Revision TKR Revision: Second Time Is the Charm
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Josephine
NURSE DIRECTOR EMERITA
Been there, done that. You are lucky to have an ortho who is not frightened of arthrofibrosis (internal scar tissue formation) and is not hesitating to perform the best possible technique for dealing with it. It was so validating later to have described to me scar tissue obliterating all areas of the knee; it had migrated into the femoral notch of my TKR, up into the quad, and there was a 1/4" band of tissue tethering my quad to bone. When I had the procedure done, my ROM was steadily going backward!
Just a warning: I came out of it with an ROM of 10/85 degrees; he said he got only 0/95 degrees "on the table" which means under anesthesia and completely relaxed, so that number represents the max. For a few weeks after there was almost no improvement, and I sought a second opinion, and that doctor offered no hope. But I tell you, my self-designed PT program worked. For a month, I did only stretches, and kept them gentle (they could be uncomfortable but not painful, so less than 4 on the 1-10 pain scale). I would sit on an exercise ball and slowly roll forward, thus bending my leg, and held that stretch 30-60 seconds. I would do 10 of these 2-3 times a day. That's all. It took a month before I got beyond 90, and when that happened it was like I passed an important marker and became encouraged and more patient and kept gaining. You have to be careful not to push a knee prone to arthrofibrosis because many believe (as I do) that PT can actually make it worse. Anything that hurts the knee stimulates more scar formation. And keep up on your pain meds and icing. I had to do extension efforts too. They hurt more and took longer to get there, but I would have my husband gently push down on my knee with a pillow behind my knee to cushion the effort as it didn't take much to make it hurt like crazy.
Again, you are in good hands, and know that this is the right path and it may take more time than you might expect.
Just a warning: I came out of it with an ROM of 10/85 degrees; he said he got only 0/95 degrees "on the table" which means under anesthesia and completely relaxed, so that number represents the max. For a few weeks after there was almost no improvement, and I sought a second opinion, and that doctor offered no hope. But I tell you, my self-designed PT program worked. For a month, I did only stretches, and kept them gentle (they could be uncomfortable but not painful, so less than 4 on the 1-10 pain scale). I would sit on an exercise ball and slowly roll forward, thus bending my leg, and held that stretch 30-60 seconds. I would do 10 of these 2-3 times a day. That's all. It took a month before I got beyond 90, and when that happened it was like I passed an important marker and became encouraged and more patient and kept gaining. You have to be careful not to push a knee prone to arthrofibrosis because many believe (as I do) that PT can actually make it worse. Anything that hurts the knee stimulates more scar formation. And keep up on your pain meds and icing. I had to do extension efforts too. They hurt more and took longer to get there, but I would have my husband gently push down on my knee with a pillow behind my knee to cushion the effort as it didn't take much to make it hurt like crazy.
Again, you are in good hands, and know that this is the right path and it may take more time than you might expect.
60mom
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I am 15 wks and the last couple of weeks I have developed an excruciating pain when I ride my recumbent bike. It does not happen all the time. I stay off for many days and then try again. I might go a day or two and then it happens again. It is abrupt and stops me dead in my tracks. Now if I go downstairs I feel a pop and the same terrible pain. Once I stop the activity it goes away. Does that sound at all like you are experiencing. I called OS but they thought it might be a cyst. Have not gone in to be seen yet. I just keep praying it will go away. I just recovered from an MUA and just don't want to hear anymore bad news. I feel for you cause the thought of anymore surgery is terribly upsetting. I have the catching but no clunking. Some swelling and aching after it occurs. I guess I will follow your thread to see how it goes for you. He didn't tell me to stop anything but then again I spoke to his nurse and did not go in. I did have pain on extension last week when I had 2 pound weights on. I have since stopped that and am doing it without the weights. Sometimes I can feel it start to happen when I flex if I am not really concentrating on doing them slowly. Seems if I am very careful I can control it but my pain is less and flexion are better so I am actually forgetting about my knee and that is when it takes me by surprise. My pain is the back of my knee, is that where yours is?
A friend of mine experienced something similar. It was soft tissue getting caught in the joint. The soft tissue had become swollen because he was overdoing it. When he rested and took NSAIDs, it cleared up.
skigirl
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Last year when I went on the first bike ride of the year (20 miles) I noticed a lot of kneecap pain---in fact at the end of the ride, i lay in a gravel parking lot for maybe 15 min, just trying to get over the pain!!
My doc does an open----removal of "scar tissue" is called a lysis of adhesions. So, I had an open lysis of adhesions---I have a thread by that name. He opened my knee and said that there was a hole of about 1 cm on my knee cap---otherwise it was completely scarred down.
The recovery was long---for the first three weeks, I did nothing much--just heel slides and leg lifts. There was pain for about a week, and I used crutches for two or three days.
My pt did very little for the first 8 weeks. MY OS cautioned me about exercising too much on an inflamed and hot knee. So, we basically waited until the swelling went down. I did table stufff---leg lifts, clam shells, heel slides.
Let me tell you that I moaned constantly here --- I felt cheated by a THIRD rehab. But, a year later---I just rode 30 miles with friends and my knee is fine. If you have adhesions, they are not going to go away by themselves. Dhare had an arthroscopic lysis of adhesions.
My doc does an open----removal of "scar tissue" is called a lysis of adhesions. So, I had an open lysis of adhesions---I have a thread by that name. He opened my knee and said that there was a hole of about 1 cm on my knee cap---otherwise it was completely scarred down.
The recovery was long---for the first three weeks, I did nothing much--just heel slides and leg lifts. There was pain for about a week, and I used crutches for two or three days.
My pt did very little for the first 8 weeks. MY OS cautioned me about exercising too much on an inflamed and hot knee. So, we basically waited until the swelling went down. I did table stufff---leg lifts, clam shells, heel slides.
Let me tell you that I moaned constantly here --- I felt cheated by a THIRD rehab. But, a year later---I just rode 30 miles with friends and my knee is fine. If you have adhesions, they are not going to go away by themselves. Dhare had an arthroscopic lysis of adhesions.
Dhare63
post-grad
Hi Spinfanatic,
What are your rom numbers again? Is it mostly extension you are having issues with or is it both flexion and extension?
I have had big issues with forming adhesions and my OS knew based on my physiology that scoping the knee would not be the answer, so went back I through the original TKR scar, removed the spacer and cleaned up the extensive scar tissue behind the knee, which had spread up behind the knee and into the spacer area. He also did a posterior capsular release which again, helped with creating more extension.This was what worked for me. The reason he didn't scope it was he was afraid he wouldn't be able to get it all unless he did it as an open procedure.
Hopefully with the MRI OS can get a better sense of what is going on and decide on the best approach.
Don't be afraid of this, but do plan to go very slow and easy while you recover. A red hot knee is perfect environment to lay down more adhesions.
Keep us posted and let me know what additional questions you have.
Best of luck,
Dawn
What are your rom numbers again? Is it mostly extension you are having issues with or is it both flexion and extension?
I have had big issues with forming adhesions and my OS knew based on my physiology that scoping the knee would not be the answer, so went back I through the original TKR scar, removed the spacer and cleaned up the extensive scar tissue behind the knee, which had spread up behind the knee and into the spacer area. He also did a posterior capsular release which again, helped with creating more extension.This was what worked for me. The reason he didn't scope it was he was afraid he wouldn't be able to get it all unless he did it as an open procedure.
Hopefully with the MRI OS can get a better sense of what is going on and decide on the best approach.
Don't be afraid of this, but do plan to go very slow and easy while you recover. A red hot knee is perfect environment to lay down more adhesions.
Keep us posted and let me know what additional questions you have.
Best of luck,
Dawn
spinfanatic
junior member
Thank you all for your encouragement and experience! I have full confidence in my OS and am so excited to be talking solutions. My first three months of recovery had been so wonderful with huge ROM of 148 and great pain control. Things changed quite suddenly mid January when my knee would catch and clunk with each extension or rotation. I have given the knee full rest over the last 60 days which has not been good for my mental health but the required opportunity to let my knee heal if that what it was going to do. Really pleased to have MRI scheduled but am laughing to myself as to how one has MRI with big metal implant. Oh modern technology! Talk right now is scope and not open. I hope that will be the approach although Kelly seems so pleased with open! Will know more in two weeks. All advice is appreciated. I have read both Dawns and Kelly's threads. SO HELPFUL! Staying optimistic as I really want my active life back and will do what it takes. My old knee was so much better than this new one. This has got to happen! Thanks again to you all. Anne
spinfanatic
junior member
Hi 60 mom. First pain I experienced was on spin bike in mid January at around 19 weeks. Prior to that I was fantastic! On the down rotation my knee would jerk and catch. Very noticeable and noisy. No real pain afterwards other than that rubber band feeling. Haven't been on bike since so not sure how bad it would be today. Continue to have problem with extension from 90 degrees and stairs. My clunk is inside top of TRKR knee but swelling is throughout. Seems I have some tendinitis. Hope this is helpful. You are so early on. Keep positive and be careful.
spinfanatic
junior member
Hi 60mom. Kelly's thread is called removal of adhesions. Found it by going to search option on top of page. Pressing the MORE option. Pressing the 'search threads and post' and checking box 'threads started by this member'. Type in skigirl and search. Same for Dawn...dhare63. Thank you Kelly and Dawn! My guardian angels! Good luck 60mom!
spinfanatic
junior member
Wow Maryo52! I just read many of your threads and have to say you should write a book on your journey. Thanks for sharing. Such optimism and courage! I was hoping my situation would be similar to your friends but with two months of waiting and no healing I believe that my OS will have to do his stuff AGAIN! Anxious for my MRI and hoping for a reliable fix. One thing I've learned reading the real time stories on this forum is that nothing is straightforward but everyone gets through it in their own way.
Dhare63
post-grad
It will all end well Anne, truly it will. Kelly and I both had open surgery and we have both had very good recoveries. I followed the mantra to go slow and easy and it was the key to a successful outcome.
I hope you get similar results! Will look forward to your updates, please keep us posted!
60mom, I will look for your thread and be in touch soon. Keep the faith, even when you might not be able to see the light.
Be well friends,
Dawn
I hope you get similar results! Will look forward to your updates, please keep us posted!
60mom, I will look for your thread and be in touch soon. Keep the faith, even when you might not be able to see the light.
Be well friends,
Dawn
megbabyrn
senior
Hi spinganatic,
Sorry you are in this situation. Like was mentioned, pick your date, I tried, but my ortho had a previous commitment, so I had it one week later, but I was okay. I had to have a vocal cyst removed on 11/5/12. It was the 4th time since 1997. I don't smoke, just bad reflux issues. Is it your first time for that!! I was in my son's wedding 5/2011. Didn't have my RTKR until 11/11. I would have preferred to have done it afterwards if I had a choice. I was in so much pain, couldn't wear my heels (@57, I love to rock the 4"" when I can!!!!).
Good luck with your decisions!!!
Sorry you are in this situation. Like was mentioned, pick your date, I tried, but my ortho had a previous commitment, so I had it one week later, but I was okay. I had to have a vocal cyst removed on 11/5/12. It was the 4th time since 1997. I don't smoke, just bad reflux issues. Is it your first time for that!! I was in my son's wedding 5/2011. Didn't have my RTKR until 11/11. I would have preferred to have done it afterwards if I had a choice. I was in so much pain, couldn't wear my heels (@57, I love to rock the 4"" when I can!!!!).
Good luck with your decisions!!!
By the way, Kelly had an open procedure partly because she too had a spacer exchange.
If the ROM problem involves extension, they cannot access that area of scar tissue with the scope. Therefore an open procedure is needed to access that area. If the ROM problem is mainly flexion, then that is scopable. There! a new word: "Scopable."
It's kind of nice to have all us ROM challenged folks in one area. I've been thinking of putting together a stickie on the subject of arthrofibrosis with links to youtube videos and whatnot.
On a personal note, I had a repeat scope in the Fall which helped but then I notice that in the end I am the same as before, with an effusion and thickened synovium. So once again, I feel quite tight across the kneecap. But at 2.5 years out, I'm past worrying about it or being disappointed at the results. I'm slow to accept but I'm there now!!
If the ROM problem involves extension, they cannot access that area of scar tissue with the scope. Therefore an open procedure is needed to access that area. If the ROM problem is mainly flexion, then that is scopable. There! a new word: "Scopable."
It's kind of nice to have all us ROM challenged folks in one area. I've been thinking of putting together a stickie on the subject of arthrofibrosis with links to youtube videos and whatnot.
On a personal note, I had a repeat scope in the Fall which helped but then I notice that in the end I am the same as before, with an effusion and thickened synovium. So once again, I feel quite tight across the kneecap. But at 2.5 years out, I'm past worrying about it or being disappointed at the results. I'm slow to accept but I'm there now!!
spinfanatic
junior member
Hi. Back from follow up on MRI with OS and surgery is once again recommended. Yikes! Seems I have a hyper-reactive synovium which is causing Plica to to pinch kneecap each time the kneecap glides. OS is confident a scope is appropriate and will take a look while in and fix any other problems should there be any. Surgery should take 45 minutes. I will go home same day with CPM and will be weight bearing. I am to expect extensive swelling and will have follow up three days after surgery. Surgery circled in for April 29th. Love my OS and his staff who is working to fit me in so I don't miss my kids graduations in May/June. I am both relieved to have a FIX in place and panicked. I have to laugh at myself as at appointment I had list of questions and didn't ask one. This medical stuff is so overwhelming! Wish me luck!
Dhare63
post-grad
Well, at least you have answers and a plan; that is really helpful. Please don't worry too much, it will be okay and soon you will start recovering again!
Please keep us posted and all good wishes for a successful outcome!
Dawn
Please keep us posted and all good wishes for a successful outcome!
Dawn
Buddhabear
member
Spinfanatic, can you see scar tissue in an MRI? Your recovery sounds very similar to mine. I am just over 6 months from my second TKR and have the same symptoms you describe. But I did have an MRI that showed a lot of things but not scar tissue. I have been massaging the area just above my incision where I am pretty sure there is some scar tissue left. But didn't consider scar tissue elsewhere.
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