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?

@bisutton

Since your problems are so similar to mine, I’m wondering if you have more pain when you exercise more? I really had pain when I tried warm water pool therapy. I still have the tightness around the joint, which seems to get worse. I’m just picturing scar tissue around my knee joint. I’m also wondering about laser treatments.

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I am new to this discussion group and just saw your post. Like most participants on this site I suffer from chronic pain in both knees three years after double knee replacement surgery. My diagnosis is arthrofibrosis or excessive scar tissue. I have had both knees surgically manipulated which helped initially, but then over time the scar tissue continued forming. I finally tried 25 laser treatments (deemed experimental so not covered by insurance) but my condition did not improve. Now my hip is becoming compromised because of compensating for my knee that won't bend more than 80 degrees, making it difficult to get in and out of the driver's seat in my cars. My X-rays all look perfect and my surgeon is afraid that if I try revision surgery I will simply develop the same problem post-op. I notice your post is over a year old, did you ever find relief?

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@rayreich3

Hi I feel your pain. my surgeon recommended arthroscopic surgery within the next six months if my scar tissue doesn’t heal he has never used the laser so i would like to hear about it if you use it

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In desperation I tried a series of 25 laser treatments. Unfortunately, they weren't covered by insurance and did not help.

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Are you seeing any doctor improvement from massaging?

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@greig2517

Are you seeing any doctor improvement from massaging?

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I need it to do it earlier to help ROM, but definitely have pain relief. Acupuncture has probably helped me even more

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Hi just had arthroscopic to remove scar tissue from Partial knee replacement, the knee is now swollen and hopefully no more scar will return, muscles are definitely weaker through out last year and half.
I will keep you updated.
Thanks
Ray

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@rayreich3

Hi just had arthroscopic to remove scar tissue from Partial knee replacement, the knee is now swollen and hopefully no more scar will return, muscles are definitely weaker through out last year and half.
I will keep you updated.
Thanks
Ray

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Thanks. I am debating either trying an arthroscopic surgery to remove the scar tissue or a revision. My doctor is afraid that the scar tissue will return in either case.

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@exflyer

Thanks. I am debating either trying an arthroscopic surgery to remove the scar tissue or a revision. My doctor is afraid that the scar tissue will return in either case.

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Arthroscopic would be much less invasive, faster recovery. Total revision, you would have to start completely over.

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@rayreich3

Hi just had arthroscopic to remove scar tissue from Partial knee replacement, the knee is now swollen and hopefully no more scar will return, muscles are definitely weaker through out last year and half.
I will keep you updated.
Thanks
Ray

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@rayreich3 Is the arthroscopic the same as lysis? If not, do you know what the difference is? I am considering lysis.
Please do keep us updated.
JK

Liked by gator1965

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Arthroscopic surgery
A growing number of surgeons are now turning to minimally invasive arthroscopic surgery to remove the scar tissue. This process is called arthrolysis.

Specialized arthroscopic lysis of adhesions knee procedures such as anterior interval releases may be indicated and utilized to great success, in the hands of an appropriately trained specialist.

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@dduke

Arthroscopic surgery
A growing number of surgeons are now turning to minimally invasive arthroscopic surgery to remove the scar tissue. This process is called arthrolysis.

Specialized arthroscopic lysis of adhesions knee procedures such as anterior interval releases may be indicated and utilized to great success, in the hands of an appropriately trained specialist.

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@dduke that’s what I am considering having. I am just concerned about the rehab afterward. I really do not want to go through that again.
JK

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From my experience, you don't get the burning pain pain from post-op. It is necessary to do more repetitive re-hab though.

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@contentandwell

@dduke that’s what I am considering having. I am just concerned about the rehab afterward. I really do not want to go through that again.
JK

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My experience from the arthroscopic arthrolysis is that the rehab is not as intensive as following the TKR. I did have hydrotherapy which was lush and relaxing, but not nearly as painful as it was after replacement and MUA

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@rayreich3

Hi just had arthroscopic to remove scar tissue from Partial knee replacement, the knee is now swollen and hopefully no more scar will return, muscles are definitely weaker through out last year and half.
I will keep you updated.
Thanks
Ray

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Good afternoon Ray, exflyer, and all –

Ray – This is pretty much SOP for TKR recoveries when they "are stuck". As
you (and everyone else probably) already knows, this is because the inflammation
builds scar tissue faster than your PT can break it loose – and finally the patient's
progress halts – and often the flexion and extension numbers start to reverse. In
my case, it was like moving a pile of sand on the beach. By that I mean – the amount
of scar tissue (over an inch thick in places) removed was counter-balanced by the
inflammation resulting from the arthroscopy – the result being that I was back at
square one in a matter of a few weeks. That doesn't mean this is what will happen
in your case – but not that uncommon (once you've already had a problem). For me
this was followed by a partial revision surgery and another TKR about a year later
(because of "joint loosening" – which is often caused by persistent inflammation).
The reason you and your surgeon are talking about this – is because you are already
"stuck". BUT… I would recommend that you at least have a conversation with your
surgeon about WHY this recovery (this time from the arthroscopy) will "go" differently.
That's a legitimate question to ask (although not one that generally gets asked). The
problem (from a patient's standpoint) is that there is no downside for the surgeon to
perform additional surgical procedures. His only question to be answered is – will this
guy's insurance pay for this (and I can assure you – as the surgeon is already assured
or you wouldn't be having this conversation)… and of course, they will. Exflyer's doctor
has a legitimate concern.

I'm sure you all (or most) know that chronic inflammation as a response to surgery – and
especially in the case of an implanted prosthesis… is an immune system response. In our
case (or my case… anyway) this is basically too much of a good thing. The same thing
that helps your incision heal maybe a little more quickly – is what is (for now) causing you
problems with excess scar tissue formation. Part of the reason that cortisone (or most of
the steroids) "works" is because it suppresses the normal immune system response and
by doing that… disrupts the (in my case "excess" or "abnormal") formation of scar tissue.

And just further FYI – orthopedic surgeons (when they're being honest – typically after you've
had the TKR), really don't understand the "WHY" of all this persistent inflammation. Basically –
what they know is that you either DO or DO NOT have problems with inflammation/scar tissue
after a TKR. Logically (to me, anyway) – there should be a way to test in advance (which frankly,
surgeons have no interest in doing… just like they don't test for metal allergies – although they
realize this is potentially a VERY significant – as in high numbers of people – problem). It's an
unfortunate (for the patients) fact, that none of this will ever be a problem for the surgeons.

To everyone out there thinking about a revision TKR, arthroscopy, or other/additional surgeical
procedure on your knee. IF you've had a problem with persistent inflammaton and scar tissue,
PLEASE get yourself tested for a metal allergy. Seriously. Why have additional procedures
that potentially are never going to solve your problem (if you actually do have an allergy). Please
don't take my word for this – check out NIH studies under the heading of TKR's and metal allergies.
This is not an insignificant number of people. I recommend MELISA for blood testing. Believe it or
not – there is very little serum (blood) metal allergy testing done in the US (although this is pretty
common in Europe, Asia, Latin America – etc.). I'd hate to think this was being conciously ignored
(but these surgeons and doctors have access to the same NIH, NEJM, and etc information as I do –
and are still mainly… categorically denying that this could be a significant problem. For them – it isn't.

My best to all – and I genuinely hope that your experiences are much different than mine.

John

Liked by lioness

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@exflyer

I am new to this discussion group and just saw your post. Like most participants on this site I suffer from chronic pain in both knees three years after double knee replacement surgery. My diagnosis is arthrofibrosis or excessive scar tissue. I have had both knees surgically manipulated which helped initially, but then over time the scar tissue continued forming. I finally tried 25 laser treatments (deemed experimental so not covered by insurance) but my condition did not improve. Now my hip is becoming compromised because of compensating for my knee that won't bend more than 80 degrees, making it difficult to get in and out of the driver's seat in my cars. My X-rays all look perfect and my surgeon is afraid that if I try revision surgery I will simply develop the same problem post-op. I notice your post is over a year old, did you ever find relief?

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Good morning exflyer, bisutton, and all –

Exflyer – I'm sorry to hear about your continuing struggles. I am also a "three plus year guy". My left hip is becomming problematic because of the continuing oproblems with my right knee. I'm not sure there is a good way to avoid this, because if you are walking
or standing much at all… you can not keep from placing additional strain on other weight bearing joints… and like an established
"wear pattern" on a misaligned tire – problems are likely to accelerate.

Yes, "arthrofibrosis" (the fibrotic knee joint explanation). Surgeons are good at describing this, but not at either preventing this
outcome or treating it – once it has already happened. My understanding is that this doesn't "go away on its own" and from my
previous experience, I just expect as more scar tissue accumulates (what would stop it), the flexion and extension to be further
reduced (which means more inflammation, pain, a further "affected gait" – and more problems with other weight bearing joints).
At least your surgeon is "afraid for you" (which speaks well for him). Most will jump at the chance to do a revision surgery first –
and then worry (if ever) about the health consequences for the patient.

I also would be interested in anyone who found ANY kind of relief (other than strictly by accident – like that story about taking
a fall which "ripped the scar tissue loose"… and then it got better), 'Doesn't really matter how far fetched – Ideas ???

Exflyer (and all) – Sorry to hear of your experiences with laser treatments – and thank you for sharing that ! Better for all of us
to hear about what DOESN'T work… and just FYI to all (if I didn't make this clear previously) I had PRP injections (which of
course insurance did not cover) and was thinking of stem cells (but was told in no uncertain language by two people I know
well – that this flatly doesn't work on a replaced joint inflammation situation… although of course you'll find "injection specialists"
who will take your money to "try" this). When this was suggested to me by the guy who did the PRP injections, I had already
talked to those two other people – and so asked this doctor "Have you EVER had stem cell injection therapy produce positive
results in the case of persistant inflammation/arthro-fibrosis with a post TKR knee ?" His response: "Well.. specifically, NO…but
then that's the nature of an experimental therapeutic technique – it might work in any future case, but we can't know for sure
unless we try it. Translated – That means: He is more than willing to experiment with your money and your body – although there
is exactly ZERO scientific evidence that this even could… help you at all. For the person who was asking about "Where is the
FDA to protect us from this sort of thing ?" – Nowhere in sight… and I guess an even better question is where is the AMA – who
is supposed to be at least sort of "watching over" the standards by which medicine is practiced. Bottom line: They don't.

As long term disabled and chronic pain sufferers – we are all… ESPECIALLY at risk for anyone out there "practicing at medicine"
by whatever means (approved therapies – or not). We are literally desperate for a solution and are likely to try anything – as long
as what remains of our health… and our finances… holds out.

=================================================================================================
New question – Anyone out there had any kind of "nerve ablation" (aka "nerve burning") that at least provided some relief from
the pain ? I am considering this (which insurance does cover) – and the story I am being told is: If the nerve block you probably
received prior to surgery provided significant relief (temporarily), then – maybe this will also provide some relief. If you have experience
with this (or have a friiend that did), I am interested in what happened. Please let me know – along with any other ideas.

Thanks – John

PS – Exflyer (and all). You probably already know this, but scar tissue does not show up on xrays.

PPS – Exflyer. None of my business, but by "Exflyer" do you mean pilot – or Philly ?

Liked by damewocane

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@contentandwell

@dduke that’s what I am considering having. I am just concerned about the rehab afterward. I really do not want to go through that again.
JK

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Good morning (again) JK, Gator, DDuke, and all –

There were some statements that arthroscopy as a treatment for arthrofibrosis was somewhat of a "new concept" – it isn't.
Neither is arthro or "open" lysis. There was a question on what this "arthrolysis" actually is. Here are the answers from NIH
(and invaluable source). Please note that when surgeons are generally aware of a problem but don't actually know what to
do – there is invariably comments about how "this is controversial" (which is another way of them saying – they don't actually
know what to do… which they seem to have a hard time saying). The same way that it is with MUA's and standard arthoscopies –
surgeons know how to do these procedures, but the actual efficacy (in other words – did it "work" for the patient) is at best
"questionable".

Depending on which report you read – you get extremely low numbers (like 3-6% in this one) but then more realistic numbers
like "one in five" (20%) who have long term problems with their TKR surgeries – the most common complaint being "a stiff and
painful knee" (and if that ain't a layman's description of an arthrofibrotic knee – don't know what is). I have heard higher numbers –
and who knows ? The one thing we do know for sure is that this is a VERY large number of people – and if it was ONLY 6% of
the people who were taking a medication (instead of having a surgical procedure reccommended) and THEN became disabled and chronic pain patients, do you think that medication would continue to be on the market without comment (or lawsuits) ?

Anyway… here's the NIH article on arthrolysis (and it's pretty detailed – as all NIH stuff is):
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4246397/
Best all,

John

PS – Maybe I wasn't listening/reading carefully, but did anyone out there say they experienced long term relief from
having had an arthrolysis (when they previously suffered from arthrofibrosis) ? Thanks for letting me know.

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