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?

You are correct about scammers. The scammer buy stem cells from sales people and the cells are dead. I worked with a dr who was trained by Regenexx and i had knee and my back done. I had great success. My TKR was a disaster. Work out in water the knee swells. Been 6 years and my TKR is twice the size of my stem cell knee. I wish i had a do over. My stem cell knee was one of following directions. The cells were taken from my hip and mixed with my blood for 3 hours. Then injected in the knee. Took 10 days of lying around reading and watching TV. Never took any pain pills. It took time but i can do everything but play tennis. Golf, gardening, down on my stem cell knee, biking etc. No swelling. I am still seeing my ortho dr about the TKR swelling and pain and i get a good shoulder shrug. The orthos who work in same hospital as stem cell dr continue to bad mouth it, but now Promedica is now covering all their employees for stem cells with Regenexx. Other insurance companies are also covering it. I wish i had a do over on the TKR . I know many have success but judging by what i read many do not. I was told , yes tennis and all the activity you did before. I now walk down my steps backwards to avoid the pain. Pretty good at it. I learned about stem cells from Mayo and its use on arthritis. I found out about DR Kruse in Toledo and i am happy with my results. I would recommend people interested to go Regenexx web site. They keep all the data on their success and failure rates. My friend had his hip done and was told it was a 50 50 chance. They were honest with him. He is happy with the results.
My back had an L4 and a L5 rubbing on the nerve. 2 friends had the same and had operations twice and did not work. I had the injection and within weeks i noticed the difference,
Bottom line, do your homework. Do not go to drs who buy stem cells. Chances are they are dead. Use your own and stay away from meds and pills that kill your stem cells and their are many. Good luck

REPLY
@cobweb

You are correct about scammers. The scammer buy stem cells from sales people and the cells are dead. I worked with a dr who was trained by Regenexx and i had knee and my back done. I had great success. My TKR was a disaster. Work out in water the knee swells. Been 6 years and my TKR is twice the size of my stem cell knee. I wish i had a do over. My stem cell knee was one of following directions. The cells were taken from my hip and mixed with my blood for 3 hours. Then injected in the knee. Took 10 days of lying around reading and watching TV. Never took any pain pills. It took time but i can do everything but play tennis. Golf, gardening, down on my stem cell knee, biking etc. No swelling. I am still seeing my ortho dr about the TKR swelling and pain and i get a good shoulder shrug. The orthos who work in same hospital as stem cell dr continue to bad mouth it, but now Promedica is now covering all their employees for stem cells with Regenexx. Other insurance companies are also covering it. I wish i had a do over on the TKR . I know many have success but judging by what i read many do not. I was told , yes tennis and all the activity you did before. I now walk down my steps backwards to avoid the pain. Pretty good at it. I learned about stem cells from Mayo and its use on arthritis. I found out about DR Kruse in Toledo and i am happy with my results. I would recommend people interested to go Regenexx web site. They keep all the data on their success and failure rates. My friend had his hip done and was told it was a 50 50 chance. They were honest with him. He is happy with the results.
My back had an L4 and a L5 rubbing on the nerve. 2 friends had the same and had operations twice and did not work. I had the injection and within weeks i noticed the difference,
Bottom line, do your homework. Do not go to drs who buy stem cells. Chances are they are dead. Use your own and stay away from meds and pills that kill your stem cells and their are many. Good luck

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So did the stem cell help your knee. I would like to start it but very expensive my insurance will not pay for it. But with that being said if it help with this partial knee replacement that isn't getting any better I would surely do it

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@kneeproblem

So did the stem cell help your knee. I would like to start it but very expensive my insurance will not pay for it. But with that being said if it help with this partial knee replacement that isn't getting any better I would surely do it

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Look at Regenexx and mayo clinic and find Drs who know what they are doing. My Dr examined my MRI and said its doable. My TKR dr said no way. I called him and told him to look for another job. We kid a lot even though my knee is a total flop.
I keep saying regenexx because i have not found out who else to trust. You can get on their newsletter once a week. They do train the drs. My back dr was trained on back with stem cells and id now being trained on the neck etc.
It is sad to see unqualified people taking advantage of people and tgen the word is spread that it does not work. One item is unknow. How long does it work. I keep working out and working on strength of my legs. I did that before the TKR and what a disaster.
I talked to one company in Toledo whose CEO worked with Regenexx and now there company will pay for stem cells only wth them. Hate to keep blowing their horn but not sure who else to talk about. We have nurses doing it and other drs who are not qualified. Where is the FBI and FDA?

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@bevinauburn

The above describes exactly what happened to me. Six weeks post op from revision and so happy I sought out a second opinion as my original surgeon was treating me for scar tissue and never mentioned another possibility. Said he did his part well and it was now up to me to break the scar tissue. I know it can be hard to find someone who will take you as a patient but what I learned is there are doctors who specialize in revisions. I just got lucky I know as I was turned down by two doctors but don’t give up and know what this person above explained that the fit can be the culprit.

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@gutthookes

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Can I ask where did you find a revision orthopedic surgeon at I live in erie pa and can nit find one

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@gutthookd

Good morning, JK, Dame Wocane, and all –

First on the X10 – This item is ONLY covered by Blue Cross/Blue Shield in Michigan (the original surgeon/inventor
has strong links to Unniversity of Michigan Dr. Haller – also his CEO and several of his corp people are grads).
U of M has a lot of influence in that state. When you go to their website – you see the limits on the areas you can
get access to this. If you anywhere other than the mid-west (or Florida) you're making a 3-4 week pilgramage
that will NOT be covered by your insurance.

Dame Wocane – My first TKR was severely complicated by an obviously oversized upper (femoral) portion of the prosthetic.'
They don't say much about this (or anything), but these are "shelf components" stocked in these surgical centers. Yes, they
take xrays and MRI's but on the day of surgery I am told they "eyeball" the joint cavity when it is opened up and select what
they think will fit. This process is literally called (and I'm not making this up) "stuffing the joint cavity" (like a Christmas turkey
maybe). The prosthetic joint consists of three pieces – an upper, lower, and middle insert (usually polyethelyne). These are
"sized" like shoes. What isn't commonly known is that – it's common for someone to receive a size #6 upper portion and then
a 6-1/2 or #7 lower portion based on their individual physiology (and what should ideally fit best). When you understand that
most of these surgical centers are in a literal race to see how many of these they can do in a day… it's easy to see how these
mistakes (which are usually never admitted by theoriginal surgeon – deemed "close enough") happen frequently. In my own case,
foe the partial revison I got two opinions from respected local surgeons who both commented that the upper portion was clearly
oversized. The one who said this "the loudest" is the one I chose. Writing up the recommendation to my insurance for the necessity
of the procedure, he significantly "soft-pedaled" this as "a possible explanation and something that might work to solve the problem"
although this was drastically stated to me as "the knee can NEVER recover properly if you don't do this". Sometime after the revison
surgery I learned that a sizeable amount of his business came from doing surgical TKR revisions from this surgeon mainly as well
as other local surgeons (all of course "highly respected" but mostly by each other). Typically… you can expect surgeons to never admit
that there ever was a problem with the surgery they themselves performed – and they assume no responsibility (financial or otherwise).
These people are being very well paid as "guardians" of our best health interests. At some point we must ask the question:
Quis custodiet ipsos custodes?

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@gutthookd My last TKR was done with a custom made knee. They do an MRI of your knee and make one that fits exactly the same. I chose that because it has the reputation of having a quicker recovery, plus one of the designers of the knee is in Boston and I had him do the TKR. He offers other knees, I presume he must have to, to not have a "conflict of interest" but of course I chose his, the Conformis, and it has worked out great. I am very surprised more people do not opt for custom made knees. I think, not sure, that there are others besides the Conformis.
My first TKR was a regular knee, I am not sure of the brand, but despite having minor pain after a lot of exercise, and not having quite the ROM I would like, I really cannot complain.
JK

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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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Dear kneeproblem, win sturgeon, (and all) –

Kneeproblem 1st – I'm in Oregon (Oregon City, actually)… but it shouldn't be that different in Erie, PA. At any point you can
schedule an appointment with another orthopedic surgeon for a 2nd opinion. Yes… sometimes it's tough to get a 2nd opinion
if you go to another orthopedic surgeon in the same clinic (or maybe even in the same town – surgeons tend to stick together).
If… you have either been released from continuing care by the original surgeon (or have "fired" him or her), then typically any
other surgeon will consider you "fair game" – and frankly… then you have to be careful on the answers you get regarding if a
revision surgery is needed or NOT. It is in the economic interest of any surgeon – to do another surgery. You may think I'm
"nuts", but most orthopedic surgeons believe that the best solution to an orthopedic problem… is surgery (done by them). This
is how they get paid. If I were you (and I'm not), I get two completely unrelated (different clinic, different area of town – maybe
different town) surgical opinions… and don't be in a hurry to make a decision. Originally… I sort of :"figured" that if the 1st surgery
was "a problem" that the next surgery could "fix it" (figuring – no big deal… sure the 1st one had a problem, but these guys know
what they're doing and they'll get it right the next time). That isn't necessarily true. I hope it will end up finally "being true" in my
case, but really what I've found out… is that there is a lot they DON'T completely understand (and you could potentially be put
into a bad health situation by surgery that is NOT healed or fixed by subsequent surgey). I know that's not very encouraging,
but that's the truth of my situation (which doesn't mean it will be for you – and I hope not). When surgeon's are "selling you"
on the idea of having the surgery… they do sort of make it "sound that way", but like Humpty-Dumpty… not everything that
is broken can be "fixed – good as new" and I've found myself ready to accept less and less. One thing is for sure (at least
for now)… after 3 surgeries (2 complete TKR's and 1 partial revision), I will not be having another TKR unless or until they
can give me a good reason to assume I will have a different outcome (because I don't have that now).

win sturgeon: Good question re "And where is the FBI or the FDA ?" The only way I know how to answer that – is to ask
you how many people you know of who were actually put in jail for all the financial fraud that clearly went on during that
little "mortgage crisis" and resultant near-depression that will end up costing trillions ? Just like with campaign financing
laws (that were put in place after that minor misunderstanding we know as "Watergate"), the actual laws with actual teeth
regarding medical misrepresentation or medical malpractice are so watered down that it is nearly impossible to get any
kind of case in front of a jury – for anything other than actually amputating the wrong leg (which is one of the reasons they
do make sure they are damn positive on that). The conversation between surgeons and their patients is private and "nuanced"
in favor of making it sound like problems "nearly never" happen. If you think about it (as far as after a TKR recovery has become
a problem – and then what all these various specialists who are typically NOT covered by your insurance will suggest), we are not
in a much different situation than we were (as patients/consumers) before there ever was an FDA. Yes, there have been significant
advances (medically and otherwise), but this is still mostly about making a ton of money and the customer is nearly desperate and
ready to believe (or pay) nearly anything. I don't know if most of you are aware of this, but the medical device industry (prosthetics
and etc.) is regulated a whole lot less – even than Big Pharma and depending on whose numbers you believe… it may be a bigger
market. So… who is really "out there" protecting the health, safety, and interests of the patient/consumers ? Not many people… and
at times it seems like nearly no one (and I am talking about both political parties – who both take a ton of money from these industries).
The industries who give so much money to politicians are not making a "donation" – they're making an "investment" (and this is an
investment that pays off for them). That's just the reality of that situation (and has been for some time).

My best all,

John

REPLY

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

REPLY
@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?

Jump to this post

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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