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?

John – Thank you for posting the link to propublica. I was able to look up surgeon 1, who did my R knee. He received a total of 40.00! Now, more interestingly, I went to see a surgeon in Boston for a second opinion on knee number 1 and to consider having him replace my L knee. He received well over 2M! However, he is either the creator or one of the creators of the Conformis custom knee. What do you make of his earnings?

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@gutthookd

Good afternoon contentandwell (and all) – Yes, I am aware that there are such things as "custom made knee prosthetics", but these are
very much the exception rather than the rule. I didn't have that option with my insurance (and most people – don't). I'm glad that you had
a mostly good experience with both your knees (even if one was somewhat – or maybe a lot – better). It isn't as if I am not aware that people
don't have good experiences – I wish everyone did (including me). One other thing that a whole lot of TKR (shoulder, hip, etc) patients are
NOT aware of… is that with many of these prosthetic manufacturers (of all types), there is a "little something exgtra" in the way of a financial
incentive to exclusively use one brand versus another. No… I'm not kidding. This information used to be considered "private" and was not
easily available. But… just as some doctors are kind of "additionally comped" for prescribing for instance a "name brand" drug vs the generic
(even though this usually costs much more), surgeons are also "taken care of" by medical device manufactures – and sent on lavish trips plus
paid well additionally to recommend these same devices to other surgeons (because who can "maket" a surgeon better – than another surgeon…
and of course he can get paid some additional dollars, too). Years ago Pro Publica won a series of lawsuits which require that this is now "public
information". Nothing "against" the surgeons, but I think nearly anyone can understand that in certain cases this could definitely cause a conflict
of interest. Anyway… if you are interested in finding out who is "getting paid additionally" (or not – all you have to do is type their name in:
https://projects.propublica.org/docdollars/

No, I do not "have anything against" doctors in general or orthopedic surgeins in particular (although I am a WHOLE lot more skeptical now
regarding what I am told by doctors – especially where it seems in conflict with what I believe might be true or actual). By that I mean – when
you have a knee that is nearly double the size of the other and quite warm to the touch… I am skeptical when the surgeon tells me "how good
the knee looks". I don't distrust him because "he's a doctor", but because of the objective circumstances. The medical field is not (by a long shot),
the only specialized field which will occasionally mischaracterize something – based on their assumption that the person they are talking to "doesn't
know any better" and will tend to "go with" and trust… nearly anything they are told. Most people (my age 60+… especially) will tend to make strong
assumptions that any doctor or surgeon would always give them "the straight scoop" and would primarily be interested in the patient's health. I would
agree that there are definitely doctors who "are still – like that", but I do wonder occasionally if these are becomming less common. I hate to think that,
but in my own case – have had things told to me (both before – and after surgery) that just simply were not true and tended to support the surgoen's point
of view on the matter being discussed. THAT in conjunction with other doctors and surgeons privately commenting in strong terms on the honesty and
reasoning of other doctors/surgeons but then failing to publically (or where a written opinion is required) confront what they themselves consider (or have
privately said they did) unsafe, illogical, or "strictly for the money" behavior…. does concern me (because it potentially puts us all at risk when these people
are essentially "left in place" to continue practicing medicine in these same ways – because of other medical professionals being unwilling to confront these
types of behaviors). It's just another case (and there are many) where the persons most capable of "seeing and understanding that these problems exist"
choose NOT to personally involve themselves. I don't know if anyone out there other than me remembers the sad case of Kitty Genoveeese, but a sort of
"watershed" event for that time period… on the subject of "getting personally involved" vs avoiding this… and that there are consequences.

Anyway… please understand that I am not by nature "a negative person", but have had an expensive education (and quite a bit of this learned – "the hard way"). I really do wish everyone else out there a better experience, but wouldn't agree that sticking our heads in the sand regarding problems and conflicts
that do exist… would be the best way to avoid these. The more you can know about your surgeon and the surgery you are considering before you have surgery – the better. Had I known more then, I believe I would be in a different situation now (and if I can cause one person to avoid a similar experience –
just by asking these questions earlier than I did… then I'll consider I have accomplished something worthwhile).

My best to you – and everyone out there,

John

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@gutthookd I am very aware that the doctors do get comped by drug companies, and I presume by device manufacturers. Our local newspaper printed the names of all of the local doctors and how much each received from drug companies a few years ago. It was eye-opening. I wish they would do that again. I realize too well that drug companies are making way more money than they should be by charging exorbitant prices for necessary drugs. Of course, they are entitled to make a profit but the profit they make is unconscionable, particularly when they take a drug off the market that is helping a small segment of people but they are not making enough profit for them.
Medicare and my supplemental paid for my knee, I paid virtually nothing. I think I would have paid some extra though to get the knee I have. I did do quite a bit of research before I chose my surgeon and knee. Knowing what I know now, I believe that is essential, particularly with something like a TKR that has such a high dissatisfaction ratio.
I truly hope that you can get some more positive results with your knee. You have gone through much more than you ever should have had to.
JK

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@babette

John – Thank you for posting the link to propublica. I was able to look up surgeon 1, who did my R knee. He received a total of 40.00! Now, more interestingly, I went to see a surgeon in Boston for a second opinion on knee number 1 and to consider having him replace my L knee. He received well over 2M! However, he is either the creator or one of the creators of the Conformis custom knee. What do you make of his earnings?

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@babette That is my knee, and I presume the doctor who did my TKR. The large amount he made is of course profits from other doctors using that knee, not being paid by Conformis for using it himself.
It is refreshing to see doctors whose profits from drug companies and device companies are under $100. They have their patient's best interest at heart, not their wallets.
JK

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@babette

John – Thank you for posting the link to propublica. I was able to look up surgeon 1, who did my R knee. He received a total of 40.00! Now, more interestingly, I went to see a surgeon in Boston for a second opinion on knee number 1 and to consider having him replace my L knee. He received well over 2M! However, he is either the creator or one of the creators of the Conformis custom knee. What do you make of his earnings?

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Good Morning, Babette (and all) –

Yes… this is interesting stuff (and if you're like me – a little surprising that people who are so well compensated…
figure endless ways of "getting a little more"). This is now very common. I guess I don't draw a whole lot of
conclusions from his vs other surgeon's "additional earnings". My questions for any surgeon would be – how
involved will YOU be during my recovery and is there a coordinated care plan (ideally there would be a nearly
seamless hand-off to physical therapists who would stay in contact with the surgeon and fully report on your
progress). If he (or she) waffles on answering these questions, personally – I'd say find someone else despite
their qualifications. The potential problems are not generally caused by their lack of skill as a surgeon, but more
by a lack of willingness (or in some cases – a determination to not under any circumstances) to involve themselves
in anything OTHER than just the surgery (and the healing of the surgical incision – which generally includes making
sure there is no infection concern related to the surgery).

Based on what I think I have learned (personally – and in conversations with others)… where there are inflammation
problems (which are common) during initial stages of recovery – the race to make gains before enough scar tissue
results to halt the progress can be lost by the patient because of generall failures in communication (regarding that
there is a serious problem emerging) between the patient, physical therapist, and surgeon (sometimes also the PCP
where he has stayed a little involved and is aware of the situation). All the medical professionals in this situation defer
to the surgeon – and no one of these wants to make too much noise about patient concerns (although they all are
completely aware this is a time loaded situation). Unfortunately, maintaining these "professional relationships" seems
more highly regarded than patient concerns/distress and it is common that these are discouraged or explained away
as "normal progress".

When I read about that X10 machine and how it came to be developed (by an orthopedic surgeon – a Dr. Halley)
because of him seeing so many problems with his own patients and because of NOT seeing better results with
use of a CPM immediately after the TKR surgery. While this is no kind of "magic" – it is at least an attempt by a
surgeon to help patients recover in response to what he was seeing, rather than just standing back and letting
"this" continue to happen.

I think I'm going to try to do a little further research on what "other countries" (other than the US) are doing so far
as how they are avoiding or helping patients progress through more problematic recoveries. I think we (as US
citizens) tend to think that WE know best regarding how we handle heathcare (and maybe everything else). The
statistical numbers (how much we spend as a percentage of GNP for healthcare – and what our outcomes are)
just don't "add up" favorably for what we are doing. Generally we spend (a lot) more – and get (a whole lot) less.
Even though this is an older program, I recommend Frontline's "Sick Around the World" (which basically looks at
8-9 democratic market economies… some with "public" care and some with "private" care, but single payer through
taxes (and by the way – not higher taxes than what we already pay). What all these other countries have in common
is that they lack a medical insurance industry…period. I think "the way" we receive health care in this country skews
the motivations of those providing it – and in some cases (I think) puts surgical patients at greater risk. Anyway…
this is all interesting stuff (please draw your own conclusions). I think we might all agree… we can do better.
https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

My best to you (Babette – and all),

John

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@debbraw

Hi Mary Ann @registerednurse – Welcome to Connect! Great people here with great experience to share. I'm 68 years old and had my first TKR in April 2017. My next one is coming up next Tuesday 1/29/19… I feel for you on the difficulties you experienced with your TKR. I would have been totally frustrated with those results. I'm curious about what kind of physical therapy you had? Wish me luck on my next TKR on Tuesday. I'm hoping I get good recovery on this one.

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Good morning, registerednurse (and all) –

Infection in the joint capsule after a TKR is a big deal (typically). I hope the antibiotics "work"
and i am crossing my fingers for you. My own situation is so inflammation sensitive that my
previous surgery arthroscopy essentially ended up being like bailing water from a seriously
leaky boat (we regained the scar tissue to the same degree – almost immediately). I'm glad
to hear your exerience has been better (or sounds as if it has – and I hope that continues).

Yes (JK), those gym hot tubs (and swimming pools) do have bacteria in them of all types
(regardless of the amount of clorine put in them). If I had immune suppression issues, I would
share that same concern. Counter-intuitively (at least based on what I think I understand now),
my inflammation problems are driven by too much of an immune system response (some
inflammation being "the normal response"). That's part of "why" a steroid injection "works" to
reduce inflammation – it does this by partially suppressing that same immune system response.
It would make a lot of sense to me – that they would consider "bathing" the joint capsule with
steroids during the TKR surgery (particularly where this is a revision – with a well-understood
history of inflammation causing previous problems), but it's my understanding they generally
will not do this.

More "grist for the mill"

Best to all (and good luck JK),

John

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@gutthookd

Good morning, registerednurse (and all) –

Infection in the joint capsule after a TKR is a big deal (typically). I hope the antibiotics "work"
and i am crossing my fingers for you. My own situation is so inflammation sensitive that my
previous surgery arthroscopy essentially ended up being like bailing water from a seriously
leaky boat (we regained the scar tissue to the same degree – almost immediately). I'm glad
to hear your exerience has been better (or sounds as if it has – and I hope that continues).

Yes (JK), those gym hot tubs (and swimming pools) do have bacteria in them of all types
(regardless of the amount of clorine put in them). If I had immune suppression issues, I would
share that same concern. Counter-intuitively (at least based on what I think I understand now),
my inflammation problems are driven by too much of an immune system response (some
inflammation being "the normal response"). That's part of "why" a steroid injection "works" to
reduce inflammation – it does this by partially suppressing that same immune system response.
It would make a lot of sense to me – that they would consider "bathing" the joint capsule with
steroids during the TKR surgery (particularly where this is a revision – with a well-understood
history of inflammation causing previous problems), but it's my understanding they generally
will not do this.

More "grist for the mill"

Best to all (and good luck JK),

John

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All pools have bacteria in them. I went in a hydropool 36 hours post arthroscopic arthrolysis and debridment of left knee, no problems it was highly chlorinated.
I paid 12K for a knee replacement in the UK, only to get me back to work ASAP….it didn't work due to scar tissue. I still don't have knee flexion to what some people get 96 degrees….

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@gator1965

All pools have bacteria in them. I went in a hydropool 36 hours post arthroscopic arthrolysis and debridment of left knee, no problems it was highly chlorinated.
I paid 12K for a knee replacement in the UK, only to get me back to work ASAP….it didn't work due to scar tissue. I still don't have knee flexion to what some people get 96 degrees….

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I too am a registered nurse

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@contentandwell, @debbraw, and all the other mentors: I wish there was a way (perhaps there is??) to get word of this website out to the general public. I happened on it by lucky accident, of course AFTER the TKR, which has had generally successful results so far. However, it would be so much better when more people could gain some insight into the problems, the questions to ask before the surgery, and also hear about the positive outcomes experienced by actual patients. Obviously the latter are not posted here as frequently, though. Thanks for the good work!

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@ellerbracke

@contentandwell, @debbraw, and all the other mentors: I wish there was a way (perhaps there is??) to get word of this website out to the general public. I happened on it by lucky accident, of course AFTER the TKR, which has had generally successful results so far. However, it would be so much better when more people could gain some insight into the problems, the questions to ask before the surgery, and also hear about the positive outcomes experienced by actual patients. Obviously the latter are not posted here as frequently, though. Thanks for the good work!

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@ellerbracke – Thanks for the kind words! I agree that the Connect platform can really be a lifesaver when we are going through some of these medical "adventures" and need friendly encouragement and support. We try to get the word out with flyers and brochures but it can be an uphill battle. Meantime, please share on any social media platforms you use yourself. Also, is there a way you think might be even more effective to spread the word?

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@ellerbracke

@contentandwell, @debbraw, and all the other mentors: I wish there was a way (perhaps there is??) to get word of this website out to the general public. I happened on it by lucky accident, of course AFTER the TKR, which has had generally successful results so far. However, it would be so much better when more people could gain some insight into the problems, the questions to ask before the surgery, and also hear about the positive outcomes experienced by actual patients. Obviously the latter are not posted here as frequently, though. Thanks for the good work!

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@ellerbracke
I had my TKR 5 years ago. Although I did wind up back in the hospital a couple of days after being released, it was due to kidney issues, not my knee surgery. The knee surgery was probably typical, with pain and swelling after. I’ve hesitated to comment because I’m so happy with the results. I have maximum ROM and negligible pain. I did the exercises before and after surgery and had PT. I remember while doing PT, my knee was cracking a lot. The therapist said it was probably scar tissue breaking. When I’ve gone in for follow up appointments, the dr always gets a little grin when he sees how far my knee bends. I’ve told him that it was the best thing I’ve done for myself. That was before my kidney transplant, though. I was pretty naive about what could go wrong. Maybe that was a good thing. I hope this is encouraging for anyone considering a TKR.

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@cmael

@ellerbracke
I had my TKR 5 years ago. Although I did wind up back in the hospital a couple of days after being released, it was due to kidney issues, not my knee surgery. The knee surgery was probably typical, with pain and swelling after. I’ve hesitated to comment because I’m so happy with the results. I have maximum ROM and negligible pain. I did the exercises before and after surgery and had PT. I remember while doing PT, my knee was cracking a lot. The therapist said it was probably scar tissue breaking. When I’ve gone in for follow up appointments, the dr always gets a little grin when he sees how far my knee bends. I’ve told him that it was the best thing I’ve done for myself. That was before my kidney transplant, though. I was pretty naive about what could go wrong. Maybe that was a good thing. I hope this is encouraging for anyone considering a TKR.

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@ellerbracke It sounds as if both the knee and the kidney have worked out great for, that's wonderful.
What is considered to be "maximum ROM"? I know that if you reach 120 that is considered to be good but a woman in my water aerobic class claims to be at 145. Is that even possible? I'm wondering if she may have misunderstood something.
JK

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@ellerbracke

@contentandwell, @debbraw, and all the other mentors: I wish there was a way (perhaps there is??) to get word of this website out to the general public. I happened on it by lucky accident, of course AFTER the TKR, which has had generally successful results so far. However, it would be so much better when more people could gain some insight into the problems, the questions to ask before the surgery, and also hear about the positive outcomes experienced by actual patients. Obviously the latter are not posted here as frequently, though. Thanks for the good work!

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@ellerbracke I think some people realize the importance of being as knowledgeable as possible about their medical care, and those people will google things and may well discover Connect.
There are people who just assume that everything will be great and do no research. They, of course, will not come upon a forum like Connect.
I think Facebook can be a great way to get people informed but other than that I don't know how you would do it.
JK

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@contentandwell

@ellerbracke It sounds as if both the knee and the kidney have worked out great for, that's wonderful.
What is considered to be "maximum ROM"? I know that if you reach 120 that is considered to be good but a woman in my water aerobic class claims to be at 145. Is that even possible? I'm wondering if she may have misunderstood something.
JK

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I don’t know the maximum Rom. The orthopedist holds up his measurer and I’m well beyond so he just smiles and sets it down and tells his assistant taking notes that it’s at maximum. Because it was never an issue, I didn’t ask.

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Hi. I had knee replacement, in Aug. 2018, got to 90° Bend, then fell, severed quad muscle, fractured femur, had surgery was in cast then stabilizing brace. Now my knee won’t bend past 60° I started at under 30, progressed to 60 ° nowbuts stuck. Was told can not be manipulated even tho 4 months after quad reattachment. Could re damage, p.t.is torturous and wouldn’t mind if I was making progress, I’m not, been 5 weeks going on 6 stuck Dr. Wants me to wait at least another 3 to 4 months before even thinking about arthroscopic. After every p.t. session, which is very painful, I have swelling, black and blue, sever pain. At my wits end. Anyone else experience this?? Any suggestions???

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@aabhealey

Hi. I had knee replacement, in Aug. 2018, got to 90° Bend, then fell, severed quad muscle, fractured femur, had surgery was in cast then stabilizing brace. Now my knee won’t bend past 60° I started at under 30, progressed to 60 ° nowbuts stuck. Was told can not be manipulated even tho 4 months after quad reattachment. Could re damage, p.t.is torturous and wouldn’t mind if I was making progress, I’m not, been 5 weeks going on 6 stuck Dr. Wants me to wait at least another 3 to 4 months before even thinking about arthroscopic. After every p.t. session, which is very painful, I have swelling, black and blue, sever pain. At my wits end. Anyone else experience this?? Any suggestions???

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Hello @aabhealey, welcome to Connect. You may notice that I moved your discussion and combined with an existing discussion on scar tissue after knee replacement. The conversation is a bit long, but by moving your post, all the members who are discussing scar tissue issues after knee replacement or surgery will see your message. You can also read through some of the previous posts made by members as well. If you are replying by email, in your email notification to this message, you can click on VIEW & REPLY to be brought to the new location of your post and to see other posts.

I also experienced severe scar tissue after my knee replacement in 2006. It took two manipulations and a freak jumping incident to finally loosen my scar tissue a good 18 months after my initial surgery. However, I did not have the added complication of breaking a femur, which, from what I understand, is a major recovery on its own. Has your surgeon or PT provider mentioned muscle atrophy as a potential reason for slow gains? I am not a medical professional, but it would be reasonable to assume that the surgery, which causes scar tissue, combined with having to be sedentary and not move your leg would be a combination for the scar tissue to grow while the muscles weaken.

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