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?

@timb

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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I had arthroscopic scar tissue removal surgery and it helped tremendously. Because it is done arthroscopically, there is less chance of scar tissue returning than open surgery.

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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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Thank you Justin for sharing your story. You have come a long way. Scar tissue should not be over looked when it can have a huge impact on recovery. It was never discussed before surgery and I think this should be a topic any OS should start having with TKR patients prior to surgery. If I only knew then what I know now I would have postponed my surgery until I was older and more informed about everything I should have asked before TKR

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@dduke

I had arthroscopic scar tissue removal surgery and it helped tremendously. Because it is done arthroscopically, there is less chance of scar tissue returning than open surgery.

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I also had the same surgery January 30 of this year and it has helped reduce my problem and my knee with scar tissue but scar tissue did develop and I had to go to PT and break it down it’s still there I guess I’m just huge scar producer I should go into Ripley’s believe it or not for how much scar tissue I can produce

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@timb

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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hI @timb – Welcome to Connect! I am so sorry to hear of all the problems you have had with your knee replacement. I can imagine that it must be terribly discouraging and scary. I'm glad you are signed in on this thread. I know there have been a number of members who have commented on problems with scar tissue, difficulties with MUA's and other complications. I'm going to tag a few members to see if they can share any insight on the arthroscopic scar tissue removal: @JustinMcClanahan, @doodles418 and @babette . Also, here is an article that might help:
https://www.healthline.com/health/total-knee-replacement-surgery/arthrofibrosis#outlook
With that much swelling, it's interesting that you still have great ROM! How is your pain? and your mobility? I can imagine that it must be affecting your ability to go about your normal activities.

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@debbraw

hI @timb – Welcome to Connect! I am so sorry to hear of all the problems you have had with your knee replacement. I can imagine that it must be terribly discouraging and scary. I'm glad you are signed in on this thread. I know there have been a number of members who have commented on problems with scar tissue, difficulties with MUA's and other complications. I'm going to tag a few members to see if they can share any insight on the arthroscopic scar tissue removal: @JustinMcClanahan, @doodles418 and @babette . Also, here is an article that might help:
https://www.healthline.com/health/total-knee-replacement-surgery/arthrofibrosis#outlook
With that much swelling, it's interesting that you still have great ROM! How is your pain? and your mobility? I can imagine that it must be affecting your ability to go about your normal activities.

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It definitely effects my daily duties. It is "stiff" and painful. Between my two knees, I have had 12 surgeries and 19 overall. I'm becoming immune to the pain and have learned to live with it. I have degenerative joint disease. I'm very dissapointed with results of "correct" replaced knee. It feels quite hopeless. Sorry to sound like a fatalist….

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@timb

It definitely effects my daily duties. It is "stiff" and painful. Between my two knees, I have had 12 surgeries and 19 overall. I'm becoming immune to the pain and have learned to live with it. I have degenerative joint disease. I'm very dissapointed with results of "correct" replaced knee. It feels quite hopeless. Sorry to sound like a fatalist….

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No @timb – you don't sound like a fatalist. You do sound fed up with what you are going through and I can't blame you. I don't know how to begin to weigh the pros and cons of having arthroscopic scar tissue removal. If you don't mind sharing, did the same doctor do the original TKR and the replacement to get the right size implant in? I'm wondering if there is some value in getting another opinion before you have an additional surgery – especially since you sound kind of conflicted about it anyway.

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@debbraw

No @timb – you don't sound like a fatalist. You do sound fed up with what you are going through and I can't blame you. I don't know how to begin to weigh the pros and cons of having arthroscopic scar tissue removal. If you don't mind sharing, did the same doctor do the original TKR and the replacement to get the right size implant in? I'm wondering if there is some value in getting another opinion before you have an additional surgery – especially since you sound kind of conflicted about it anyway.

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No. The second doc is a TKR specialist and the first one is the defendant in a lawsuit. I am more worried about the chance of success in getting scar tissue removal surgery. I guess my thought is that if he gets rid of 70% of the scar tissue and 30% comes back…..it's a win

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@timb

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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Hi @timb and welcome to the group. I am sorry to hear of all the problems you have had with your knee. Your ROM is great but being in pain with a stiff and swollen knee is not good.
I have not had to have scar tissue removed, but I may have some there. My ROM is not what I would like it to be. I am in no pain though and getting along fine with about 115 flex so I am planning to leave it alone. Have you discussed the probability of scar tissue returning with your new doctor? Of course if the probability is high it would definitely have a negative impact on your decision.
I am interested in hearing what the new doctor says about the scar tissue and if it will probably return. I would think if the probability is high that they would not bother removing it at all.
JK

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@rayreich3

I also had the same surgery January 30 of this year and it has helped reduce my problem and my knee with scar tissue but scar tissue did develop and I had to go to PT and break it down it’s still there I guess I’m just huge scar producer I should go into Ripley’s believe it or not for how much scar tissue I can produce

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I also had arthroscopic arthrolysis and debridment of left knee last September. I am glad to say my knee flexion is now 120 degrees. It has been hard work.
However I still have awful pain and stiffness…. paying for physio …..again

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@gator1965

I also had arthroscopic arthrolysis and debridment of left knee last September. I am glad to say my knee flexion is now 120 degrees. It has been hard work.
However I still have awful pain and stiffness…. paying for physio …..again

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@gator1965 This is what I was considering, but I’m afraid that I could end up worse off after it. What was your flex before lysis?

I really do not want to go through PT again.
JK

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@contentandwell

@gator1965 This is what I was considering, but I’m afraid that I could end up worse off after it. What was your flex before lysis?

I really do not want to go through PT again.
JK

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My knee flexion was 70 degrees in September pre arthrolysis , 5 months after TKreplacement. It is worth while having the surgery, I am back at work full time as a nurse, but I do still have neuropathic pain.
I have had several physiotherapists, my current one seems to understand arthrofibrosis, he is now working on my muscle weakness

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@timb

It definitely effects my daily duties. It is "stiff" and painful. Between my two knees, I have had 12 surgeries and 19 overall. I'm becoming immune to the pain and have learned to live with it. I have degenerative joint disease. I'm very dissapointed with results of "correct" replaced knee. It feels quite hopeless. Sorry to sound like a fatalist….

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Alas, I feel that this may be what may happen to me- i am So sorry to hear of your pain- the thing is -to me-how much can you take? When will it end ? Do you accept or give up…

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CHANGE OF TOPIC: GALLBLADDER SITUATION ALL DAY TODAY – ATTACK – PAIN – SYMPTOMS – POSSIBLE SURGERY? I have had gallstones for 6 months – started right before TKR. I have managed the few episodes "attacks" by eating smaller meals, few fats, recommended diet. HOWEVER, TODAY MY ATTACK HAS LASTED 8 HOURS. NOT GETTING BETTER. SOME CHILLS. A TINY BIT OF NAUSEA. NO APPETITE. TRIED TEA, TUMERIC, VEGGIES, CRACKERS. HAD SOME CHILLS. A LITTLE DISCOMFORT IN SHOULDERS. Every attack has seemed different – but they were ok. HOWEVER, THIS ONE IS NOT O.K. More intense; more symptoms. I do not fear surgery. But I have read many complications and problems in the Mayo Clinic forums. It is not as easy as people think. There can be complications post surgery. I am furious about losing a body part; especially when I am basically healthy and active. I do "admit" to being over 70 yrs. old, but let's not dwell on that as to me it is not an issue. I have seen 2 gastroenterologists. Both say "HAVE IT REMOVED". I am doing last-minute research on lining up potential surgeons. I found one, recommended by my TKR Dr., who, among other things, has Advanced Laparoscopic skills according to his Bio. He is young-ish (maybe 40???). Another is much older – has 30+ yrs. of related experience. Now, I am the last person to be age biased, but sorry to say, I am looking for middle aged – although experience is crucial I realize. Sorry to go on and on – but no surgeons I find on internet list "gallbladder" as a specialty. They list "abdominal or laparoscopic or pediatrics or other specialties. Any suggestions?
I would try to withstand the pain if there wasn't the threat of waiting too long when laparoscopic is no longer an option. (This is a crazy way to do medical research I know – all sort of last minute.) Not my style. (I have had 2 successful recent TKRs. Also abdominal surgery 35 years ago.) As you can see, I am not prepared for this…..

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Sounds very serious and scary, but I doubt that the average person posting on this forum can be of much help. Hope you expanded your urgent message to other relevant Mayo sub-sites. Best wishes to you.

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Hi @tennisgolf – It must be so discouraging to have this kind of problem in parallel with your TKR recovery. I feel for you. I'm going to agree with @ellerbracke – I'm afraid you might not get good responses here in the Joint Replacement Group. I would suggest you check out the Digestive Health Group.

Here is good place to start:
https://connect.mayoclinic.org/discussion/gallbladder-surgery/?orderby=DESC#chv4-comment-stream-header

Wishing you the best of luck AND good insight and support from the folks over in the Digestive Health Group!

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