when these surgeries don't work out as well as we expect… and we're really not sure why, but at some point you as the pateint has to accept this and move on with their life". When I hear that, my question
is always – would YOU accept this and do you realize that this leaves me with not much of a life at all ?

You will notice than in about the first year after a TKR, other surgeons are gun-shy at "getting involved" considering this as somehow
"being the last surgeon's knee". Once the last surgeon custs you loose (ususally well after any intervention could do you much or any
"good")… it magically becomes "YOUR knee" once again.

Thanks LKinny for your additional info on X10. Weird that it's so difficult to get answers out the company and too bad that people
who live anywhere but the Midwest (or Florida) don't have access to the machine pretty much peroid. For me (if I am going to get any access) I will need to make about a month's long pilgramage to Michigan ('course I guess it's closer than Lourdes). The good news is that this (X10) is that it is approved for Blue Cross/Blue Shield – but only in Michigan. At some point – I don't think "cost" (of any kind)
enters into the equation. Most of us would mortgage our houses to raise the money if we thought this (or anything) would help.

If you (all) think about it – What kind of country's medical establishment would allow people to do hundreds of thousands of these
surgeries without a known (or at least actively researched) game-plan for the large numbers of people with difficult and downright
failed recoveries. Per my previous (borrowing from JFK) "Success has a thousand fathers – while failure remains an orphan". We
are those "orphans" – but do we have to be "quiet orphans" and so much more easily swept under the rug of all this surgical financial
success ? Personally, I don't think so and I encourage you not only to speak out in this and similar forums, but while you're at it maybe
write your senate and congresspeople. Honestly… these efforts to make ourselves heard may not end up helping us (or helping is much), but could pave the way toward better research, more responsibility being assumed by surgeons (other than just for making sure
no infection develops which could be linked to their surgery and to make sure the surgical incision heals proeperly). As it stands now –
that's about all we can expect and if you think about it – WE have allowed this "paring down of responsibility for our long term recovery"
to become "the legal standard". If we do not assume some responsibility for "changing this back to something more reeasonable", do
you really think this will happen ? Are there nearly enough empathetic surgeons who will take a little less of the substantial fortune
thrown their way and spend a little more of their time (which will cur down on the numbers of surgeries they can "get done") to make
a difference – or does this have to be legally mandated ? Unfortunately, I'd have to say they will do this when they are essentially forced to (and not before).

Please feel free to ask me any questions and to share your experiences – I want to learn something new (if I can) everyday.

Thanks to you all – and my best !

John

REPLY
@gutthookd

Dear Angela –

I'm genuinely sorry to hear your story. My own is not "the same", but probably similar in a lot of aspects. There
is so much that we as patients do not know prior to surgery – and everyone I've ever talked to that ended up
having problems after… mostly trusted in their surgeons that "this was no big deal" and that they would be "well
taken care of". In reality, there mostly isn't a co-ordinated care plan of any kind (that includes your surgeon – or
anyone else). If you are lucky, you'll get a physical therapist who is empathetic – and who will try to do something
other than just telling you "how great your knee looks" (when it doesn't) and "how good you are going – how well
you are progressing (when you clearly aren't). Many of these physical therapist's (I can't say "most" – although
I suspect this) won't honestly communicate the difficulties you are having (physically), the pain you seem to be
experiencing and etc.) back to your surgical team. IF the physical therapist does this (and of course – they should),
they will potentially "cost themselves business" (because a lot of these surgical teams… want patients "encouraged",
don't want to be bothered with problems they probably do believe are temporary – and will eventually resolve over
time… and more importantly – to them, don't want their time wasted doing things which are NOT additional surgeries).
As a physical therapist — if you "get a name for" being a patient advocate or honestly reporting problems when you
see them… there is a good potential for you to be "punished" with less referrals from surgeons (and less business,
period). This is another case of incentives pointing exactly the wrong way if you are a patient.

After you have a TKR surgery and experience problems with your recovery… while you are sitting around (elevating
and icing), you start to "get educated" on this subject. Most TKR surgical recoveries are a kind of "race" between
the inflammation and scar tissue formation – and getting the necessary flexion (bending) and extension (straightening).
Based on individual differences your inflammation and scar tissue formation may proceed faster than you can develop
much flexion and extension. Of these two – the extension is absolutely the most important (because if you can't "straighten"
the leg properly, your walking "gait" is negatively affected and it's more likely that you will just continue building scar tissue
to the point that all progress first "stops" and is then "reversed" (and you find that over time you are able to bend and straighten
the leg progressively less – as this is "blocked" by scar tissue accumulations… which just increase over time). The scar tissue
does not "go away" on its own… generally. ASTYM can reduce surface scar tissue, but not the scar tissue which accumulates
in the joint itself. Arthroscopy can remove the scar tissue but often (in my case) promotes exactly the same response (serious
inflammation – and massive scar tissue accumulation resulting almost immediately). This is a process which is well understood
by surgeons and PT providers, but they don't seem to have a good idea for how to avoid this. The most common complaint for
people who have problems with their TKRs is "a persistently stiff and painful knee". In some cases (maybe a lot of cases), this
may be due to a metal or in some cases I am aware of… an adhesive allergy… in my own case originally, this was an allergy to
components of the alloy used in what I believed was a "titanium" prosthetic, but was in fact… a titanium alloy). If you think about
how many women (I guess "men" too – these days) have an allergic reaction to an earring "post" that isn't sterling silver or a
certain kind of stainless steel… you begin to understand the potential numbers of people involved (especially when you are also
considering this is a metal device implanted in your body… AND that metal isotopes are regularly released as part of the normal
process of an articulating joint… moving). This process of metal isotopes being released in the bloodstream (and what negative
effects could be – or are being experienced) is not well understood. When you multiply the numbers 723,000 TKRs in 2017 in
the US by the fact that the Nationl Institute of Health (NIH) says that about 15% of the US population has some degree of allergy
to Nickel or Chromium (which are common in prosthetic alloys) then you start to understand the potential numbers of people who
may be experiencing long term problems.

I was almost a "poster child" of a 59 year old male who had dropped a bunch of excess weight (and kept it off). Now I am soon
to be 63 – and have had an original TKR, a MUA, an arthroscopy, a partial revision, and then (finally) a metals allergy test (with
me – it was Maganese and Molybdenum… which were both present in my first prosthetic alloy) and then another TKR – this with
hypoallergenic components. I still have problems with inflammation and scar tissue formation – and have had another MUA
after this latest surgery (12/17/18) – the only difference being this time with a cortisone injection… which has helped. Maybe… I
am starting to improve slowly (but still… have a ton of pain and inflammation).

Beware of… "pain clinic persons" who are typically "injection specialists" and will try to sell you on PRP, stem-cells, and you
name it (none of which can do much for an already replaced knee). Diet can help (some) with the inflammation. Other than
that, I'd say definitely get yourself tested for a metal allergy if you continue to have problems. Do your own research, but
I think you will find that the MELISA test is the "gold standard" as far as this is concerned (not a simple skin allergy "scratch
test" – which might work fine for a certain make-up applied to the skin, but NOT for an object to be implanted in your body).

I recommend reading up on the subject (of problems with TKRs – you'll find what you are describing is the most common
complaint). Personally… I'd rather have an honest answer than a bunch of blue sky and sunshine. I hope there is an
immediate "cure" for all of this – for you, but there may not be. Honestly, I have to admit that I have some level of outrage
that surgeons are actively promoting these surgeries – when they don't understand "how to make it all better" if problems
are experienced (and frankly, I don't see a lot of interest from the surgical community on this… even as they try to figure
out ways to do even more surgeries – in the shortest amount of time possible). It's a BIG MONEY making business – and
like I said previously (from the patient standpoint), all the incentives are pointed in the wrong direction as far as helping
you to achieve a full (or as much as possible) recovery.

But like I also said – I do believe "the answer" is out there… and I haven't given up looking for this. Who is properly
"incentivized" to find an answer… other than the people who are suffering from these "less than optimal outcomes".

My very best to you (and everyone). Please feel free to ask me any specific questions. I can point you toward reseach
I am aware of… and if I really just "don't know" – then I'll say "I don't know" and maybe we can both (or all) find out.

John

I believe that there is probably an answer that will work for you (and me, and others) out there (somewhere – maybe not in
this country… which as it turns out is very backward in certain areas as far as the practice of medicine goes).

Jump to this post

@gutthookd John, I am so sorry for all you have been through with your knee. I really never realized how fortunate I was to be doing as well as I am. I appreciate that a lot more now.
It will be interesting if the X10 does help you, if you get it I hope you will let us know how it's working out.
JK

REPLY
@kneeproblem

I wish my surgeon would do that procedure for me but he says no it won't work have to open up the knee and do another replacement I told him I will not do that again he just said ok see ya later. I have tried for a second opinion but no o e will talk to me until 1 year is up. I am lost at what to do

Jump to this post

@kneeproblem That may be true of many doctors. I did not look into this before so I don't know if my surgeon would have done it sooner, but at this point, I am more than a year out from having the TKR. Frankly though, I am getting nervous about having the lysis done Maybe I shouldn't mess with what's really not that bad.
JK

REPLY
@melcpa86

@blessangela2019 Don’t give up on finding a second opinion. I had the arthroscopic lysis of adhesions procedure done 8 weeks ago at 8.5 months. The PT routine afterwards is brutal – but seems to be working. My original surgeon offered it and my second opinion doc said no – revise. I went with original doc. I’m in Texas in a town of 100K people north of Houston.

Jump to this post

@melcpa86 Is the PT as bad after a lysis procedure as it was after the original TKR? I think I really need to think about this.
JK

REPLY
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