Joint Replacement Patient Forum
Welcome to BoneSmart, glad you joined us.
Sorry to hear all you have been through, if you click #arthrofibrosis, other posts with the same hashtag will be available to you. You will have to scroll down to find posts relevant to you.
If you can we recommend a Phased return to work . Going to work will proved additional activity and exercise, when you get home plan on resting, icing, and elevating.
Listen to your knee and slow down.
To keep scar tissue from coming back, you will need to keep inflammation at bay. It is the inflammation that causes scar tissue.
@skigirl , has experience with #arthrofibrosis . Click on the hashtag and posts about arthrofibrosis will pop up.
Here is a link to recent article.
Follow the BoneSmart Manta and let your knee calm down and heal.
Here are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock as prescribed
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!
Click on the arthrofibrosis hash tag above, a list of other members with a similar challenge will pop up.
Sounds like you have a tendency to develop excess scar tissue with surgery, while not guaranteed you will develop excess scar tissue, it is always something you want to keep in mind.
Let us know how you get along,
@maryo52 I am sorry to hear that you are still struggling. Although my left knee is not completely normal like my right, i don't have anymore pain from adhesions and my rom is still 135. That side tightens up more easily and I do stretch it every day. I also ride a stationery bike about 30 min every day. Do you have the information for the study you mentioned? A source?
As you know, I have a friend who dealt with #arthrofibrosis as well. She ended up having a revision to an Oxinium knee from Smith and Nephew and also treatment for a low grade infection. Apparently this is an infection that only shows up with a 14 day study---most are only 10 days. It is frustrating searching for answers, but I still think there is hope.
Biomed Res Int. 2013;2013:804391. doi: 10.1155/2013/804391. Epub 2013 Nov 6.
Propionibacterium acnes: an underestimated pathogen in implant-associated infections.
Portillo ME1, Corvec S, Borens O, Trampuz A.
The role of Propionibacterium acnes in acne and in a wide range of inflammatory diseases is well established. However, P. acnes is also responsible for infections involving implants. Prolonged aerobic and anaerobic agar cultures for 14 days and broth cultures increase the detection rate. In this paper, we review the pathogenic role of P. acnes in implant-associated infections such as prosthetic joints, cardiac devices, breast implants, intraocular lenses, neurosurgical devices, and spine implants. The management of severe infections caused by P. acnes involves a combination of antimicrobial and surgical treatment (often removal of the device). Intravenous penicillin G and ceftriaxone are the first choice for serious infections, with vancomycin and daptomycin as alternatives, and amoxicillin, rifampicin, clindamycin, tetracycline, and levofloxacin for oral treatment. Sonication of explanted prosthetic material improves the diagnosis of implant-associated infections. Molecular methods may further increase the sensitivity of P. acnes detection. Coating of implants with antimicrobial substances could avoid or limit colonization of the surface and thereby reduce the risk of biofilm formation during severe infections. Our understanding of the role of P. acnes in human diseases will likely continue to increase as new associations and pathogenic mechanisms are discovered.
[PubMed - indexed for MEDLINE]
Bonnie I am so sorry to hear you are again struggling with ROM and #arthrofibrosis again. My knee has settled in to a ROM of about 100 to 105 and although I wish it were more it is functional. I too am one who got good ROM at first then slowly things would tighten and scar up. I did have one manipulation which even though we got me to around 125 at the time it only bought me a tiny bit of improvement when all settled down. Very frustrating because people who had no idea what we go through would insinuate the I was not trying. Not true.
One thing that my PT said to me when I considered a second manipulation is that each time we undergo surgery or manipulation we stir up the inflammation which can cause more scarring and loss of ROM. He urgently stressed to me that if I went through a second manipulation I would stir up inflammation and more scarring. So I opted for his way to gently fight to keep and try to improve what I had.
He stressed that daily we do not always go to our maximum ROM in our normal activities. Of course I know that you are one of those who fight daily for the range so that does not really apply to you. I also know you know well all these things. But gentle stretching twice a day is what he gave me to do for the rest of my life. Do I do all that? No because life and work and time and just sometimes not taking the time to spend on the exercises. But at work when I have to bend I try to incorporate a deeper bend and also in other daily activities.
I'm not sure if these thoughts will help you. I just know that scar tissue never goes away and looking at scars visible on peoples skin from various injuries makes me think about what is in my knee. Some people make worse scars yes but no one escapes them. We just have to keep remodeling the tissue as my therapist said. Gentle stretching to elongate the tissue left behind.
I think of you from time to time and hope you are doing well. I hope for you success in your battle. Good luck Bonnie!!
Hi all. I have not been on this forum really for about three years. I was one of the ones to be hit with aggressive #arthrofibrosis. Although it's possible my surgeon's technique was a contributing factor, I credit him with not being shy about going in and removing the scar tissue so that I have a decent bend. My 34" inseam legs really needed that in order to fit into things like theater seats and cars!!
Anyhow, I was recently checking in with the research that's happened in the last couple of years on this topic and came across a study where tissues of TKAs and revision TKAs were studied, and they found that all TKA patients have fibrotic tissue changes. I'd been thinking, again, should I go for revision? Because part of having arthrofibrosis (even after arthroscopically resolved) is a recurrent synovitis, which I get tired of, and which causes me to have something called "arthrogenic muscle inhibition" - in other words, my quad on that side is atrophied. But after reading this study, I am convinced more than ever that, for me, surgery would only re-activate the fibrosis.
You might at least explore the arthroscopic option. (I actually underwent a second arthroscopy about two years out, and, yes, there was more scar tissue that was removed.) Your story makes me glad that I have not lost ROM over the past few years. Not only is that physically challenging, but mentally challenging.
12 weeks today. Nothing much has changed. I do have most of my energy back from the reaction to the pain meds that sent me into a tailspin. But my knee is still too swollen, IMHO, and I still have more pain than I should. My ROM isn't very good due to the swelling, it's approx. 10/90, which isn't enough bend to ride my bike again. I still can't walk very long before the pain kicks in, but have been trying to ignore it so I can grocery shop without using the electric cart every time. I did use it a couple of days ago as I'd been on my feet too long without a break and had no choice, but generally I make myself shop without it, except for long trips through Sam's Club. Yes, I know I'm stubborn...lol. I'm still icing often as it helps with pain control, but not really for the swelling. I see my OS on the 23rd, but seriously don't know what can be done at this point. I've actually thought about e-mailing Dr. Maale, but haven't as I'm not sure it's bad enough to warrant bothering him. Overall, it's totally frustrating to not know if this is all I get, if something more can be done, or if it'll get any better in the coming months which is more than doubtful. #arthrofibrosis