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  1. PLEASE NOTE THAT ONE RECOVERY THREAD ONLY IS PREFERRED. PLEASE DON'T START ADDITIONAL THREADS ABOUT YOUR RECOVERY.

[TKR] Scar tissue removal one year out from TKR

Discussion in 'Knee Replacement Recovery Area' started by Pisczak, Nov 12, 2012.

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  1. Pisczak

    Pisczak New Member

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    I will be having scar tissue removed in Jan 2013. I had TKR in 12/2011, 2 mup. Never gain full extension and about 75 range of motion. It seems after each mup the knee would lock up at the 2 week period. My dr says that he will over extend the knee and will be in a brace for 8 weeks to keep the leg straight except when doing pt.
    Has anyone else have this much problems after TKR.
     
  2. katydid3

    katydid3 Member

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    Not yet! I'm only starting my 12th week but when I was in rehab after the surgery, the PT said that it seemed that my tendons had been tight for some time which told him I hadn't straightened my leg fully for quite some time, probably because my knee had been painful for years. I don't know if that will mean something has to be done in the future or if I can get mt ROM to improve. I certainly wish you the best and although your healing is taking longer than you'd prefer, you'll be so much better in the end!
    :bicycle1:
     
  3. Pumpkln

    Pumpkln Forum Advisor

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    Pisczak,
    Welcome to Bonesmart, we have some Bonesmarties here who have had scar tissue removed, i will tag one of them for you Dhare63.
    Be sure to check out the links in the library for more information.
     
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  4. Dhare63

    Dhare63 Sr Bonesmartie

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    Hi pisczak,

    I have been right where you are at. It's been a year for me and although on a better path now, it has been a challenge. I don't have a lot of time now but will post later with my experience. You can also read through my thread which is long but there are detailed accounts of my MUA, and then the revision to remove scar tissue which was done in August 2012. I will help you in any way I can.

    Best,

    Dawn
     
  5. Pumpkln

    Pumpkln Forum Advisor

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  6. maryo52

    maryo52 Sr Bonesmartie

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    Hi - been there, done that. What is your extension? I had about the same ROM (10/75) when I went in and had the scar arthroscopically removed. Afterward I had about 10/85. So discouraging. I did not return to PT. I used the CPM machine several hours a day and did gentle stretches 3x day. I knew if I went to PT I would end up going along with a program that might not be helpful. PT can actually worsen the adhesions. The progress was slower than molasses at first. Not even noticeable. Finally after about a month I started getting past 90 and I am now at 120 or more. The extension actually took longer, and it was more painful, but I did get to zero in two months and then I stopped "trying" and resumed "living." The improvements continued!

    I'm surprised about the brace. I guess if your extension is 15+ I can see the reason for the brace.
     
  7. Dhare63

    Dhare63 Sr Bonesmartie

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    Hi,

    I finally have some time to reply properly. Thanks pumpkin for attaching my thread!

    So, for me, extension was the issue. I never got past 10 for extension unless the pt was basically putting all his weight on my knee and I was in excruciating pain. I had the MUA which would have worked had it not been for aggressive pushing by pt immediately after, which caused the knee to swell like a balloon. I tried massage, etc.

    Finally had a frank conversation with OS about my options. He said that going into remove the scar tissue would not be enough. He said getting the scar tissue from the front would only address flexion, not extension. We went with a more involved approach; open the original incision, remove the spacer, release the posterior capsule which surrounds the knee and remove all the scar tissue behind and in front of the knee.

    The surgery was long, taking 2 hours. The scar tissue behind the knee had Calcified into the crease behind my knee. That was the reason I could not get extension. The physicians assistant who was in surgery with us, said that usually removing scar tissue is smooth and fairly straightforward. He said in my case, the OS was chiseling the scar tissue away, it was that bad. The OS said it was going to be very painful for the first few days and it was. After day 4, everything got a lot better. I wasn't using crutches, I felt really good, there was stability and I could tell right away that the leg was so much straighter. I was between 15-20 degrees from straight before this procedure. Very quickly I was at near zero. It was almost like a miracle!

    I went to a different pt after this procedure and followed the Bonesmart way. I spent my days controlling swelling, focused on gentle stretching, and took my pain meds as ordered. I also asked my pt to do lymphatic massage which helped to move the excess fluid out of the joint and away from the body.

    This procedure was exactly what I needed. My OS was very clear that it was important to do everything that was needed while the knee was open, so we wouldn't have to go back in again. I had complete confidence that he knew what he was doing.

    Make sure you know the full extent of what the os plans to do while in there. Make sure you ask lots of questions and write things down so you can remember later. When my OS was describing the scar tissue being calcified,he drew a picture on the whiteboard in my room showing me what he meant. I actually took a picture of it with my phone so I could remember. Those first few hours and first days you are so foggy,that it's helpful to use little tricks like that.

    I just started pt in a therapeutic pool, 92 degrees. It is a good workout and the water feels great while in it, but you are working those muscles. I know I have done something a few hours afterwards, but in a good way. It's much more gentle, and the pt says it will help with the whole body. I am doing this as I want to be sure I keep the extension I have waited so long to get. I feel like this is helping!

    Let me know what questions you have. I will help in any way possible.

    Take care,

    Dawn
     
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  8. maryo52

    maryo52 Sr Bonesmartie

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    That's quite an ordeal, Dawn. Your experience offers a lot of insight to all of us. I'm always encouraged to hear stories like this because once you have significant scar tissue, things are not going to work out until the scar tissue is out. The stuff behind the knee is the hardest.
     
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  9. ElanorG

    ElanorG Post-Grad

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    Dhare63 or anyone else, Why is there scar tissue behind the knee? I guess that confuses me because the incision is in the front of the knee so I am clueless as to how you get scar tissue on the back of the knee. I would love to understand this better since I am having a few issues with my extension, although the issue of MUA has never come up with me and I don't think it will. But I would just like to understand this better if someone can enlighten me or refer me to something that discusses this. Thanks.
     
  10. maryo52

    maryo52 Sr Bonesmartie

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    Yes, like many other terms, "scar" has different meanings. There is the scar from the incision.

    The scar that is problematic is inside. It is white-ish non-vascular tissue that grows abnormally as a result of some growth factor. It's basically gristle, if you know what I mean. It tends to adhere to different surfaces and tether bone to muscle in a knee, thus limiting movement. Or it can simply get in the way of the joint mechanism. There are several youtube videos on the subject. This one shows the procedure I had.
     
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  11. ElanorG

    ElanorG Post-Grad

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    Great video, thanks! I can see with those little teeth things going a mile a minute that I can understand why they want to be really careful behind the knee.
     
  12. maryo52

    maryo52 Sr Bonesmartie

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    Yes but in addition, arthroscopic procedures access the front and side of the knee and the part from the kneecap up. They are not able to access the posterior of the knee or below the knee except I recall at least one paper by an ortho who did figure out a way to access the posterior knee.
     
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  13. skigirl

    skigirl Moderator

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    Mary, good posts and good information!!

    I also had scar tissue removed this spring---my thread was "the Removal of scar Tissue". I had an open lysis of adhesions--which means removal of adhesions.

    After the surgery my doc cautioned me to go slowly and not to exercise on an inflamed knee. He thought that that was one of the things which caused adhesions to grow. I did almost nothing for 8 weeks--just table exercises.

    If you are going to have a brace on for 8 weeks, I caution you to make sure your kneecap is moving. There are videos on You tube of "knee cap mobilizations" my pt did them and I did them myself four or five times a day. Also, you need to do some work on the rom. I think 8 weeks in a brace with no flexion would be hard on your knee and your rom. I gues you might consider asking your doc about that. Kelly
     
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