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?

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

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@dduke

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

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

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

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

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@damewocane

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

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

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@dduke

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

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

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@ellerbracke

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

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

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

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@lkinny

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

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

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

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

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@contentandwell

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

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

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

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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

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@lkinny

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

Jump to this post

@lkinny : I know that I am super lucky and the exception with good flex. I never considered it as “only”, but as wow! Granted, my measuring is improvised and not perfect, but here it goes: once I have gotten the knee nice and loose when laying on my back doing heel slides, I bring the good knee up into the same position (heel distance from butt). I slowly sit up, double check that I did not cheat, then relax the TKR leg and use a compass to measure angle on the good knee (anklebone to hipbone, with a thin long dowel where the pencil would go in the compass, so it is fairly accurate in positioning). Then the angle can be measured with a protractor. Another indicator would be that when I kneel on the TKR leg (pillow, of course!), I can get my skinny butt to within 3” of my heel with foot flat on floor. On the other hand, it took me 4 months to get full extension, and I still work every day on keeping it! Go figure!
Regarding water exercises for knee bend: I was given a program that involved sumo squats (wide stance deep squats), front bent knee raises toward chest (fast up, down slow), and knee bends (facing pool wall lifting heel to butt, again, fast up, slow down), and lunge walks. I think those exercises did help a lot in making the knee more flexible.

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@ellerbracke

@lkinny : I know that I am super lucky and the exception with good flex. I never considered it as “only”, but as wow! Granted, my measuring is improvised and not perfect, but here it goes: once I have gotten the knee nice and loose when laying on my back doing heel slides, I bring the good knee up into the same position (heel distance from butt). I slowly sit up, double check that I did not cheat, then relax the TKR leg and use a compass to measure angle on the good knee (anklebone to hipbone, with a thin long dowel where the pencil would go in the compass, so it is fairly accurate in positioning). Then the angle can be measured with a protractor. Another indicator would be that when I kneel on the TKR leg (pillow, of course!), I can get my skinny butt to within 3” of my heel with foot flat on floor. On the other hand, it took me 4 months to get full extension, and I still work every day on keeping it! Go figure!
Regarding water exercises for knee bend: I was given a program that involved sumo squats (wide stance deep squats), front bent knee raises toward chest (fast up, down slow), and knee bends (facing pool wall lifting heel to butt, again, fast up, slow down), and lunge walks. I think those exercises did help a lot in making the knee more flexible.

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Maybe this will help. This is one of the TKR range of motion charts and what those ranges mean in terms of functionality. Replacements are not meant to move more than 135 degrees according to my surgeon. A normal knee may go to 155 (your heel can touch your butt).

I had less than 105 before the lysis. It’s at 132 now when the PT measures it – BUT that is a passive measurement – meaning I have to hold it there with a strap or the PT holds it. It’s painful. On my own active – I’m somewhere between 120 and 125 – meaning no holding. For me the goal is 130 active with no pain since that is my passive maximum.

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@melcpa86

Maybe this will help. This is one of the TKR range of motion charts and what those ranges mean in terms of functionality. Replacements are not meant to move more than 135 degrees according to my surgeon. A normal knee may go to 155 (your heel can touch your butt).

I had less than 105 before the lysis. It’s at 132 now when the PT measures it – BUT that is a passive measurement – meaning I have to hold it there with a strap or the PT holds it. It’s painful. On my own active – I’m somewhere between 120 and 125 – meaning no holding. For me the goal is 130 active with no pain since that is my passive maximum.

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Thanks! Very informative! Also thanks for warning not to push any further. Never used strap or had PT push on knee. Current trick I’m using to achieve maximum flex and holding it there for a while is a modification to heel slides. I lift leg, bend it, put toes down first, then gently lower heel. That gives me great bend, and it does not hurt, so I’m sure I do no harm.

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