Revision TKR August 1st 2023 Second TKR Revision Left Knee

Definitely let us know if you get to see Dr. Gill!
 
Could you give us the exact dates of the following procedures please, so we can complete a signature for you.

Left Revision July 20th 2021
Open arthrolysis clean out March 11th 2021
Left TKR October 2nd 2020

^Edited above
 
Last edited by a moderator:
Thank you for those dates!
 
On Friday 11/19 I saw Dr. Thomas Gill. At various times he has been team or head physician for the Boston Bruins, Red Sox, Patriots, and the Boston Ballet. He is said to be one of the best arthroscopic surgeons around.

He thinks he can get another 10-20° range of motion for me when all is said and done, which would get me to around 95-100°. Doesn't sound like much but it will allow me to walk comfortably, use stairs, and maybe pedal a bicycle.

He doesn't want to do the surgery until at least the six month point, to allow my knee to calm down and let the current inflammation subside.

Does anyone have experience with arthroscopic debridement of scar tissue, and what was your recovery like, compared to your original TKR?

@ValleyGirl, did you ever have your consultation with Dr. Finn?
 
I've scheduled my arthroscopic LOA and MUA with Dr. Gill for March 7th. I wanted to do it around the end of January but the hospital is closed to any new elective surgery appointments until after 2/21. There is a chance I can get a cancellation at the end of January.

I intend to plan my recovery and "PT" around the experience of a user from KneeGuru named 'JakeM'. Use any search engine to find his content.

One of the great things about his thread, in addition to being one of the few to completely recover from arthrofibrosis, he updated his thread for the following 15 years, which is super helpful. So many people stop posting and you always wonder what happened to them and whether they were ultimately successful.

JakeM's posts are the single most useful posts I've found dealing specifically with recovering from surgery for arthrofibrosis. If you suffer from this condition I recommend reading them through from end to end.
 
@WFD I got a 2nd opinion from Dr. Kinder at Panorama Ortho in Golden, CO. Great doc. He is sending me to another pain doc (go see my thread). Also a Dr. Robinson at Panorama does debridements. Will talk with him after pain doc and revisit with my OS.
 
@WFD My surgeon now wants to do another MUA. Have booked an appt with Dr. Robinson at Panorama Ortho for 2nd opinion. Really want to find a doc local that uses irradiation though. :umm:
 
@WFD My surgeon now wants to do another MUA. Have booked an appt with Dr. Robinson at Panorama Ortho for 2nd opinion. Really want to find a doc local that uses irradiation though. :umm:

The surgeon with whom I am booked for arthroscopic LOA and MUA on March 7th said he wouldn't do radiation because:

1) There are no good studies that show it is any better than no radiation. All studies to date are pretty much anecdotal, have no controls, and are not blinded.

2) He is concerned about interaction between the radiation and the existing metal parts in the knee.

3) He is concerned about the potential for an increase in long term cancer risk due to the level of radiation used, which has to be powerful enough to damage the tissue and make the scar tissue not grow. This is a lot more power than is used for x-rays for example.

In the end I agreed with him and decided not to pursue radiation. The potential benefits are unproven and the risks are genuine and concerning.

What I think is more important is the following:

1) A plain MUA without arthroscopic LOA is not good. The torn scar tissue will bleed inside the joint and the blood will not be drained (at least not without aspirating the joint at some later point in time), leading to a high likelihood of immediate development of scar tissue and adhesions. If you are as prone to arthrofibrosis as I am, I expect this cure would be worse than the disease.

2) The desirable surgery is an primarily an arthroscopic LOA using an electrocautery tool instead of a debriding tool. The standard debriding tool has metal teeth that chew away at the scar tissue and cause a lot of bleeding. An electrocautery tool burns away the scar tissue with an electrically heated tip. The scar tissue is automatically cauterized, reducing the bleeding.

Not every surgeon uses this tool so you should ask.

3) The MUA that is done along with the arthroscopic LOA is done partly for diagnostic purposes and partly to remove adhesions the surgeon cannot otherwise get to. Because this is done during the surgical procedure, any bleeding can be drained immediately.

4) The post-surgical recovery process is extremely important, which of course everyone on this site already recognizes. The procedure I hope to follow will be modeled on one documented by user JakeM over at KneeGuru. Do a search for

"kneeguru" "JakeM" "How to beat Arthrofibrosis"

and it should come up as the first hit. That page also includes a link to his log that documents his recovery and the following 15 years, which is really helpful and inspiring.

My surgeon trained at the Steadman clinic which is one reason why he is up on the best practices for treating arthrofibrosis. If you can find another Steadman alum in your area that might be one approach.

Hope this helps. If you have any trouble finding JakeM's page, PM me and I'll send a link.
 
I just had my surgery yesterday - an arthroscopic LOA and MUA of my left knee. This is my last chance at getting rid of the massive scar tissue that developed after my last three surgeries (TKR / open arthrolysis / revision).

Mods, could you change my title to "Arthroscopic LOA and MUA - March 7, 2022"? Thanks. I've already updated my signature.

I am convinced that, given my strong tendency to develop scar tissue, that one of the main contributors to the scar tissue after my previous surgeries was the aggressive PT prescribed for me and which I did not then know enough to refuse. For this reason I will not be using outside PT services this time around. Later on, if I am having trouble with my gait, I may go to PT for that kind of problem. I have had impaired range of motion and have not been able to walk normally for nearly two years, so this is a real possibility.

The lysis of adhesions was done with an electrocauterization tool and the MUA done afterwards was relatively mild. I am shocked at how little pain and swelling I have 24 hours later, much less than I had after any of my arthroscopic meniscectomies. I guess that makes sense since the traumatized meniscus is part of the load path when you put weight on the knee and the scar tissue removed yesterday is not part of the load path. The nerve block should have worn off by earlier this morning. I was given Tramadol for pain but I think it is too powerful and I don't like the side effects so I think I am going to try tapering it down.

After my last surgery the revision surgeon gave me a prescription for generic Celebrex, in part to reduce inflammation and in part to block the formation of bone inside scar tissue in my quad, which had happened after the previous surgery and was very painful. It seems to have been successful, since the bone and most of scar tissue in the quad did not return. One connection I didn't make at the time but did later when I went through my notes, was that I had made good progress on range of motion up until the time the 30 day prescription expired and then progress went rapidly negative. It might be a coincidence, but this time around I asked for a 90 day prescription and may try to extend it further, if I get good results.

The doctor said that prior to commencing the operation he measured 55° flexion. After the surgery the doctor reported that after the LOA and MUA, with no scar tissue left to release he measured 100°. Resistance to further motion was caused by tight muscles and tendons, caused in turn by the impaired range of motion I have suffered over the last two years. 100° does not sound like much but it is still a huge improvement. Furthermore, I have hopes that after I have gotten past the scar tissue danger zone and everything is healed up solid, that I can proceed to then stretch the tight muscles and connective tissues and maybe get to 120° or better. That's far in the future - I have to concentrate now on healing up without triggering the formation of scar tissue.

My plan for this week is:

* First day (today) - mainly CPM while icing with my ice machine, alternating with easy PT - ankle pumps, elevated quad sets, and patellar mobilization.

* Remainder of week - Four cycles a day consisting of 2 hours of CPM while icing followed by "PT" (ankle pumps, patellar mobilization, wall slides, heel slides, elevated quad sets, and straight leg raise). Two extra sets of patellar mobes - 1st thing and last thing.

All exercises are done very gently to the point of slight to moderate tension, but not even close to any sensation of pain.

I am perfectly capable of walking normally without pain, but am trying this week to use my crutches and stay as close as possible to non-weight-bearing, to keep stress off the knee and minimize the chances of triggering the formation of scar tissue. I am staying on the second floor of our house so I don't have to take the stairs.
 
Mods, also can you change my prefix to "Arthroscopy"? I don't seem to be able to change it, though I was able to set it when I created the first post. Thanks.
 
WFD,
Thread title and prefix updated for you.
Sounds like you are doing well and have a good plan to avoid further scar tissue and promote healing your knee.
Wishing you all the best for an uneventful recovery.
 
Week 1 Update -

I continue to have less pain than before the surgery. I expected that, even after arthroscopic surgery, it would get worse before it got better, but it actually got better before it got better.

Every morning, I use a tape measure to measure the circumference of my knee to see how the swelling is trending, use an IR thermometer to measure the temperature of the knee relative to the non-surgical knee, and measure the RoM (range of motion). The swelling continues to be less than it was before the surgery by 0.5cm or so (still about 5cm bigger than the non-surgical knee.) Before the surgery the surgical knee was consistently about 2°F warmer than the non-surgical knee, and this week it was 0.4-1.5°F warmer, so again a slight improvement. The range of motion is about 70-75°, about the same as it was before the surgery.

I expect to use the measurements of temperature and swelling to warn me when I am doing too much, and to show me when the inflammation has mostly subsided and I can start strengthening exercises.

I'll continue with the same plan for this week coming up - CPM machine, icing, easy PT, partial weight bearing (though I can walk fine), and no stairs.

I'm cautiously optimistic that it will work this time.
 
Best of luck with your recovery, @WFD . It sounds like things are going well so far. Keep us posted!
 
I forgot to mention that I had tapered off the Tramadol by day 5. The pain is pretty manageable and I really didn’t like the way the Tramadol made me feel. After my past surgeries I had oxycodone, which I tolerated much better.
 
I'm cautiously optimistic that it will work this time.
I surely hope this procedure will work for you. I know it’s hard after all you’ve been through but try to be patient, (I know, much easier said than done, been there, done that!) Also be cautious with your rehab. I’m sure you are trying to find that sweet spot between too much and too little.
 
Wow you’ve had a tough time. I’m sorry to hear it.

My body produces ridiculous amts of scar tissue too. I had 2 MUAs and an arthroscopic clean out (called a lysis of adhesions). I’m not sure what the reluctance is to consider the LOA.

Part of my issue with scar tissue stems from having lupus. Autoimmune conditions do strange, weird and sometimes painful things to the body. Is there any chance of an undiagnosed AI condition?

Boston has great doctors - I hope you can find someone to help with this. If you don’t get satisfactory responses, would you consider another opinion from someone at HSS in NY? They have a special team that deals with the tough cases. Here is their link


I do know that many of them are reluctant to take on cases that are less than a year out from the last procedure. But you may be able to get a consult. ALL of them are great.

Good luck. I answered your other question on my thread.
 
Thanks, @Magsmom .

I am quite happy with my current surgeon so far. The arthroscopic LOA/MUA he performed has been relatively painless so far.

I don’t seem to have any autoimmune diseases, though my mother had rheumatoid arthritis, and once i tested positive and once negative. I don’t have the symptoms though so I think I am good.

I do have early onset osteoarthritis, and that might be a contributor. I’ve taken glucosamine for decades and that keeps the OA itself at bay.
 
Dude - you and I are alike in our meticulous attention to detail! Measuring and checking temp of your knee daily- impressive!! Either that, or we’re both nerds.
Couple of quick things:

I’m glad you’re using the cpm. I hear mixed feedback from various doctors, PT etc. I chose to use one after my second MUA/LOA and believe (even if it’s just in my head) that it helped.

10-20 degrees of addl ROM is HUGE! I can certainly appreciate that part.

I didn’t like Tramadol at all. Just didn’t do anything for me. I hate the opioids but sometimes the pain & discomfort is overwhelming.

For nsaid, I take Celebrex or Naprpxen. Happy with both but I think it’s a personal choice.

I’m fascinated by this radiation topic and will read up on it more.

Hope you are feeling better. You’re just over a week post op, right?
 
Yup, day 8.

Studies show that CPM is helpful for people with arthrofibrosis like me, but regular people end up at the same point by the 5 month mark, regardless of whether or not they use a COM machine.
 

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