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?

Gosh. That sounds so painful and difficult. Is it appropriate to ask you where you had it done? If not the hospital then at least the city/state
Good luck with reaching the best point possible.

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@sparky233

I had total knee replacement March 15 and after one week started physical therapy which ended up being aggressive. Started at 56 degrees and got up to 95 degrees but was brutally painful and when PT bent my knee to try and get it further I was always ending up screaming and in tears. Finally went back to my surgeon who was the best and he took me off PT and has me doing three exercises every hour hoping more frequent movements will help. I know there is scar tissue and it doesn’t seem to be getting any more flexible and still very painful. I go back this Friday to see him again. Manual manipulation has been discussed. Pain pills don’t even phase it. Nurse told me manipulation is like starting over! Very down in the dumps! All I do every day is exercise and set and ice! Don’t think I’ll ever consider doing other knee…not worth the pain!

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Hi @sparky233 – First of all, welcome to Connect. I know you are going to find many kindred souls here who have had similar experiences. I am so sorry to hear about your pain and difficulty with the recent knee replacement. It must be awfully frustrating. I'm glad the surgeon took you off that terribly aggressive PT. I know that there are people who really benefited from manipulation to remove the scar tissue. Will your doctor explain more about the options tomorrow? I'm wishing you the best.

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@sparky233

I had total knee replacement March 15 and after one week started physical therapy which ended up being aggressive. Started at 56 degrees and got up to 95 degrees but was brutally painful and when PT bent my knee to try and get it further I was always ending up screaming and in tears. Finally went back to my surgeon who was the best and he took me off PT and has me doing three exercises every hour hoping more frequent movements will help. I know there is scar tissue and it doesn’t seem to be getting any more flexible and still very painful. I go back this Friday to see him again. Manual manipulation has been discussed. Pain pills don’t even phase it. Nurse told me manipulation is like starting over! Very down in the dumps! All I do every day is exercise and set and ice! Don’t think I’ll ever consider doing other knee…not worth the pain!

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@sparky233 You seem confident of your doctor, so it apparently is simply your own body that's causing the scar tissue. After my first TKR I had a physical therapist who would bend my knee so far I actually did scream in pain too. Other than when she did that I was not in pain though. I hope your doctor has some hope for you, please let us know what he/she has to say.

Every TKR is different. I have heard that a person can have both knees done at the same time with totally different results so I would not be totally opposed to doing the other knee if it gets painful enough. I know little about stem cell, but I have heard that some people love it and some people have not had results as good, the same as with traditional TKRs.
JK

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@sparky233

I had total knee replacement March 15 and after one week started physical therapy which ended up being aggressive. Started at 56 degrees and got up to 95 degrees but was brutally painful and when PT bent my knee to try and get it further I was always ending up screaming and in tears. Finally went back to my surgeon who was the best and he took me off PT and has me doing three exercises every hour hoping more frequent movements will help. I know there is scar tissue and it doesn’t seem to be getting any more flexible and still very painful. I go back this Friday to see him again. Manual manipulation has been discussed. Pain pills don’t even phase it. Nurse told me manipulation is like starting over! Very down in the dumps! All I do every day is exercise and set and ice! Don’t think I’ll ever consider doing other knee…not worth the pain!

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Sorry to hear you are going through this @sparky233 . I had bilateral (both knees) done on Jan 7th. My first 4 weeks of pt I was a rock star! Then week five nothing past 90 degrees, week 6 no progress on both knees. I had the visit with surgeon and we decided to do the manipulation under anesthesia (MUA). It is not fun. But when you wake up there is not a lot of pain. Even that first pt session, which immediately followed, was not too awful. Actually to hear that my bend was at 117 and 112 after struggling at 90 gives you a boost to keep fighting. And you'll need that for the rigorous pt that follows an MUA. Mine was 2 weeks straight for 80 min a session. There were tears on both me and my therapist! I had to go back on the Oxycodone for the following month. Heads up for active scar tissue growers: it does want to come back because you are dealing with inflammation once again. Keep doing your pt and home exercises. Yes my life was pt, ice, home pt, ice and rest repeat, repeat. Because an MUA does lengthen your recovery it's very easy to be overcome with depression. Have someone or something to fall back on. Whether it's your faith or a significant other. Don't let it win. Keep fighting for that outcome you want.Good luck for a good recovery.

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@debbraw

Hi @sparky233 – First of all, welcome to Connect. I know you are going to find many kindred souls here who have had similar experiences. I am so sorry to hear about your pain and difficulty with the recent knee replacement. It must be awfully frustrating. I'm glad the surgeon took you off that terribly aggressive PT. I know that there are people who really benefited from manipulation to remove the scar tissue. Will your doctor explain more about the options tomorrow? I'm wishing you the best.

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I see the surgeon again Friday and we’re going to talk about options and manual manipulation. I’m just disappointed that it hasn’t gone like I expected! I forgot I tend to get scar tissue or I’d have brought that up before surgery! Thanks for the kind words…I’ll keep you posted!

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@sparky233

I see the surgeon again Friday and we’re going to talk about options and manual manipulation. I’m just disappointed that it hasn’t gone like I expected! I forgot I tend to get scar tissue or I’d have brought that up before surgery! Thanks for the kind words…I’ll keep you posted!

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I understand the disappointment. I did bring up the active scar tissue that I build but neither my PT's or Surgeon/PA seemed to address it. I brought it up every time I had Pt and followups. Maybe there's not much to do about it. I've never gotten a good clear answer on why or how to prevent it. Keep us posted.

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@doodles418

Sorry to hear you are going through this @sparky233 . I had bilateral (both knees) done on Jan 7th. My first 4 weeks of pt I was a rock star! Then week five nothing past 90 degrees, week 6 no progress on both knees. I had the visit with surgeon and we decided to do the manipulation under anesthesia (MUA). It is not fun. But when you wake up there is not a lot of pain. Even that first pt session, which immediately followed, was not too awful. Actually to hear that my bend was at 117 and 112 after struggling at 90 gives you a boost to keep fighting. And you'll need that for the rigorous pt that follows an MUA. Mine was 2 weeks straight for 80 min a session. There were tears on both me and my therapist! I had to go back on the Oxycodone for the following month. Heads up for active scar tissue growers: it does want to come back because you are dealing with inflammation once again. Keep doing your pt and home exercises. Yes my life was pt, ice, home pt, ice and rest repeat, repeat. Because an MUA does lengthen your recovery it's very easy to be overcome with depression. Have someone or something to fall back on. Whether it's your faith or a significant other. Don't let it win. Keep fighting for that outcome you want.Good luck for a good recovery.

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@doodles418 – Your response on the MUA issue was great. You didn't whitewash the downside, but you made it very clear that for you the positives outweighed the negatives. Your story has to be a great motivator to those who are considering this procedure. Thanks for sharing!

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@cobweb

welcome to my world. i had my cane beside me and the therapist thought i was going to hit her. the drs office next door sent 2 nurses to investigate the screams . i got to 119 and quit. 5 years later i am not close to that. now it may be lose but i will put up with pain as long as i can. that is why i did stem cells for the other knee.

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The pt guy bends my knee
Back and I not only scream , a few nasty words come out of my mouth. The assistant holds my foot down and holds my hand. I was st 113 last week and again yesterday, so he tried again and got it to 118. I found at home health care the pt girl had me sit on a chair and bending knee back was easier and not as painful.

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@doodles418

Sorry to hear you are going through this @sparky233 . I had bilateral (both knees) done on Jan 7th. My first 4 weeks of pt I was a rock star! Then week five nothing past 90 degrees, week 6 no progress on both knees. I had the visit with surgeon and we decided to do the manipulation under anesthesia (MUA). It is not fun. But when you wake up there is not a lot of pain. Even that first pt session, which immediately followed, was not too awful. Actually to hear that my bend was at 117 and 112 after struggling at 90 gives you a boost to keep fighting. And you'll need that for the rigorous pt that follows an MUA. Mine was 2 weeks straight for 80 min a session. There were tears on both me and my therapist! I had to go back on the Oxycodone for the following month. Heads up for active scar tissue growers: it does want to come back because you are dealing with inflammation once again. Keep doing your pt and home exercises. Yes my life was pt, ice, home pt, ice and rest repeat, repeat. Because an MUA does lengthen your recovery it's very easy to be overcome with depression. Have someone or something to fall back on. Whether it's your faith or a significant other. Don't let it win. Keep fighting for that outcome you want.Good luck for a good recovery.

Jump to this post

@doodles418 had asked about my experience with a second manipulation – what was my experience like, was it painful, did it help, and how did I know if it was scar tissue, when did it occur during my recovery?

My recall on the exact details may be a bit fuzzy because I had my knee replacement in 2006 (can't believe it has been that long already). I had end-stage arthritis in my right knee caused by a genetic bleeding disorder that prevents my blood from clotting on its own. When I was a child, the medication to help this disease (hemophilia) was not as good as it is now. Essentially, my blood wouldn't clot without injecting the clotting factor that I was missing. Most people think a cut is the issue, but the bigger issue was internal bleeding. My right knee was my "target joint" meaning I continually had internal bleeding in that joint as a kid which led to arthritis at age 8. By the time I was 19, my knee was completely arthritic and deformed – it was no longer a ball & socket joint, the bones had worn to squares. Because of this my knee – prior to surgery – had not been able to straighten to 0 degrees for almost a decade already. So I went in to surgery fighting all sorts of muscle and ligament atrophy as is.

My initial recovery from the replacement was awful. The ligaments were stretched straight upon waking up for the first time in 13+ years so the pain was intense. Scar tissue took hold almost immediately (likely due to my young age and immune system being much more active than waiting until later in life). Ultimately I had to have a manipulation – more painful to wake up from than the actual surgery. Scar tissue took hold again and I had to have another manipulation, I believe somewhere close to the 8 month mark from the original replacement (but could be closer to one year). Unfortunately, that still did not do the trick. I was told at that point that you cannot do additional manipulations because the scar tissue becomes strong enough to risk breaking your femur at that point.

To answer the question of how did they know, it was determined via x-ray to show the joint itself was not the issue and based on the mechanics they determined it was most likely scar tissue. I tried a full leg cast that had hand cranks built in to it to try and turn the knobs and bend the leg. That did not work. What ultimately ended up working was when I jumped up to catch a football one day and landed and felt a pop (no real pain as I remember). Within a week after that pop sensation, I was 0-90 or so. Over time, I gained additional ROM and landed somewhere between 0-110. I would have liked to get to that 130 range, but 0-110 is much better than my initial 15-50 ROM that basically equated to a frozen leg joint.

A bit long-winded, but it was quite the experience and a very long road to recovery. All said, I think it took somewhere close to 18 months for me to get to that 0-110 range.

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Hello. These are disturbing experiences re scar tissue. Simple Q.: My TKR done in 2015 is quite good and I can play sports, walk, never was that painful.
The bend, however, is only about 112 or 115. Is that considered "good enough"? I seem to be OK with it. My second TKR was 6 months ago.
Again, a not-very painful experience and good results immediately walking, 4 months later playing racquet sports, golf (not enough confidence yet for outdoor bicycling). Still a lot of stiffness in the knee and some swelling and the bend is only about 100. Is that considered "not enough"? Is it too early to want more? The improvement rate since surgery 6 months ago has plateaued. Would that be due to scar tissue or just normal? I am not uncomfortable. I am 75, but want the maximum successful outcome possible. My surgeon is not concerned about my progress at this time. I realize my plight is not as extreme as some others, but I know early action is essential. Thank you and best of success and comfort for you all.

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@JustinMcClanahan

@doodles418 had asked about my experience with a second manipulation – what was my experience like, was it painful, did it help, and how did I know if it was scar tissue, when did it occur during my recovery?

My recall on the exact details may be a bit fuzzy because I had my knee replacement in 2006 (can't believe it has been that long already). I had end-stage arthritis in my right knee caused by a genetic bleeding disorder that prevents my blood from clotting on its own. When I was a child, the medication to help this disease (hemophilia) was not as good as it is now. Essentially, my blood wouldn't clot without injecting the clotting factor that I was missing. Most people think a cut is the issue, but the bigger issue was internal bleeding. My right knee was my "target joint" meaning I continually had internal bleeding in that joint as a kid which led to arthritis at age 8. By the time I was 19, my knee was completely arthritic and deformed – it was no longer a ball & socket joint, the bones had worn to squares. Because of this my knee – prior to surgery – had not been able to straighten to 0 degrees for almost a decade already. So I went in to surgery fighting all sorts of muscle and ligament atrophy as is.

My initial recovery from the replacement was awful. The ligaments were stretched straight upon waking up for the first time in 13+ years so the pain was intense. Scar tissue took hold almost immediately (likely due to my young age and immune system being much more active than waiting until later in life). Ultimately I had to have a manipulation – more painful to wake up from than the actual surgery. Scar tissue took hold again and I had to have another manipulation, I believe somewhere close to the 8 month mark from the original replacement (but could be closer to one year). Unfortunately, that still did not do the trick. I was told at that point that you cannot do additional manipulations because the scar tissue becomes strong enough to risk breaking your femur at that point.

To answer the question of how did they know, it was determined via x-ray to show the joint itself was not the issue and based on the mechanics they determined it was most likely scar tissue. I tried a full leg cast that had hand cranks built in to it to try and turn the knobs and bend the leg. That did not work. What ultimately ended up working was when I jumped up to catch a football one day and landed and felt a pop (no real pain as I remember). Within a week after that pop sensation, I was 0-90 or so. Over time, I gained additional ROM and landed somewhere between 0-110. I would have liked to get to that 130 range, but 0-110 is much better than my initial 15-50 ROM that basically equated to a frozen leg joint.

A bit long-winded, but it was quite the experience and a very long road to recovery. All said, I think it took somewhere close to 18 months for me to get to that 0-110 range.

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@JustinMcClanahan – I had tears in my eyes to think of what a painful struggle your little 8-year-old self had to deal with – not to mention when you were 19. Thank you for sharing your story and for doing so much to manage and contribute to our joint replacement conversation. I admire your ability to be such a huge contributor in spite of having faced so many obstacles.

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@JustinMcClanahan

@doodles418 had asked about my experience with a second manipulation – what was my experience like, was it painful, did it help, and how did I know if it was scar tissue, when did it occur during my recovery?

My recall on the exact details may be a bit fuzzy because I had my knee replacement in 2006 (can't believe it has been that long already). I had end-stage arthritis in my right knee caused by a genetic bleeding disorder that prevents my blood from clotting on its own. When I was a child, the medication to help this disease (hemophilia) was not as good as it is now. Essentially, my blood wouldn't clot without injecting the clotting factor that I was missing. Most people think a cut is the issue, but the bigger issue was internal bleeding. My right knee was my "target joint" meaning I continually had internal bleeding in that joint as a kid which led to arthritis at age 8. By the time I was 19, my knee was completely arthritic and deformed – it was no longer a ball & socket joint, the bones had worn to squares. Because of this my knee – prior to surgery – had not been able to straighten to 0 degrees for almost a decade already. So I went in to surgery fighting all sorts of muscle and ligament atrophy as is.

My initial recovery from the replacement was awful. The ligaments were stretched straight upon waking up for the first time in 13+ years so the pain was intense. Scar tissue took hold almost immediately (likely due to my young age and immune system being much more active than waiting until later in life). Ultimately I had to have a manipulation – more painful to wake up from than the actual surgery. Scar tissue took hold again and I had to have another manipulation, I believe somewhere close to the 8 month mark from the original replacement (but could be closer to one year). Unfortunately, that still did not do the trick. I was told at that point that you cannot do additional manipulations because the scar tissue becomes strong enough to risk breaking your femur at that point.

To answer the question of how did they know, it was determined via x-ray to show the joint itself was not the issue and based on the mechanics they determined it was most likely scar tissue. I tried a full leg cast that had hand cranks built in to it to try and turn the knobs and bend the leg. That did not work. What ultimately ended up working was when I jumped up to catch a football one day and landed and felt a pop (no real pain as I remember). Within a week after that pop sensation, I was 0-90 or so. Over time, I gained additional ROM and landed somewhere between 0-110. I would have liked to get to that 130 range, but 0-110 is much better than my initial 15-50 ROM that basically equated to a frozen leg joint.

A bit long-winded, but it was quite the experience and a very long road to recovery. All said, I think it took somewhere close to 18 months for me to get to that 0-110 range.

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@JustinMcClanahan Your story is a heartbreaker for any who has had children. Your parents must have been so distraught to see you struggling so, and of course you must have been a very strong child to have managed with these problems. The important thing is that you are so much better now. I wonder where you knee would be now if not for the fortunate landing, catching a football. Sometimes things happen that we could never imagine.
Thank you for sharing your story.

@tennisgolf I think we all to some extent feel differently as to what is acceptable in flex. My L knee is about 115. My ortho said he could do a lysis to give me more flex and I considered it, but then decided that what I have is fine. I have absolutely no pain. Sure, every now then I wish my flex was better but for me it’s simply not worth going through another surgery. From what I’ve heard the surgery itself is minor but you have to go through PT all over again and that’s a thought I don’t relish.
JK

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@contentandwell

@JustinMcClanahan Your story is a heartbreaker for any who has had children. Your parents must have been so distraught to see you struggling so, and of course you must have been a very strong child to have managed with these problems. The important thing is that you are so much better now. I wonder where you knee would be now if not for the fortunate landing, catching a football. Sometimes things happen that we could never imagine.
Thank you for sharing your story.

@tennisgolf I think we all to some extent feel differently as to what is acceptable in flex. My L knee is about 115. My ortho said he could do a lysis to give me more flex and I considered it, but then decided that what I have is fine. I have absolutely no pain. Sure, every now then I wish my flex was better but for me it’s simply not worth going through another surgery. From what I’ve heard the surgery itself is minor but you have to go through PT all over again and that’s a thought I don’t relish.
JK

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@tennisgolf : Impressive that you were able to play racquet sports after 4 months. I played tennis for decades, but after 8 months I still don’t feel confident enough to get back on the court. I’m concerned about the sideways-twisting motion, and the abrupt stops, putting too much stress on the knee.
@contentandwell : Lucky you in that you have absolutely no pain! I still have constant sensation ranging from a little soreness to twinges to moderate (2-3 level) pain pretty much most of the time. Does not stop me from doing most things, it is just irritating. And it really ramps up when I forget and try to quickly pull off a sock or tight shoe while standing (where normal people bend their leg with the heel sideways and raised………. ouch!!!) I think I might trade exceptional flex for no pain….. or perhaps not…..

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@tennisgolf

Hello. These are disturbing experiences re scar tissue. Simple Q.: My TKR done in 2015 is quite good and I can play sports, walk, never was that painful.
The bend, however, is only about 112 or 115. Is that considered "good enough"? I seem to be OK with it. My second TKR was 6 months ago.
Again, a not-very painful experience and good results immediately walking, 4 months later playing racquet sports, golf (not enough confidence yet for outdoor bicycling). Still a lot of stiffness in the knee and some swelling and the bend is only about 100. Is that considered "not enough"? Is it too early to want more? The improvement rate since surgery 6 months ago has plateaued. Would that be due to scar tissue or just normal? I am not uncomfortable. I am 75, but want the maximum successful outcome possible. My surgeon is not concerned about my progress at this time. I realize my plight is not as extreme as some others, but I know early action is essential. Thank you and best of success and comfort for you all.

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@tennisgolf : Just really read through your post, and there are some things that for me just don’t work. You seem to have very little pain, playing racquet sports at 4 months, but have not much flexibility. Relatively speaking, of course. Who am I to say.
Anyway, in my opinion, after 6 months, if you still do the exercises, there is still an upside, but not as much as earlier in the recovery. 100 seems to be pretty low, (mine is about 132) , but if you can do all you want to do, just try to up it as much as possible, and leave it at that. (Pray that you don’t have to pull weeds or clean a tiled bathroom floor on your knees – that’s a whole different can of worms altogether).

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Hi. New to group. I had TKR 18 months ago. Doc put wrong sized implant in and new doc did revision. Correct sized implant in now, but 6 months post op and lots of scar tissue. Knee is constantly swollen and stiff. ROM is good, 125 and 0 degrees on extension. But the scar tissue is causing the swelling. It's rubbing on tissue and causing bleeding. Most is above the knee and caused by the quad tendon being cut and repaired numerous times. Had 40cc's drained off and it was red, fresh bleeding. Knee still looks terrible. Cannot see kneecap or any definition. New doc says only hope is arthroscopic scar tissue removal surgery. This will be my 7th surgery on that knee. Can't decide if the risk of scar tissue returning is worth it. Any similar stories????

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