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Revision TKR Never give up, keep trying, don't settle - that's me, Bonnie

skigirl

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Bonnie, my friend, the ski instructor is doing great after her new replacement with a Smith Oxinium knee and the discovery of the infection they think she had from the first implant on. At any rate, she now has a rom of 115, which is wonderful for her.
 
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RunA42K

RunA42K

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Well...I'm going down this road again. 10 months post op and losing ROM. I see my surgeon on Friday the 16th of September. #Arthrofibrosis has gotten me again....why????

More to come :cry::bawl::shrug:
 
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Pumpkln

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Bonnie,
I am sorry to hear you are losing ROM again, :console2:.
Let us know what your surgeon says. I hope he has more resources for you.
:scratch:
 

Celle

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Oh no, Bonnie! :groan:
I'm so sorry to hear you're losing ROM again. :console2: :friends:
Do let us know what your surgeon says.
 

Kneebox

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Well...I'm going down this road again. 10 months post op and losing ROM. I see my surgeon on Friday the 16th of September. #Arthofibrosis has gotten me again....why????

More to come :cry::bawl::shrug:
What did your metal testing come back with?
 
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maryo52

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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.
 
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turtle68

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Oh Bonnie I am so sorry this's is happening to you again. I had my revision two months ago where my Rom was down to 100, but rom and extension so far are good. Are you going back to the same surgeon who did this last revision. I will be thinking of you

Dorothy
 
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RunA42K

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What did your metal testing come back with?
My metal allergy testing which was one year ago came back absolutely positive as allergic to nickel and chromium. Thus my knee was replaced for a 3rd time 10 months ago. My doctor was hoping that I grew all that scar tissue that required two surgeries because of the allergy to nickel. I've done so much better this time but I've peaked at 126 with ROM and now I have about 105 functional. I have a second doctor lined up for an opinion after my Friday appointment with my 3rd TKR surgeon.
 
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RunA42K

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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.
Mary I've already had two arthroscopic surgeries for #Arthrofibrosis, and it came back each time so I have no clue what my answer may be.
 
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Cflower

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Hi Bonnie, sorry to hear about all the problems you have had with your knee. What type of doctors are you going to? The reason I asked is that I'm still having that tight band feeling in both knees which were done in 2012 (three months apart). Went for my four year check up a month ago and my surgeon has never had a patient with my complaint. I have 129/130 range of motion in both knees, no pain other than the 24/7 tight feeling. He referred me to a physical medicine/rehabilitation doctor and she also has no idea what's causing it. She told me I could try taping it (after I told about someones' story I read here on bonesmart) she said try and do a lot of stretching since it seems like my calves and hamstrings tighten up really quick when I start walking. I don't want any other surgeries I just want to know what is causing this feeling. This last doctor more or less said when I wake up in the morning just tell myself it isn't going to get the best of me.

On my four year appoint the doctor ordered blood test to make sure there wasn't any type of low grade infection going on. It was clear, no infection. I've also seen a chriopractor and he did acupuncture, laster therapy and active release therapy. No change.

Did you ever have the tight band feeling or was your problem entirely different from that.
 

Pumpkln

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Bonnie,
Sounds like you are on the right track, seeing your revision surgeon and obtaining a second opinion.
:friends:

She told me I could try taping it
I use kineseo tape, it helps me. You can have a PT or an Athletic trainer show you how to put it on yourself.
 

kneeworn

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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!!
 
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NightQuilter

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Oh Bonnie - what a frustrating development! I too have the nickel issue - fortunately my OS was aware of it and understood the impact nickel-containing implants could have so I didn't have to deal with what you've gone through. I hope he has some good ideas for you. My massage therapist advocates shiatsu massage to minimize scar tissue development.

@Cflower - since you mention your hamstrings and calves tighten up so quickly, I am wondering if getting additional bioavailable magnesium into your system would help. A product like Calm (powder you add to juice or water - citrusy) really helps when I get leg cramps - also wonderful for constipation. Magnesium seems to be one of those undervalued minerals we don't get enough of from foods anymore and is critical to so many body functions - most importantly keeping muscles smoothly functioning. Pills in the supermarket/pharmacy don't have the same effect. Just a thought. And more Vitamin D - preferably liquid.
 

skigirl

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@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.
Author information

Abstract
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.

PMID:

24308006

[PubMed - indexed for MEDLINE]
PMCID:

PMC3838805
 
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LaPaz

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Hi Bonnie and so sorry to hear about your struggles with the knee. I have lost ROM also after having my knee replacement and 3 revisions to the knee. I am too struggling with this but I don't have any type of allergic reaction going on. My last surgery was last Feb. 2016 where they cleaned the knee and put in a new spacer. So, my heart goes out to you and I look forward to reading your future posts with hopes you get improvement. I guess I have just gave in to the fact it will not get much better for me. But I do hope I will not need another surgery.
 

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Well...I'm going down this road again. 10 months post op and losing ROM. I see my surgeon on Friday the 16th of September. #Arthrofibrosis has gotten me again....why????

More to come :cry::bawl::shrug:
I am so sorry to hear about the arthrofibrosis returning! My prayers are with you!
 
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I saw my knee surgeon today. My scar tissue is back and growing. I knew it already. Monday I'm going back down to the hospital to have water therapy in the hospital pool. I don't know how often they will want me to do that but I have to try, before I lose all my ROM AGAIN

I'm so tired of being disappointed and starting over and I've taken on this walking group. Last week when I was done walking I had to lay down on the bed the rest of the day because I hurt so much.

I started crying at the doctors office. They wanted me to go down and talk to this one person in Physical Therapy named Kelly, and so I went down there then they told me I could not the see Kelly, I started crying again. They felt bad and went and got her. She came out and hugged me and sat in a chair and talked to me. She made arrangements for me to come back on Monday when there was nothing available for two weeks.

They want to see if aquatic therapy will help because I just can't keep having surgery. I know this road I'm on...I'll do it so they can't say that I didn't but I know I'm going to wind up with 40 degrees and limping again.

If man can walk on the Moon, then why can't some one figure out aggressive scar tissue.

Help I need a specialist in Arthofibrosis!! not a revision so not necessarily an OS, a scar tissue doc!
 

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