TKR Arthofibrosis

[Celle]

Doctor says that I have not improved and that I probably have scars and that he wants to probably change my implants.......he continues saying that I am healing to slow.....I can not bend my knee and I still do not have a full extension.....he wrote on my paperwork arthofibrosis......not a clue what this is and he prescribed more physical therapy.

Hi @Starpoint54
Can you tell us how far your knee will bend and straighten now, so we have a better idea of the problem? And also give us an idea of how much activity you're doing each day - how much housework, walking and exercises.

Right from the start, your surgeon has been impatient with your progress.
He doesn't seem to realise that complete recovery from a knee replacement can normally take as long as a full year.

Unless something acute happens, most surgeons won't consider doing a revision/replacement until that year has passed.

I disagree with his recommendation of more PT - that's often what doctors suggest when they don't know what else to do. If you have arthrofibrosis, also known as adhesions, it was probably contributed to by too much activity and PT in the early days after your TKR anyway.

Arthrofibrosis is what many PTs call "scar tissue" It's different from normal scar tissue, which is essential for the healing of your knee. These articles explain:
Scar tissue and adhesions - what's the difference?
MUA (Manipulation under Anaesthetic) and Adhesions

If it was me, I would be reluctant to let your current surgeon have another go at fixing my knee. I would ask for a second opinion from a surgeon who specializes in problem knees. Because most surgeons won't do anything until about a year post-op, you may have to wait a while before someone will take you on, but that second opinion will be worth it, because these surgeons see problem knees every working day and they can often spot a problem or a solution that has eluded the original surgeon.

If you truly have arthrofibrosis, the usual solution is not a complete re-do of the replacement. Instead, they do a gentle lysis (removal) of adhesions. PT after that surgery should be very gentle.

 

[Celle]

By the way, @Starpoint54 ,
You'll notice that I have merged your two threads together as it's best if members in recovery only have one thread.
This is because:

• That way, you have all your information in one place. This makes it easier for others to go back and review your history before providing advice.
• If you start new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

Please keep all your questions and updates on this thread. We won't miss your new question as, between us, the staff read all new posts each day.
If you need an urgent response to a question, tag a member of staff.
Tagging other members and answering tags

If you prefer a different thread title, just post what you want and we'll get it changed for you.

Here are the instructions on finding your thread, How can I find my threads and posts?

A helpful hint - Many members have found it useful to bookmark their thread so they don't lose it.

Best wishes,
Celle

 

[Celle]

@Starpoint54 ,
Did you surgeon ever suggest doing a manipulation (MUA) to help with your knee flexion (bending)? If so, did he do one, and when?

As far as the pain in your other joints, it would be a good idea to see your own doctor/PCP about that, and ask for bloodwork and other tests to see if there is a cause.

 

[Starpoint54]

He did not mention MUA. He said A change of implant. I was planning to pick up another round of PT on Monday, but I am dreading it because It is so inflamed. I do my regular daily activities......I am up since six and taking care of my granddaughter who is only two months......I do go up the stairs constantly because my kitchen is on the upper floor. I run errands, laundry, cook, etc. etc. I drive back and forth around 50 miles to take care of granddaughter. I also tend my chickens and my dog. The only thing I am not doing right now is working full time. I thought I would be ready by August after the surgery but decided to wait before going back. I can not even imagine working full time plus all my other duties. if I can not get my knee to work properly I do not see myself working by January...

 

[sistersinhim]

I do my regular daily activities......I am up since six and taking care of my granddaughter who is only two months......I do go up the stairs constantly because my kitchen is on the upper floor. I run errands, laundry, cook, etc. etc. I drive back and forth around 50 miles to take care of granddaughter. I also tend my chickens and my dog.

Oh my goodness, no wonder your knee is inflamed. Your knee is only halfway through this year-long recovery. You don't need PT, you need rest. Your knee is still healing and not in training. Back off of most of these activities. They are too much for your new knee. Spend time icing and elevating to get the inflammation and swelling down.

 

[Celle]

sistersinhim is right.

No wonder you knee can't bend or straighten properly yet - it's being kept in an inflamed and swollen condition because you're doing too much.

How far will your knee bend and straighten right now?

You don't need a re-do of your knee - you need to rest, ice and elevate your knee more, to try and help it to calm down, and to reduce the internal swelling that is stopping it from being more mobile.

Please don't be tempted into adding more PT as well.
Knee recovery - Lose the Work Ethic!!

I know you want to help by looking after your granddaughter, but this is a year-long recovery and you owe it to yourself and your knee to look after that knee properly and stop overdoing things.
having to drive 50 miles every day is asking too much. Can her parents find a minder closer to their home until your knee has healed?
Nurturing mother: how to let go and accept help

 

[Jockette]

I agree with both sistersinhim and Celle. Please try to cut back your activities and rest, ice and elevate your leg and give it the time it needs to heal. All this activity is not helping your knee. If you give your knee the time it needs to heal now, you’ll be able to do all these things later.

 

[Pumpkin]

You will want to work with a surgeon that has experience with Arthrofibrosis, here is a list of surgeons for you.
Arthrofibrosis: Names of US surgeons with experience in arthrofibrosis

Arthrofibrosis is an inflammatory condition, too much activity and aggressive rehabilitation in individuals with a tendency to scar is a risk factor to develop arthrofibrosis.

 

[jsa]

Sorry you are still having troubles, I'd be looking up those surgeons Pumpkin has posted for a second opinion. It's a long road to start again with another full replacement before at least hearing what a specialist in that field can do for you. Don't stress and rush about to accommodate everyone, sometimes we try to fit it all in forgetting that there is a lot more recovering to do. And sorry but IMHO that doc sounds very unhelpful and totally out of touch if he thinks you should be over it after 2 weeks. I can empathise with the teary moments but the people on here are lovely to talk to if you need an ear to listen, they helped me when I was low and I'm sure they will do the same for you.

 

[Starpoint54]

Thanks for the response....I will then cancel the new PT for tomorrow...I was truly debating this because I live in a very small town and all my doctors are like 45 to 50 minute drive. Including the new PT person recommended by the dr. The Dr. even asked me to sleep with a brace. I am already having issues sleeping, and does a brace really help to keep up with the extension?

 

[Starpoint54]

I truly believed I was not doing a lot at home. Plus I felt guilty not keeping up with the house chores...this is the hard part...resting....

 

[Jockette]

Right now your painful knee needs extra care. Try not to look at it as slacking off your responsibilities and don’t look at resting as doing nothing, look at it as giving your knee the best opportunity in which to heal.

 

[Starpoint54]

is There an easier way to ice? Refrigerator is upstairs....

 

[sistersinhim]

is There an easier way to ice? Refrigerator is upstairs....

I used an ice machine. It has a bucket that you put ice in, or frozen water bottles, and a little bit of water. You plug it in and it circulates ice water through tubes to baffles that you wrap around your knee. I used this the whole time I was sitting or laying down for the first few months. This kept the swelling and pain lower. When the ice was all melted and the water warmed up then my knee would start aching. I had to replace the ice about every 3-4 hours at first. As the knee healed it wasn't as hot and the ice would last longer. I highly recommend them.