TKR Flexion concerns

[mainegirl1]

They'd like continuing income
They tried to sell me the same bill of goods
When I told them
I was not getting anything from them I could not do at home they were miffed

 

[Jockette]

You do not have to keep massaging “scar tissue” so your knee will bend. My PTs didn’t do that and my bend is good.

A certain amount of “scar tissue” is necessary or else your wounds won’t heal. That doesn’t get massaged away.

PTs carry on far too much about “scar tissue.” It really isn’t an issue.

 

[sistersinhim]

PTs need to stay in business. They do that by keeping people coming to them as long as they can. They charge the insurance companies an outrageous amount for something you can do at home.

 

[bertschb]

Hello, I have another question for all you bone smarters. The physical therapist is telling me that it's important I continue with PT because there massaging of the scar tissue is necessary to break that up and allow the joint to move freely. I'm just wondering what everyone's opinion is on this. Thank you.

Break up the scar tissue???? Good grief!

I won't be going to PT if I need to have my other knee replaced. No way. It was worse than a waste of time. It actually set my recovery back. And to think I paid for that....

 

[Melticey]

That's what I was thinking as well. But it seems so unethical to outright lie to someone. The fear tactic is a great motivator for repeat business.

 

[klinkmcbear]

@bertschb thank you so much for posting your flexion numbers. This is really encouraging. I keep reading to not worry about flexion, but seeing where you were and where you ultimately ended up is just what I need to keep my hopes up. I keep saying I don't care how long it takes as long as I know I can get there. This makes me think I can - Thanks!!

 

[bertschb]

...But it seems so unethical to outright lie to someone. The fear tactic is a great motivator for repeat business.

My PT said there was a window of opportunity to work on PT to improve ROM and if I missed that window it would close forever and my ROM would be stuck at 60 or wherever it was at that time. Nice try Mr PT!

 

[mainegirl1]

I remember the angst the PT people pitbuou through Brian
It was so not right. All it did was raise self doubt and eventually mistrust in PT

 

[Melticey]

Brian, thanks for all the good information. It's very helpful as I've nothing to compare this to. I tend to believe whatever medical people tell me and it's very disappointing when therapists put an artificial timeline on rom improvements. I have been stressing out and obsessing over my rom for the past few weeks. But everyone's advice on here is leading me to believe that I don't need to worry about it. It'll happen when it happens.

 

[sistersinhim]

Many of us never even thought about ROM. What was important was what we could do. Function is so much more important than numbers! As long as you'll be able to do what you need and want to do, then your surgery is a success!

 

[Rockgirl4]

@Melticey I'm definitely not an expert on ROM and not a Dr, but after 11 knee surgeries (including my recent TKR 4 wks ago), a 20+ yr lower back problem, plus a couple of ankle problems, I've experienced 2 types of PTs (and you can imagine how many I've encountered in 25 yrs)......

1) Those that only focus on numbers and time frames. They used a lot of "you must" and "we have to" phrases, repeated "scar tissue" like a broken record, and wouldn't sit and have a TRUE conversation with me about what I wanted and how I felt. They blew off my concerns and focused on their own. Many had quite the ego.

2) Those that actually spoke to me about whether I thought things were too little/too much, if my pain was controlled or increasing, plus form and function of my gait and desired activities. Mostly, they focused on the whole me, not just my knee and it's numbers. They had no ego. They focused on numbers only when they had to give updates to surgeons or ask for more PT visits from insurance. I've gone back to one like this for my lower back off/on for 10 yrs now and consider her a friend.

I'm a notoriously slow healer, whether I had a simple arthroscopy for meniscus removal, arthroscopy with cartilage repair (3 Microfractures), or Arthrotomy for ACI. Swelling ALWAYS hangs around for months on end. My TKR recovery has had a few setbacks, but all things considered, it's too early to say slow or speedy. My point is all of this history has given me insight into knowing what my body is or isn't capable of, and whether the PTs are feeding me a line of . I KNOW what it's like to NOT be like everyone else....and with TKR, there's no such thing as a "normal" or "typical" recovery. I've had one minor issue with my TKR therapist, but we've resolved things beautifully because she has no ego and only wants what's best for me. Even after speaking to my surgeon's office Monday, and realizing they're no help, she says it's what I want, when I'm ready, and she works for ME.

If you continue PT or need one in the future, I'd research and "interview" a few to see if you can find someone more dedicated to the patient than worried about their own ego or the insurance company. It only took ME 25 yrs!!!

 

[Melticey]

So I just got off the phone with the surgeon's PA because I'm still obsessing over my ROM. It has changed very little from the first couple weeks post surgery. She told me that if ROM is bad going into a knee replacement that they don't expect it to be much better coming out because scar tissue has already formed around the joint from having the bad knee years before I got it replaced. I wish I had been told this prior to surgery just so I wouldn't be expecting to have a fully functioning knee. I've been very limited in my ROM for about two or three years so I guess that's about the best I can hope for. She said they are just getting rid of the pain by doing the knee replacement. Have any of you been told this or had a different outcome after your surgery with bad ROM going in?

 

[Melticey]

To add to the above note, regardless of the numbers I still have difficulty doing things, like getting in and out of a car, putting on pants unless I either sit down or bend over at the waist so that I barely have to lift my foot off the floor, stepping over something on the floor. Just little things like that with poor flexion makes everything more difficult.

 

[Rockgirl4]

In my opinion and from people's experiences here, I don't see why the TKR would cause worsening flexion problems afterwards, making you less functional (?). It's one thing to not expect a LOT more and for the surgeon to say you won't gain much more.

However, if you didn't have problems with shoes/pants/car before, I think you will get there again in time. There's that dirty word again though---time! I wonder if this is just the surgeon's way of saying he doesn't know what's possible, knowing you were somewhat flexion-deficient before TKR.

 

[Rockgirl4]

I forgot to add I'm not sure I buy your surgeon's "well you had lots of scar tissue" excuse......

I had 7 surgeries worth of scar tissue in my right knee before my recent TKR, one of which was a horrible scarring/adhesion experience from my ACI arthrotomy that caused a year's worth of flexion & extension problems in 2015-2016. My TKR surgeon spent half my TKR cutting out as much scar tissue as he could, knowing I have a tendency to make it faster than most, and he said it was SUPER extensive. Even with all of that, he still thinks I'll get the 120 degrees (cold) and probably 125-130 (if warmed up) in time----he and my PT both warned me though to lower my expectations and expect it to take many months, with lots of tiny gains.

So yeah--I still wonder if your surgeon is saying all of this because he doesn't know what you might end up with.

 

[Melticey]

No I had all those problems before the TKR. I was under the impression that once I had a new knee it would function exactly like my knee functioned years ago before the arthritis came along. But what I'm hearing now is that a new knee doesn't really change what your rom was right before the surgery, it only gets rid of the bone on bone pain.

 

[Rockgirl4]

It will be interesting to see if someone else comes along and can give you some hope. I remember a few mentioning they gained more, but I don't know how common it is. I'm sorry this has been such an ongoing problem for you.

 

[Larryhg3]

Again I can only add my experience here. My knees (both of them) were bone on bone for close to 10 years. They were “bad” for as long as I remember. I personally was blessed with a great PT who completely understood my situation. They were patient with me and helped me to achieve my goals. You are 8 weeks out that is so very early in this journey. Give yourself permission to heal at the rate that your knee allows. I personally went to PT for 14 weeks. They were never “happy” with my ROM numbers but I never cared. I was also lucky that they have a personal conditioning group as well. I transitioned there where twice a week I do 90 minutes of exercise, stretching and generally getting better. Everything is based on body weight exercises. But my legs and rest of my body are much stronger than when I started this journey. Ultimately only you can decide if PT and conditioning is your thing. I believe that in time you will gain back what you want functionally but not in Your time. Your knee is your guide

 

[sistersinhim]

I think you will exceed your previous bend. Arthritis pain was keeping you from bending much. Now, that is gone. That new knee has no arthritis pain, just post surgical pain and swelling. As you heal and the swelling goes down you will find it easier to bend. But, not today or tomorrow, maybe not even a month from now. It will happen, though, I feel certain. I had 5 previous surgeries on my tkr knee. I'm sure there was lot of scar tissue in there, but no adhesions! They are very, very rare. You have to have scar tissue to knit your wounds back together!

Be patient and don't worry about it. Enjoy each little improvement you achieve. Don't try to 'work' your way into a better bend. That has the opposite outcome by inflaming and swelling your knee. Swelling restricts bend.

 

[kneeper]

I don't know about the "scar tissue" claim, but my OS did tell me that the best predictor of post op ROM is pre-op ROM. I got a few degrees more than I started with in the end but it didn't happen all at once. I would say I continued to gain a couple of degrees over the first year. I think a lot of that had to do with just using the knee--doing activities that required some bending.