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?

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gutthookd | @gutthookd | Jan 23, 2019

In reply to @kneeproblem "I wish my surgeon would do that procedure for me but he says no it won't..." + (show)

Dear knee problem (and all) -

I am starting to believe that there are basically two kinds of people with post TKR problems. The minority (unfortunately) are those
who either don't talk about it with others or who have stopped out of frustration. In the course of over 3 years of my own struggles
(which are not over), I've been inplaces of dark despair - including times I thought this was some sort of "fate" I just needed to "accept"
(and I've actually gotten "that talk" from two of the three surgeons - not the latest, but I'm expecting that pretty soon). You'll all hear
something similar at the point your current surgeon is looking to "cut you loose" (not wanting toinvest any further time in something he
doesn't see paying off for him). It mostly goes... "there are times when these surgeries don't work out as well as we expect... and we're really not sure why, but at some point you as the pateint has to accept this and move on with their life". When I hear that, my question
is always - would YOU accept this and do you realize that this leaves me with not much of a life at all ?

You will notice than in about the first year after a TKR, other surgeons are gun-shy at "getting involved" considering this as somehow
"being the last surgeon's knee". Once the last surgeon custs you loose (ususally well after any intervention could do you much or any
"good")... it magically becomes "YOUR knee" once again.

Thanks LKinny for your additional info on X10. Weird that it's so difficult to get answers out the company and too bad that people
who live anywhere but the Midwest (or Florida) don't have access to the machine pretty much peroid. For me (if I am going to get any access) I will need to make about a month's long pilgramage to Michigan ('course I guess it's closer than Lourdes). The good news is that this (X10) is that it is approved for Blue Cross/Blue Shield - but only in Michigan. At some point - I don't think "cost" (of any kind)
enters into the equation. Most of us would mortgage our houses to raise the money if we thought this (or anything) would help.

If you (all) think about it - What kind of country's medical establishment would allow people to do hundreds of thousands of these
surgeries without a known (or at least actively researched) game-plan for the large numbers of people with difficult and downright
failed recoveries. Per my previous (borrowing from JFK) "Success has a thousand fathers - while failure remains an orphan". We
are those "orphans" - but do we have to be "quiet orphans" and so much more easily swept under the rug of all this surgical financial
success ? Personally, I don't think so and I encourage you not only to speak out in this and similar forums, but while you're at it maybe
write your senate and congresspeople. Honestly... these efforts to make ourselves heard may not end up helping us (or helping is much), but could pave the way toward better research, more responsibility being assumed by surgeons (other than just for making sure
no infection develops which could be linked to their surgery and to make sure the surgical incision heals proeperly). As it stands now -
that's about all we can expect and if you think about it - WE have allowed this "paring down of responsibility for our long term recovery"
to become "the legal standard". If we do not assume some responsibility for "changing this back to something more reeasonable", do
you really think this will happen ? Are there nearly enough empathetic surgeons who will take a little less of the substantial fortune
thrown their way and spend a little more of their time (which will cur down on the numbers of surgeries they can "get done") to make
a difference - or does this have to be legally mandated ? Unfortunately, I'd have to say they will do this when they are essentially forced to (and not before).

Please feel free to ask me any questions and to share your experiences - I want to learn something new (if I can) everyday.

Thanks to you all - and my best !

John

JK | @contentandwell | Jan 23, 2019

In reply to @gutthookd "Dear Angela - I'm genuinely sorry to hear your story. My own is not "the same",..." + (show)

@gutthookd

Dear Angela -

I'm genuinely sorry to hear your story. My own is not "the same", but probably similar in a lot of aspects. There
is so much that we as patients do not know prior to surgery - and everyone I've ever talked to that ended up
having problems after... mostly trusted in their surgeons that "this was no big deal" and that they would be "well
taken care of". In reality, there mostly isn't a co-ordinated care plan of any kind (that includes your surgeon - or
anyone else). If you are lucky, you'll get a physical therapist who is empathetic - and who will try to do something
other than just telling you "how great your knee looks" (when it doesn't) and "how good you are going - how well
you are progressing (when you clearly aren't). Many of these physical therapist's (I can't say "most" - although
I suspect this) won't honestly communicate the difficulties you are having (physically), the pain you seem to be
experiencing and etc.) back to your surgical team. IF the physical therapist does this (and of course - they should),
they will potentially "cost themselves business" (because a lot of these surgical teams... want patients "encouraged",
don't want to be bothered with problems they probably do believe are temporary - and will eventually resolve over
time... and more importantly - to them, don't want their time wasted doing things which are NOT additional surgeries).
As a physical therapist -- if you "get a name for" being a patient advocate or honestly reporting problems when you
see them... there is a good potential for you to be "punished" with less referrals from surgeons (and less business,
period). This is another case of incentives pointing exactly the wrong way if you are a patient.

After you have a TKR surgery and experience problems with your recovery... while you are sitting around (elevating
and icing), you start to "get educated" on this subject. Most TKR surgical recoveries are a kind of "race" between
the inflammation and scar tissue formation - and getting the necessary flexion (bending) and extension (straightening).
Based on individual differences your inflammation and scar tissue formation may proceed faster than you can develop
much flexion and extension. Of these two - the extension is absolutely the most important (because if you can't "straighten"
the leg properly, your walking "gait" is negatively affected and it's more likely that you will just continue building scar tissue
to the point that all progress first "stops" and is then "reversed" (and you find that over time you are able to bend and straighten
the leg progressively less - as this is "blocked" by scar tissue accumulations... which just increase over time). The scar tissue
does not "go away" on its own... generally. ASTYM can reduce surface scar tissue, but not the scar tissue which accumulates
in the joint itself. Arthroscopy can remove the scar tissue but often (in my case) promotes exactly the same response (serious
inflammation - and massive scar tissue accumulation resulting almost immediately). This is a process which is well understood
by surgeons and PT providers, but they don't seem to have a good idea for how to avoid this. The most common complaint for
people who have problems with their TKRs is "a persistently stiff and painful knee". In some cases (maybe a lot of cases), this
may be due to a metal or in some cases I am aware of... an adhesive allergy... in my own case originally, this was an allergy to
components of the alloy used in what I believed was a "titanium" prosthetic, but was in fact... a titanium alloy). If you think about
how many women (I guess "men" too - these days) have an allergic reaction to an earring "post" that isn't sterling silver or a
certain kind of stainless steel... you begin to understand the potential numbers of people involved (especially when you are also
considering this is a metal device implanted in your body... AND that metal isotopes are regularly released as part of the normal
process of an articulating joint... moving). This process of metal isotopes being released in the bloodstream (and what negative
effects could be - or are being experienced) is not well understood. When you multiply the numbers 723,000 TKRs in 2017 in
the US by the fact that the Nationl Institute of Health (NIH) says that about 15% of the US population has some degree of allergy
to Nickel or Chromium (which are common in prosthetic alloys) then you start to understand the potential numbers of people who
may be experiencing long term problems.

I was almost a "poster child" of a 59 year old male who had dropped a bunch of excess weight (and kept it off). Now I am soon
to be 63 - and have had an original TKR, a MUA, an arthroscopy, a partial revision, and then (finally) a metals allergy test (with
me - it was Maganese and Molybdenum... which were both present in my first prosthetic alloy) and then another TKR - this with
hypoallergenic components. I still have problems with inflammation and scar tissue formation - and have had another MUA
after this latest surgery (12/17/18) - the only difference being this time with a cortisone injection... which has helped. Maybe... I
am starting to improve slowly (but still... have a ton of pain and inflammation).

Beware of... "pain clinic persons" who are typically "injection specialists" and will try to sell you on PRP, stem-cells, and you
name it (none of which can do much for an already replaced knee). Diet can help (some) with the inflammation. Other than
that, I'd say definitely get yourself tested for a metal allergy if you continue to have problems. Do your own research, but
I think you will find that the MELISA test is the "gold standard" as far as this is concerned (not a simple skin allergy "scratch
test" - which might work fine for a certain make-up applied to the skin, but NOT for an object to be implanted in your body).

I recommend reading up on the subject (of problems with TKRs - you'll find what you are describing is the most common
complaint). Personally... I'd rather have an honest answer than a bunch of blue sky and sunshine. I hope there is an
immediate "cure" for all of this - for you, but there may not be. Honestly, I have to admit that I have some level of outrage
that surgeons are actively promoting these surgeries - when they don't understand "how to make it all better" if problems
are experienced (and frankly, I don't see a lot of interest from the surgical community on this... even as they try to figure
out ways to do even more surgeries - in the shortest amount of time possible). It's a BIG MONEY making business - and
like I said previously (from the patient standpoint), all the incentives are pointed in the wrong direction as far as helping
you to achieve a full (or as much as possible) recovery.

But like I also said - I do believe "the answer" is out there... and I haven't given up looking for this. Who is properly
"incentivized" to find an answer... other than the people who are suffering from these "less than optimal outcomes".

My very best to you (and everyone). Please feel free to ask me any specific questions. I can point you toward reseach
I am aware of... and if I really just "don't know" - then I'll say "I don't know" and maybe we can both (or all) find out.

John

I believe that there is probably an answer that will work for you (and me, and others) out there (somewhere - maybe not in
this country... which as it turns out is very backward in certain areas as far as the practice of medicine goes).

Jump to this post

@gutthookd John, I am so sorry for all you have been through with your knee. I really never realized how fortunate I was to be doing as well as I am. I appreciate that a lot more now.
It will be interesting if the X10 does help you, if you get it I hope you will let us know how it's working out.
JK

JK | @contentandwell | Jan 23, 2019

In reply to @kneeproblem "I wish my surgeon would do that procedure for me but he says no it won't..." + (show)

@kneeproblem That may be true of many doctors. I did not look into this before so I don't know if my surgeon would have done it sooner, but at this point, I am more than a year out from having the TKR. Frankly though, I am getting nervous about having the lysis done Maybe I shouldn't mess with what's really not that bad.
JK

JK | @contentandwell | Jan 23, 2019

In reply to @melcpa86 "@blessangela2019 Don’t give up on finding a second opinion. I had the arthroscopic lysis of adhesions..." + (show)

@melcpa86 Is the PT as bad after a lysis procedure as it was after the original TKR? I think I really need to think about this.
JK

dduke | @dduke | Jan 23, 2019

In reply to @contentandwell "@melcpa86 Is the PT as bad after a lysis procedure as it was after the original..." + (show)

In my experience (I also had the lysis), the P.T. was not as painful as it was originally, you are working through the scar tissue and not the surgery, but, it has to be almost constant. I configured a bike of ours into a stationary bike. After the lysis, I set the timer for three hours and woke myself up every three hours and biked for 10 minutes. Had office P.T. every day and did PT at home several times a day. The knee is not perfect but can do about everything I want. Pushing hard I can get 130 degrees.

gator1965 | @gator1965 | Jan 23, 2019

In reply to @contentandwell "@melcpa86 Is the PT as bad after a lysis procedure as it was after the original..." + (show)

With me, I found hydrotherapy very beneficial following the arthroscopic lysis surgery, and was in the pool 36 hours post op. The physio was not nearly as bad as it was following the TKR, I spent hours either trying to dangle my legs off the dining room table, or trying to pedal on an excercise bike. I experienced neuropathic pain, had my dosages of baclofen and amitriptyline increased and was able to bend my knee.
My knee bend still is not ideal at 96 degrees even at 4 months following the lysis surgery and nearly 10 months following my TKR. I have been told by my physio that my knee bend might never improve which is a great disappointment as I am relatively young (53).

JK | @contentandwell | Jan 23, 2019

In reply to @dduke "In my experience (I also had the lysis), the P.T. was not as painful as it..." + (show)

@dduke was every three hours what was recommended? I cannot imagine getting up to bicycle.
JK

JK | @contentandwell | Jan 23, 2019

In reply to @gator1965 "With me, I found hydrotherapy very beneficial following the arthroscopic lysis surgery, and was in the..." + (show)

@gator1965 hydrotherapy? As in using a whirlpool bath? I’m surprised that you were able to use this so soon after the procedure since I assume the cuts were not healed yet.
What your flex prior to the procedure?
JK

dduke | @dduke | Jan 23, 2019

In reply to @contentandwell "@dduke was every three hours what was recommended? I cannot imagine getting up to bicycle. JK" + (show)

This was not recommended. I just didn't want that scar tissue to take over again and thought that frequent bending would help.

JK | @contentandwell | Jan 23, 2019

In reply to @dduke "This was not recommended. I just didn't want that scar tissue to take over again and..." + (show)

@dduke I admire your tremendous committment, getting up in the middle of the night to exercise. If I do go ahead and have this done I will, like you, set a clock to exercise every three hours- except during the night.
JK

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