TKR Nine weeks out and still limited ROM

[Gilina]

OK. So, here is a question: @Josephine Will delaying an arthroscopic lysis of adhesions surgery--say for 5 to 6 months until spring--be a bad thing? That is, will it cause more problems or result in a more difficult recovery down the line? Snow and weather and roads and long travel distances are an issue here from mid-Nov until April. And it seems to me that after the procedure (currently planned for Nov 3) there would be more appointments to keep--and I don't drive on bad roads.

I can see where not stretching ligaments/tendons for a long time due to the adhesions blocking bend might be an issue. Are there others? I am considering getting a second opinion as well--I think my insurance allows for that.

Gilina

 

[Josephine]

That is what we call on here a "how long is a piece of string" question!

I can see where not stretching ligaments/tendons for a long time due to the adhesions blocking bend might be an issue. Are there others?

In the worst case scenario, soft tissues (muscles, ligaments, tendons and other tissues) can become tight and may even shorten, what we called contracted. But so long as you are ambulant and active, this is unlikely to happen to any serious degree.

 

[skigirl]

Since your doc is so uncooperative, I think a second opinion is a great idea. I delayed my surgery for five months so that I could ski!! Also I was scared---I was happy when I finally did it and it worked. I think that Frank Noyes wrote a book that was advertised on Amazon on Adhesions. I am old and could be wrong, but I am pretty sure that is where I saw the book---which is a download.

Also, I am hoping that Bonnie @RunA42K (she is going to kill me ==this is the third time tonight I have tagged her!!!) will tell you her experience with arthroscopic lysis of adhesions. Her doc proscribed a cream which was compounded to help prevent the regrowth of adhesions as well.

There are two other threads on this forum about folks who are struggling with adhesions. They are: Scar Tissue Keeps Forming and Two Years on from TKR. You can search them at the top of the page. It might be good for the three of you to talk too.

Most of all, don't give up there are solutions out there.

 

[RunA42K]

@Gilina @skigirl Hi Kelly, don't worry about tagging me, it is fine. Here it is 4 am and I should be sleeping but I am not...too many knee worries keep me awake. My scar tissue has taken over again in 6 months after my last surgery to remove it. The expensive compounded creams did not help me in the grand scheme of things. If you stop in and read my newest updates to my thread, I had metal allergy testing and bone scan and knee aspiration done, seeing a new specialist. I am highly allergic to nickel and my implant in my tibia is loose because if it. They say the metal allergy is the reason for my repeated scar tissue growth. I'm having my Stryker knee removed on November 5 I'll be non weight bearing for 6 weeks after surgery to help prevent my fragile tibia from cracking. Maybe this information can help someone else.

 

[Gilina]

They say the metal allergy is the reason for my repeated scar tissue growth.

After I saw your post in your thread yesterday, I wondered about the connection between nickel allergy and adhesions and thought I would ask you--once you were feeling a little better. I can't imagine going through what you are going through. But, it also made me think that if I ever get my other knee done, it will not be done using a nickel containing implant. I wish you the best and hope you will have lots of help and support at home, too.

I delayed my surgery for five months so that I could ski!! Also I was scared-

I'm scared, too, for a variety of reasons, not all of them surgery related. Thanks for the titles of the other threads--I have searched previously, but the titles will definitely help. And, I'm glad to know waiting did not affect your outcome. Means I have time to consider my options. It even occurs to me that other docs probably do MUAs later than 3 months (maybe avoiding surgery altogether)--need to do more research on that.

But so long as you are ambulant and active, this is unlikely to happen to any serious degree.

That is wonderful news. I had already thought if I do delay, I will use the time to do a lot of walking (I can walk all winter as long as I have packed snow to walk on) and other exercises--my legs are strong (no quad issues), but I want to also work on my back/abdomen and upper body strength. Thankfully, my extension is good.

Wow, thanks, ladies. I feel like I can now ask the right questions about delaying and make an informed decision (which I think I have already made). And maybe relax and sleep a little better. Good way to start my day.

Gilina

 

[Josephine]

I can walk all winter as long as I have packed snow to walk on

Have you seen these? I use them when ever we have snow but they are lethal on ground with no snow! Safety: walking in snow and ice after surgery

 

[Gilina]

Have you seen these?

Yes, I have some YakTrax. I learned very fast they do not work in stores with smooth floors! Great on packed snow (though usually just my boots with knobby soles are fine on our type of snow), but useless on glare ice (as I found out a couple winters ago!) I also have "poles" for walking and snowshoeing which I hope to be able to do again some day.

Reading about adhesions--seems like the body should be smart enough to gradually dissolve them/loosen them over time, but I guess not. Perhaps surgical type "injuries" are not something our bodies needed to evolve to "fix"; more likely the response that actually occurs saved the lives of cave men--or something. Just riffing--need breakfast!

Gilina

 

[Gilina]

@Josephine Well, just before I left the house this morning, the OS's PA called me. (The one I don't care for.) I asked about the need for appointments after the surgery--"Oh yes, there will be many. We expect you to go to PT every day starting the day after surgery." Oh no, the same aggressive PT dogma. Sigh. (Closest PT for me is a 1/2 hour drive each way. Plus, I won't be able to drive myself at least at first.) Told him since I can't fly, I wouldn't be able to do that. I have no one to drive me.

Then I asked about delaying the lysis until spring. He said not a good idea due to contraction of the ligaments/muscles, etc. (I agree that could be an issue, but falling on ice or ending up in the ditch in a snow storm doesn't really appeal either.)

It has since occurred to me that this may be a procedure they don't do very often (using the shaver tool that other OSs have mostly stopped using is one clue I think).

Since I have to call my insurance about whether home PT is possible, I guess I will ask about other surgeons. Maybe I can find one who does MUA later than this OS's 3 month cut off--or one who does arthroscopic lysis more often. Or something.

I feel like giving up on these guys and just seeing when I am by April and moving on from there. If so many people who refuse/don't have an MUA end up with good ROM at one year anyway (like was found in that one published paper) maybe wait and see is not such a bad idea. Maybe if I hadn't worked with doctors for so many years, and become aware of their fixed ideas about certain things, I would be more easily influenced. I imagine they don't like being questioned. My OS is really pretty good; his physician assistant is too full of himself and completely unable of thinking outside the box. (Good cop, bad cop??) It bothers me that they are both so negative about the procedure.

Gilina

 

[skigirl]

That would bother me too. I know that the PT of my husband's heart surgeon was actually cruel---he took pleasure in being petty. He knew that we had a long drive home and delayed taking out a catheter until after lunch---he then announced that Bob would have to lie still for three hours---making me drive home in the dark. Like I said, Petty. The look on his face as he announced the additional delay was amazing. I told him that he reminded me of a boy in the third grade---the same emotional age as he was! He slammed the door as he left, and I was very happy not to see him ever again.

Whenever I am feeling important, I know that I need to look about me and find out why I am being so silly. Am I gleaming onto the tails of others so that I can feel important to be with them---woe is me if that is the case!!

A second opinion will set your mind at ease. Are you near enough to Chicago for a day trip? Or Indianapolis?

 

[Gilina]

I know that the PT of my husband's heart surgeon was actually cruel

It's the "I know best/I am in control of you" mindset. I have seen that in the hospital--it is worse in nursing homes where they don't even listen to the family.

Can't get to Chicago (not a day trip from where I am!). Indy is even further. I am thinking about Madison or Wausau now though for the procedure (still not a day trip and still no one to drive me). In most ways, I don't want to wait--I'm uncomfortable and wanted so much to be walking normally and comfortably by next summer. But, since adhesions are uncommon, as I said, I suspect it is a surgery my OS doesn't do much. The PA definitely does not see patients as individuals and he made a semi-nasty comment to me that I won't repeat, but that I think will end my relationship with that OS.

@Josephine Also, is arthroscopic lysis of adhesions something I should seek out an OS who does "revisions" for? Plan to call the insurance today and see what I can find out about a number of things.

Gilina

 

[Craig1]

Hi Gilina,
I have just read through your thread re MUA or open lysis of adhesions. I am scheduled to have an MUA soon which will be two years after my knee replacement. I am a bit worried that after two years my orthopaedic surgeon may not be able to a achieve much more rom for me however I feel I need to take the chance.

 

[Gilina]

I am scheduled to have an MUA soon which will be two years after my knee replacement.

Wow. Has your knee been "stiff" ever since surgery? What kind of PT did they have you do after the original surgery? I will be interested to hear how it goes. Timing on MUAs is confusing to me--what is too early, and what is too late. If my doc had said something earlier to me about MUA, I could have had help at that time after the procedure.

I just asked the office how often my doc does the lysis procedure--answer probably once every few months. I have been wondering if a sports medicine doc might be a better choice for the arthroscopic procedure.

Feeling stressed--just canceled my surgery date. Looking at options downstate where I have relatives I might be able to impose on for a week or two, but again, not until spring. Most of them live in areas my insurance doesn't cover.

Gilina

 

[Gilina]

I told him that he reminded me of a boy in the third grade---the same emotional age as he was!

Having worked in the hospital for years, I have been yelled at by doctors and nurses many times--just because. We weren't allowed to talk back. But, I did finally learn to tell them since I wasn't the one responsible for whatever the [mythical] problem was, it wouldn't be me they took it out on and then asked them if they would like to talk to a supervisor. Not treating patients like people--as individuals--is unforgivable in my book.

Gilina

 

[PolarBear60]

My dad seemed quite satisfied with his UW Health System experience in Madison. I can ask him if he would recommend his OS. I'll be visiting them at then end of this month, and we'll have time to talk.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005

 

[Gilina]

@PolarBear60 according to the website, my insurance doesn't cover Dane county. Will have to wait for Medicare for that. But, having the information in my pocket won't hurt. Thanks.

I am so disappointed and frustrated (yes, I know it could be much worse) to still be dealing with this instead of taking long walks with my camera. I remember reading a post on here months ago--some fellow said he broke his adhesions himself. Don't remember how, but it is beginning to sound tempting. Argh.

Gilina

 

[Craig1]

Hi Gilina,
After my previous MUA's my surgeon got my rom to 100 degrees however it has dropped back to 65 and has been like this for a while now. Will you doctor not consider an MUA at this stage? Physio after TKR was weekly however I was never pushed to the point of pain. Good luck in getting another opinion.

 

[Gilina]

After my previous MUA's my surgeon got my rom to 100 degrees

So, you have had MUAs done before? And, the effect didn't last. Seems to me, you are repeatedly creating "scar tissue" (but, I am not an expert!) and maybe they should consider another option.

I remain surprised at how many people have issues after this "oh-so-common" surgery. Of course, the people who do not have problems do not seek advice on BoneSmart.

Gilina

 

[Josephine]

seems like the body should be smart enough to gradually dissolve them/loosen them over time, but I guess not.

Wouldn't that be nice! But did you see the photos in the MUA article that explained adhesions? MUA (Manipulation under Anaesthetic) and Adhesions.

So, you have had MUAs done before? And, the effect didn't last. Seems to me, you are repeatedly creating "scar tissue"

I think it's a lot more simple than that - the reason it appeared not to last is that adhesions are most likely not his problem. So when he was knocked out and unable to resist, the surgeon was ale to get really good ROM. Maybe it lasted a few days but then the resistance from swelling and other issues came back into play again.

 

[Josephine]

Also, is arthroscopic lysis of adhesions something I should seek out an OS who does "revisions" for?

Not necessarily. It's not actually in the 'revision' sector.

I have been wondering if a sports medicine doc might be a better choice for the arthroscopic procedure.

I would caution against it. They may do replacements but in my experience, their attitude very much tends towards the 'no pain no gain' philosophy because that's how the sportsmen like it!

 

[jmdearras]

I remain surprised at how many people have issues after this "oh-so-common" surgery. Of course, the people who do not have problems do not seek advice on BoneSmart.

I beleive that is a real effect of help forums. They provide a great service, but seem to present a tilted view of the average person. I am 8 weeks out, driving since 2 weeks, basically pain free since 4-5 weeks. I can handle stairs, no problem, I can even run down stairs. Sit on the ground, * almost* crossing my legs. Etc. There are a lot of us out there that have had good results from the start. It's nothing I did, it's the OS and God.