TKR A light at the end of a long, dark tunnel

[Roy Gardiner]

My cousin was a lot stiffer than I was after her 2 knee replacements. Her surgeon told her that you cannot get more ROM than you had before surgery. A lot of people's ROM decreases a little from what it was before surgery.

That's a surprising thing for a knee surgeon to say in that it's completely wrong. Indeed, the reverse is often the case; bone spurs are removed during surgery, leaving full ROM possible. Of course one has to stretch to get full range, but even without that one's ROM is likely to be better after surgery as just day-to-day life will help.

I am a case in point. ROM on both knees is vastly better than pre-surgery.

stretching ends up weakening the muscles, so the non-stretching exercises are for strength, and the stretch exercises are to increase range of motion, but the ROM stretches decrease strength for a while after stretching.

I would be interested to know your source for this information, I've never heard of stretching weakening muscles.

 

[Dolphin5]

Hi all. My CT scan was on Sunday. My appt with the consultant was today. His secretary rang me yesterday as he'd seen something on the scan for which he wanted me to have another x-ray prior to seeing him. There was a mix up with going to the wrong x-ray dept so I saw the consultant BEFORE the x-ray instead of after. He said there was possibly something 'off' at the knee cap so wanted a special x-ray done, toe to hip. He estimated my ROM today at about 40o. He said there are, so far, three options: 1. To have an MUA. He said he'd do it gently but would want me in hospital for a few days to have extensive physio. I don't like the sound of this as it sounds like the physio is going to be forcing my knee back.

Two: to have the scar tissue removed but he said it would simply come back. Three: I can't remember! It may have been to have some metal changed?

He said it's early days but if it was a year then that would be difficult. So he believes in there being a 'window' but it being a long one.

Tomorrow morning he's having a regional zoom meeting with four experts who specialise in complex cases. They will look at the scan and the x-ray I had after my consultation and he'll ring me late morning.

I'm praying, hoping, that something will be found and I get a diagnosis. The icing on the cake would be a faulty procedure as I'll then sue the previous hospital and get my many expenses reimbursed and compensation. Any procedure I need doing I'll go private as my mental health isn't great due to all this.

My lovely friend/neighbour insisted (again) that I DID do all my exercises from day 1. I can't remember. She said I was complaining about not being able to do the heel slides on the bed very well due to the stiffness. I knew I would've done them but started to question myself.

It was 17 weeks yesterday since my op. I'll let you know the outcome of my consultant's call tomorrow.

 

[EalingGran]

He said it's early days but if it was a year then that would be difficult. So he believes in there being a 'window' but it being a long one.

It's good that your surgeon appreciates that the window for MUA is much longer than a lot of surgeons think. Some want to do it very early but the research I read supports your consultant's view.

 

[Dolphin5]

My consultant rang me this afternoon after his zoom meeting with several experts on complex knee issues. I think it's good news.....the x-rays/scan show nothing amiss. He wants to do keyhole surgery on my knee to remove the scar tissue. I'll then stay in hospital for a few days with my leg on a machine which will keep my leg moving to keep it on 90o movement.

By staying in hospital I'll be monitored and hopefully I won't have the previous problem of excessive swelling. To remind you, after a big op I ALWAYS come out of hospital weighing exactly one stone heavier. Fluid. In this case half a stone went during the first week but the other half stayed whilst my leg had ballooned out with fluid. A blood clot was found and blood thinners got rid of the extra half a stone. However my leg was hugely swollen from a few days after surgery for about two weeks. Heel slides and other exercises wouldn't have been done very well because of this, despite doing my best.

I've never been very flexible and on a riding holiday about 30 years ago, riding for 3/4 hours each day, I remember at times taking my leg, the right one (!) out of the stirrup because it had gotten stiff. I asked the consultant if my current situation is due to the exercises I did and he said immediately, no you've just been unlucky.

I'm going private and the date, to be confirmed, is Sunday 1 June. I'm trying not to get too excited as it's perhaps possible I'll be driving a few days after this. I'm also trying not to think about if this procedure doesn't work. He said if it doesn't then I'll have to have a full revision. The problem with this is that I could end up exactly the same.

It is now 17 weeks and 2 days since my op on 15 January. I'm desperate to get my life back.

Any thoughts on how long my recovery will be from the keyhole surgery? I'm guessing you'll all be reminding me that my full recovery is still about a year!

In the meantime, with still only being able to lift my foot about 3 inches off the ground I must continue to concentrate on not tripping over.

 

[Jamie]

I’m glad to hear you have a team of doctors looking into the problems you are having. It sounds like a condition called arthrofibrosis, which is a possible complication following a knee replacement. It’s good that you will be under observation after the surgery for a while. Even though you will be having an arthroscopic surgery, it’s still surgery and there will be a lot of disruption of the internal tissues in your knee as any scar tissue is cut out. You need to be prepared that recovery from that surgery will likely not be just a couple of days. Your surgeon will be the best person to guide you for activities like driving. Adhestions (scar tissue) are more likely when there is inflammation and heat in your knee, so it will be important to minimize any post-op swelling with rest, ice, elevation, and pain management. Again, your surgeon should be able to inform you of what you should and should not be doing.

All the best to you on June 1st. In the meantime, take things as easy as you can.

 

[Dolphin5]

Thank you Jamie. It'll be like old times after surgery doing the ol' rest, ice and elevation again . I had an arthroscopy 13 years ago on the same knee. Would there be additional scar tissue from that keyhole surgery?

 

[Layla]

Hi Dolphin,
Sounds like you have a plan and I certainly hope it's a success. We will add June 1, 2025 to your signature, so please let us know if the date changes.

I did read that it is possible for scar tissue to form again after the keyhole procedure. However, frequent movement and stretching prevents scar tissue from re-accumulating, so that's likely why he wants you in the hospital for a few days on the CPM machine and to keep pain under control so you're able to more comfortably and engage in any rehab they prescribe. With any luck you're feeling hopeful and it is my wish that this procedure gets you back on the road to healing and all that your missing in life. Have a nice weekend!
@Dolphin5

 

[EalingGran]

I'm trying not to get too excited as it's perhaps possible I'll be driving a few days after this. I'

Agree with @Jamie that you should only drive once your surgeon advises you it is OK- otherwise your insurance will not be valid.
It is good news that your surgeon has given you a good explanation of your issues and hopefully the arthroscopic surgery will do the trick. But it is still surgery and you need to move gently to avoid further swelling.
Good luck!

 

[sistersinhim]

I had had 5 previous surgeries on my right knee before my TKR. I asked the OS if I had adhesions and he said no. To recover from all these surgeries, I just did ADL, (Activities of Daily Living), and no PT. Even with birth defects on both knees, I have recovered well with doing just ADL.

 

[Dolphin5]

Thank you everyone. Does anyone know if the keyhole arthroscopy I had 13 years ago would have added scar tissue to my knee? Just interested to know if I had this prior to my TKR.

 

[ACIM]

Dear Dolphin5- I have been following your thread here off and on over the last few weeks. Though I know it's been an extremely difficult period for you, both mentally and physically, it's more important that I tell you how much strength I get from reading your thread. You sound like an amazingly strong person and keeping up with you has helped me tremendously to maintain my faith and trust in the process. I just know things are going to work out beautifully for you.

 

[EalingGran]

Thank you everyone. Does anyone know if the keyhole arthroscopy I had 13 years ago would have added scar tissue to my knee?

In theory any surgery can cause scar tissue- and some people do seem more prone generally. But you probably would have noticed stiffness at the time. What was your ROM like after that surgery?
I do hope things work out for you.

 

[Dolphin5]

ACIM thank you for your kind words which gave me goose bumps in knowing I've helped you on your road to recovery. I wonder if your birth sign is a fire sign like mine is, Aries. Fire signs are not known for their patience!!

EalingGran I can't remember what my ROM was like after the Arthroscopy 13 years ago but I've never been very flexible with my joints. Until 13 months ago I was playing very vigorous table tennis for two hours non stop, twice a week, and am sure this helped me with my flexibility. I had to stop when my knee 'gave up on me' the day after one table tennis session.

 

[Dolphin5]

Having just read my consultant's letter to my GP updating him it would appear that I am indeed having the dreaded MUA. This will be followed by debridement of the knee, followed by more MUA. Then put on a CPM machine. My consultant certainly downplayed this by saying he'd just be removing scar tissue!! I had expressed my aversion to having a MUA so perhaps this is why.

I'm certainly not looking forward to it and apparently the recovery is several weeks/months. But it is what it is. I have no choice and will just need to grit my teeth and get on with it. If it works then it's not a problem. I can't bear to think of the alternatives. The two times I've seen my consultant he's estimated my ROM to be nearer to 40o. I feel sorry for my knee which is still trying it's best to heal.

 

[Jamie]

Can you post the copy of the letter you’re reading or send it to me in a Direct Message (DM)? I am a bit confused by what you’ve written because a Manipulation Under Anesthesia (MUA) and the arthroscopic surgical procedure you describe (which sounds like a Lysis of Adhesions) are two separate procedures. The two are not usually done together.

Because the MUA is totally non-invasive, it would normally be the first attempt to deal with adhesions in a knee. Based on how the information was written in the letter, the surgeon may be going to attempt the MUA first and then move to the Lysis procedure if it is not success. This is just a guess on my part, but I would be interested to read exactly what the surgeon said. It would be easier to provide information for you if this was more clear.

 

[WFD]

because a Manipulation Under Anesthesia (MUA) and the arthroscopic surgical procedure you describe (which sounds like a Lysis of Adhesions) are two separate procedures. The two are not usually done together

When I had an arthroscopic lysis of adhesions, at the end the surgeon performed an MUA to break up the adhesions that he could not reach with his surgical tools, so the two procedures can in fact go together. I have no idea how often that is done however.

 

[Jamie]

Thanks @WFD……that makes sense and perhaps that is what is being proposed for Dolphin5.

 

[Dolphin5]

Hi Jamie and WFD. Thank you for your messages. Firstly, @WFD I'm so sorry for everything you've had to endure. It's amazing that you find the time to write to me when you're recovering from an amputation. I sincerely hope your recovery is going well. What a huge adjustment for you.

Jamie I'm useless at technology and have no idea how to copy the letter on here but it's a short letter and I'm accurate in what I've put, even using the term debridement which I had to Google.

With my ROM only being about 40o I reckon the consultant has his work cut out (I think there's a pun there ). I just hope nothing goes wrong and it works.

I'm ringing his secretary later to get the date of 1 June confirmed.

 

[benne68]

I'm useless at technology and have no idea how to copy the letter on here

If you have a smartphone, just take a photo of the letter and then add that photo to a post by clicking on the "Attach files" button below.

I agree with Jamie that it would be quite unusual for a surgeon to do an MUA and arthroscopy to remove scar tissue at the same time. Perhaps he is giving you options? Or saying, he will try one and then, if it doesn't work, try the other? If you can share the letter we can give you better information.

 

[Dolphin5]

Hi. I only use my phone as a phone and for photos. I don't know how to transfer a photo from there on to this site. But it's irrelevant. The letter is clear and, at least for the moment, that's what's being planned.

Because when I saw him last Thursday and an operation hadn't been decided upon, I'm seeing him this Thursday for him to go through everything with me. I'll let you know what he says. I've had the date of 1 June confirmed for the op and have my pre op assessment today.