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?

@bengalady

I hate Doctors like that. I just switch when they act like that. I’m three years TKR, still with tightness, swelling. I do get 102, as far as it’s going to go. I don’t do stairs very well, walk sideways. Gabapentin has helped with the swelling. Maybe another round of PT may help ? Good Luck

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@bengalady I doubt that PT would help much now but if your orthopedic doctor thinks it might he will prescribe it. My orthopedic doctor is huge on riding a recumbent bike, getting the seat as far up as possible. I have used that a lot. I also do pool walking/jogging. When I do that I lift my leg up high to get a good knee bend.
I did actually have slight improvement — a few degrees — beyond that first year.
JK

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You who have a decent bend ,please be thankful . I still have less than 60 degrees and the pain- unmanaged is off the charts-2 years out from original tkr.

medical-healthy-pains-rate-rates-happy-jmp100503_low

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@JustinMcClanahan

Hello @maggiet, and welcome to Connect.

I can understand your frustrations and concerns as I have experienced all of what you are experiencing now. I had my right knee replaced at age 19 because of a genetic disability that left my right knee with end-stage arthritis beginning at the age of 9. I had a horrid recovery and also had two manipulations because my scar tissue growth was so aggressive. My range-of-motion was 10-40 degrees for the better part of the first year.

I kept with my rehab and stayed active, and eventually I felt a “pop” in my knee and over the next few days I went to 0-100 degree flexion and extension. This all developed 1.5-2 years after my initial replacement. I can say 11 years later, my knee has not degraded at all and my quality of life is so much better. Stick with it, it will come, even if it takes longer than what others maybe expected. Stick with the PT & keep your spirits up.

@maggiet, how are your exercises going? I admit that I did not push myself hard enough because of the pain and that hindered my progress. How is your pain?

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Hi Justin. I hope youre still around on these boards- I read your story about the end stage arthritis you had at such an early age. My daughter was born with JRA, now they call it JIA (juvenille rhumatoid arthritis). She had knee destruction by the time she was 12. At 37 she had bi later TKR. Now two years later one leg is totally frozen. she cant bend the knee at all. tomorrow she starts physical therapy again. I dont know what they can do since I believe she had scar tissue growth like yourself. How do they tell if theres scar tissue? her xray looks good. Do you get an MRI? I was thinking of taking her back to the surgeon who did the surgery. Im concerned if she cant bend it soon it will be permanently frozen.
any suggestions? Thanks. this board is very helpful though Im reading posts from 2017 I hope you can see this in Dec. 2019.

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Hi…I am 2 1/2 years post-op, bilateral TKR and have had problems since day 1. They finally found both knees to be full of scar tissue, so I’m scheduled for the left, scope lysis of adhesions next week. Does anyone have experience with this procedure? I don’t want to mess up the recovery with too much or too little pt, exercise, etc. And I live by myself, what should I expect for recovery? Thank you!

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@kimbies1204

Hi…I am 2 1/2 years post-op, bilateral TKR and have had problems since day 1. They finally found both knees to be full of scar tissue, so I’m scheduled for the left, scope lysis of adhesions next week. Does anyone have experience with this procedure? I don’t want to mess up the recovery with too much or too little pt, exercise, etc. And I live by myself, what should I expect for recovery? Thank you!

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@kimbies1204 – problems with your TKR since Day 1 sounds like a tough road. You'll note I moved your post on adhesions after total knee replacement (TKR) here to an existing discussion on scar tissue after TKR so you can connect with members like @leithlane @bengalady @cheril252 @damewocane @contentandwell and others who may have input your situation with scar tissue and the scope lysis of adhesions.

Will you be doing any patient education at the hospital before this procedure? What day will you be having it?

Liked by damewocane

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@kimbies1204

Hi…I am 2 1/2 years post-op, bilateral TKR and have had problems since day 1. They finally found both knees to be full of scar tissue, so I’m scheduled for the left, scope lysis of adhesions next week. Does anyone have experience with this procedure? I don’t want to mess up the recovery with too much or too little pt, exercise, etc. And I live by myself, what should I expect for recovery? Thank you!

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I had that done and my Dr. was surprised there was so much scar tissue. I used my stationary bike every three hours after procedure (tiring, but I did not want the scar tissue to come back.) It worked quite well and I have been diligent about lunges, bike, walking, etc but it has come back after a year ( two years post TKR). Without the Lysis I probably would have very little movement. Good luck.

Liked by damewocane

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@lisalucier

@kimbies1204 – problems with your TKR since Day 1 sounds like a tough road. You'll note I moved your post on adhesions after total knee replacement (TKR) here to an existing discussion on scar tissue after TKR so you can connect with members like @leithlane @bengalady @cheril252 @damewocane @contentandwell and others who may have input your situation with scar tissue and the scope lysis of adhesions.

Will you be doing any patient education at the hospital before this procedure? What day will you be having it?

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Thank you! I am scheduled for the left arthroscopic lysis of adhesions, Thursday. I’m torn on recovery. CPM or not, aggressive PT or passive, etc. The last 2 1/2 years have been miserable and I’m holding onto this as possible help. I don’t want to mess it up.

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@dduke

I had that done and my Dr. was surprised there was so much scar tissue. I used my stationary bike every three hours after procedure (tiring, but I did not want the scar tissue to come back.) It worked quite well and I have been diligent about lunges, bike, walking, etc but it has come back after a year ( two years post TKR). Without the Lysis I probably would have very little movement. Good luck.

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I’m so sorry it has come back for you. I’m struggling with my post care. Aggressive PT or no, CPM or not, etc. The last 2 1/2 years have been miserable.

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@kimbies1204

I’m so sorry it has come back for you. I’m struggling with my post care. Aggressive PT or no, CPM or not, etc. The last 2 1/2 years have been miserable.

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I would go very aggressive. CPM. Everything. Ice after all care. Let us know how it goes.

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@kimbies1204

Thank you! I am scheduled for the left arthroscopic lysis of adhesions, Thursday. I’m torn on recovery. CPM or not, aggressive PT or passive, etc. The last 2 1/2 years have been miserable and I’m holding onto this as possible help. I don’t want to mess it up.

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I had an arthroscopic lysis of adhesions a year ago. My knee now easily bends to 125. However, the PT was brutal. A 10 hour a day routine for a month starting the day after surgery. I would be at the PT office 3x a week for 2 hour sessions where he would force my leg to move to the number the surgeon gave him. I learned how to cry silently as he pushed. PT then went to 8 hours, then 6. I was discharged at 3 hours of PT a day and told keep it up – don’t loose it. I now go to a rowing gym and row an hour 4 days a week and do an hour of stretching at home 4-5 times a week now.

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@melcpa86

I had an arthroscopic lysis of adhesions a year ago. My knee now easily bends to 125. However, the PT was brutal. A 10 hour a day routine for a month starting the day after surgery. I would be at the PT office 3x a week for 2 hour sessions where he would force my leg to move to the number the surgeon gave him. I learned how to cry silently as he pushed. PT then went to 8 hours, then 6. I was discharged at 3 hours of PT a day and told keep it up – don’t loose it. I now go to a rowing gym and row an hour 4 days a week and do an hour of stretching at home 4-5 times a week now.

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Thank you for your reply. I struggle because there are so many differing opinions on recovery. Some believe aggressive PT others say absolutely not. That’s why I’m so frustrated, I don’t know which direction to go. Both philosophies make sense to me.

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To everyone confused about PT:

I was very lucky to come across this British site during the run-up to my revision. It's been my experience that aggressive PT just continues to traumatize an already very acute injury, the one cause by the surgery itself. Their views on post-op exercise and PT saved me this time around. I'm against aggressive PT and so is my surgeon:
https://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463/
https://bonesmart.org/forum/threads/bonesmart-philosophy-for-sensible-post-op-therapy.37103/

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@babette

To everyone confused about PT:

I was very lucky to come across this British site during the run-up to my revision. It's been my experience that aggressive PT just continues to traumatize an already very acute injury, the one cause by the surgery itself. Their views on post-op exercise and PT saved me this time around. I'm against aggressive PT and so is my surgeon:
https://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463/
https://bonesmart.org/forum/threads/bonesmart-philosophy-for-sensible-post-op-therapy.37103/

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Hello @babette
As PT, I appreciate your comments and insight and you are right about PTs sometimes being too aggressive. I have seen PTs push way to hard and they wonder why things are worse (rebound effect). Sometimes other things need to occur (massage, soft tissue work, etc) before stretching. But there is the flip side in which some people are too passive and barely do anything and then blame the doctor or PT for their lack of progress. I do think there needs to be more education and explanation upfront about all the pros and cons before surgery. With my knee replacement surgery (and I am a PT) not one single person mentioned any risks other than infection or rejection including the lingering pain and scar tissue build up or sizing issue with the prosthesis (my issue). I never realized that a prosthesis could be too small or large! I'm not even sure how scar tissue is determined other than going back into the joint, which in itself is another traumatic event for the joint.

I do know from my experience- persistence and continuing your exercises daily, pushing a bit past your tolerance, is necessary.

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@kimbies1204

Thank you for your reply. I struggle because there are so many differing opinions on recovery. Some believe aggressive PT others say absolutely not. That’s why I’m so frustrated, I don’t know which direction to go. Both philosophies make sense to me.

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I am now totally against being extremely aggressive- and even in clinic practice, I never saw the value to being over aggressive. It's the patient that leaves the clinic in agony, not the therapist. There is no literature or evidence to say this aggressive approach results in more desired outcomes. I do feel that you have to shove gently- push to your limit but then a bit further. For those that have a low or poor pain tolerance, you have to push through.

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@dduke

I would go very aggressive. CPM. Everything. Ice after all care. Let us know how it goes.

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There is current evidence that indicates that CPM (continuous passive motion) machines are not effective in more desired outcomes in uncomplicated knee replacements. I haven't see any literature about the use of machines in more problematic knees. The biggest issue is that the machine is passive and active motion is always preferred over passive for lots of reasons.

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