Watch 2019 JRAD Videos

TKR Scar Tissue after Knee Replacement

Status
Not open for further replies.

Dhare63

Sr Bonesmartie
Joined
Oct 30, 2011
Messages
1,163
Age
57
Location
New England
Gender
Female
Country
United States United States
Hi Zoie,

Welcome to Bonesmart! You will find a great deal of first person information and support that is perfect for those of us who need help. I know that my recovery improved as soon as I started following the less is more approach.

As the others have said, it's time to step back from the activity and focus on controlling your swelling. The ice and elevating are good, and you might also add lymphatic massage. That will help push the swelling away from the knee and out the lymph system. It's important to find a pt or massage therapist who has experience with this.

If after you have the given it plenty of time to resolve with the more gentle approach, and you do need to consider other options, they really aren't so bad. If you have a lot of time, ha, click on my user name and look for threads started by me. You will hear a whole year plus history of my TKR, MUA and subsequent scar tissue removal and capsular release. I tried everything possible to resolve my issue without surgery but it wasn't meant to be. The good news is it worked! I am much better today because I took a much gentler approach and it helped so much.

Please keep us posted and let us know what questions you have. You are in the very early days of this so there is plenty of time to resolve the issue, and you will not be stuck this way....just plain nonsense!

Do take care,

Dawn
 

Ms.fixit

member
Joined
Nov 27, 2012
Messages
226
Age
66
Location
US
Gender
Female
Country
United States United States
Greetings Zoie, and welcome to our little group! I was just reading the other member's advice to you and it's one of the best threads I've found here on the subject, with the exception of the library articles Josephine recommends.

I am about 4 weeks ahead of you with my TKR and I am an avid MUA refuser! I had meniscus surgery 42 years ago and had pretty dramatic adhesions then..I think I had 50 degrees ROM at the most, and a( lousy) 10 to 15 extension, too. It took a year, but I worked on them very gradually and steadily and at the one year mark, they were gone.(Hey we're in our sixties..have you ever known anything on your body NOT to stretch, eventually? :yikes: )
Right now I am at about 90 most days. My PT and OS were in hysterics about this weeks ago, but I had already had so much pain, that I told them no way was I going in for any further work. More dithering on their parts but I was and am determined. I withdrew from PT and have continued on my own. I have read enough here and had enough experience with my own body that I am quite fine with this process taking a long time. It's MY leg, not theirs, I don't care how proud they are of their work!
Like you, I am pretty active now, and I get rebound swelling inside the new joint and inflammation in the sural nerve on the outside of my calf when I overdo..and you are right, Voltarin is a waste of money. I do better with good old Epsom salt lotion and ice, and I'm off all the RX pain meds as of about 6 weeks ago.
I've posited this before, but at least in the US, I think a lot of the rush to MUA is to protect the hospital from future malpractice suits. They want to be able to say they did everything possible to get you moving well, and MUA can indeed often help, but it also has a very high incidence of negative effects statistically. Not to mention that outcomes at one year with, vs without, MUA are remarkably close.
For me the choice was easy, I've had it with pain, hospitals and PT and that's that!
I'll be following your journey..hang in there and don't let anyone cause you to do anything out of fear!
 

referee54

omega
Joined
Dec 21, 2007
Messages
17,881
Age
65
Location
Northern Part of the Buckeye State
Gender
Male
Country
United States United States
There is no sense tryi to rush a recovery here---the more you try to reduce the time of recovery, the greater chance that yo have of increasing the swelling in your surgical knee. It is difficult to do, as we want our lives to be back to normal ASAP, but when you consider what has been surgically done to the knee, you can understand why the patient and gentle approach is the best way to do it.
 

hhilltop

senior
Joined
Feb 3, 2013
Messages
285
Age
66
Location
US
Gender
Female
Greetings, Zoie,

Seems you've collected comments from several folks that have been sending advice my way. I'm a bit further down the road in recovery, but dealing with some of the same issues, too. Finding this website is one of the best things I've discovered for my recovery process. I had an MUA (Manipulation Under Anesthesia) at 8 weeks post op because I was stuck at (70,5) for my ROM. After the MUA I was (90,15.) So there was gain, but also loss. I made progress with a lot of push it hard PT so that I got to (105,5) but there it stuck for 4 months.

Here I am at 8 months post op and I've finally started to gain ROM again. It was after I encountered Bonesmart and I quit trying so hard to push my knee through 2 hours daily of exercises as my PT's pushed me to do and I documented for them that I was doing my part. (116,5) is my latest measure. Though I should have enough ROM to be able to do stairs, it still hurts enough that I can't do it without heavy reliance upon a handrail. My OS has twice suggested scar tissue removal surgery to me. First time I dismissed it outright. The second time it scared me and made me dig on line and I found BoneSmart. I hope my new ROM is a sign I will continue to improve and won't need it. I've decided I will wait for the one year mark and try to do all my summer activities before I revisit that thought. This may not be exactly what you wanted to hear, but it is realistic for those of us who are blessed to be in the aggressive scar tissue camp. We don't make a very big percentage of all the TKR patients. It really is great that we can pool together here on Bonesmart and compare notes.

There are some experts and a very helpful library of resources here. Then there's lots of personal testimonies that will back you up with TLC.

Something you might find of interest is clicking on each of our pictures to pull up our profiles. From there you can find the person's threads - and read their stories. I think it would be good for people to list the name of their thread in their signature so it would be easier to find. Or maybe someone can tell me a more direct route that I haven't figured out yet. This can be a great activity while you have your knee elevated an icing.
 

Roy Gardiner

MODERATOR
Moderator
Joined
Jul 23, 2011
Messages
6,899
Age
68
Location
Essex and London
Gender
Male
Country
United Kingdom United Kingdom
I'm going to stop going to PT three times a week and back it off to once per week and just have her do very gentle things.
You can go to PT as often as you like as long as it doesn't hurt. Gentle stretching and massage will help, and you should do stretches at home, too, every day.
 

Josephine

NURSE DIRECTOR EMERITUS
Nurse Director
Joined
Jun 8, 2007
Messages
84,940
Age
78
Location
The North
Gender
Female
Country
United Kingdom United Kingdom
1) My medications are: Oxcodone 10-325-I take every 4-6 hours, Oxycontin 20 mg-I take every 12 hours. I did a 10 day course of Medrol (a steroid) about 3 weeks ago to try and reduce the inflammation (no change). I also take meds for pretty severe asthma, and acid reflux.
Taking anti-inflammatories for this kind of swelling is no good because it's reactive swelling, meaning it's a reaction to severe trauma (your surgery!). But you could add in enough Tylenol to make your dosage up to 1,000mgs four times a day. Just check what's in the oxycodone and do the math!
3) I elevate my knee quite a bit - at least 3-4 hours per day as it feels better when I do.
Elevate it more. Every time you are sitting down to do anything, have it elevated. You can't do it too much.
4) I'm pretty active now as my energy has recovered from the surgery.
The energy is a factor but the reason you need not be so active because of the swelling.
I just think if I am inactive, my leg/knee will get stiffer?
Stop the backward thinking! You need to figure out the difference between being inactive and resting. Your leg is stiff because it's swollen and it's swollen because you are doing too much. Read that article about the swollen leg. I've explained it in there very clearly.
I was so depressed yesterday after leaving my OS's office. My Physical Therapist had told me that there is really nothing more they can do for me - I've been stuck at the same point for the last 5 weeks - and that I need more medical intervention - probably a second manipulation.
Ignore your PT, she doesn't have a clue what she is talking about!
My OS doesn't want to do a second manipulation because the first one didn't work. He told me I may be like this for the rest of my life.
What a doom laden prophecy to speak over you! I do hope you didn't believe him!
No - he did not hear any "pops" and anything that indicated that he had broken the scar tissue. In fact, he came out after the surgery and told my husband he was surprised how "easy" it was to move the knee through the scar tissue. This indicates to ME that it was too soon and that the scar tissue was soft and pliable and then all he did was stretch it, NOT break it (and it has contracted back).
Well, listen to this old nurse very carefully! There was no 'scar tissue' and there is no scar tissue. That's why he could bend your knee so easily, because all that was obstructing your flexion was swelling. Once he had you knocked out and you couldn't feel the pain, he could do what he liked and what happened? oops a daisy - your knee bends beautifully!

See, that's what we've all been saying - your knee has plenty of bend in it right now, right this minute. All that's stopping it is swelling and pain. Did I suggest you go back and read the article on the swollen leg? I did? Then please go back and read it again! The answer is there, clear as day.

And if you needed yet another way for this to be said (which I'm sure you don't really because you sound like a very intelligent lady to me) but once you forget all this tommy-rot about your knee being frozen solid, never to bend again even if you live to be 100, and get your swelling under control, the next thing that will happen is that your pain will also be under control and you will be getting a nice bendy knee like you have always wanted.

So there is NO scar tissue, none whatsoever. Okay? :thumb: Jolly good!
 

Ms.fixit

member
Joined
Nov 27, 2012
Messages
226
Age
66
Location
US
Gender
Female
Country
United States United States
Josephine..you're the best, most reassuring nurse, ever. I am loving this thread Zoie started!
I had a flash of blinding insight the other day. The reason I am anxious from time to time about my own progress is a somewhat neurotic desire to "please" the surgeon with "good" ROM at follow up visits. So, I put time constraints on this or that goal. THEN, it occurred to me that I don't have to go to these appointments! There is no law that says I have to go.
They saw me at 8 weeks and pronounced me fine, then said to return on April 28th. Which I have just cancelled. I told them I'll see them at around a year. Now I feel relaxed again and can do things at my own pace. Ta da!
 

Nanners

post-grad
Joined
Jun 6, 2010
Messages
1,125
Age
62
Location
United States
Gender
Female
Zoie I am 7.5 mos out from a LTKR. When I stopped going to PT my ROM was 105 and 12 for the extension. I have slowly but surely got more bend and more straightening. While I am not perfect I am still getting more and more just as time goes on. I do not do PT now, or even home exercises. All I do is live everyday. I am not walking 8 miles a day, or going to a gym, nothing. But I am still gaining ROM. Just want you to see that you don't have to go crazy with this. Jo did much the samething and is doing well too. This is not a weakened knee that needs to be strengthen, it is a injured knee that needs time to heal. Good luck to you!
 

hhilltop

senior
Joined
Feb 3, 2013
Messages
285
Age
66
Location
US
Gender
Female
Nanners, I copied you and made comment on my thread. I've been thinking along those lines and may soon give it a try, too. I'm 8 months post op.
 
OP
OP
Zoie

Zoie

new member
Joined
Apr 9, 2013
Messages
13
Age
71
Location
Los Gatos, California, US
Gender
Female
Country
United States United States
Has anyone either experienced or heard of an OS prescribing Medrol (Methylprednisolone) pills to reduce inflammation after TKR? I have some stubborn, lingering inflammation. I have asthma and have asthma attacks several times per year where I am prescribed high dose Medrol (24-32 mg/day).
Medrol, a steroid, is a very strong anti-inflammatory and one of the "side-effects" of taking this drug for my asthma is that every single pain I have in my body disappears! It's really great! In an effort to get rid of this pain and inflammation caused by problems (previously posted), I thought that maybe a 2-3 week course on Medrol could cause improvement? I've had cortizone shots directly into my knee which has done nothing so I was thinking maybe a systematic approach with pills would help improve things?
Before I go to my OS, just thought if anyone else had any experience with this, it would help as my OS is not very familiar with the use of steroid pills.
What do you think Josephine?
 

Josephine

NURSE DIRECTOR EMERITUS
Nurse Director
Joined
Jun 8, 2007
Messages
84,940
Age
78
Location
The North
Gender
Female
Country
United Kingdom United Kingdom
I think it's a ghastly idea for two reasons: it can cause avascular necrosis in the hip but more importantly you are only yet 10½ weeks and post-op pain at this time is still a fact of life. This is not the way to deal with it. If the swelling or inflammation is due to disease, all well and good, but your pain and inflammation is due to trauma which is only temporary and therefore needs to be allowed to run its course. The proper treatment is pain meds.

So what about your pain meds? What have you been prescribed? What are you taking currently (how much and how often?)
 
OP
OP
Zoie

Zoie

new member
Joined
Apr 9, 2013
Messages
13
Age
71
Location
Los Gatos, California, US
Gender
Female
Country
United States United States
For pain meds I am taking: Oxycodone 10-324 (with Acetaminophen), 1-2 pills every 4-6 hours and Oxycontin 20 mg. every 12 hours for "breakthrough" pain. My pain has not improved that much from right after surgery! However, this past weekend, I did feel it was longer in between pills - maybe just because I'm feeling so much better emotionally after finding support at Bonesmart! (Josephine). My worst pain is actually at night because I can't seem to find a comfortable position. When I wake up in the morning, I'm actually in so much pain that I find it hard to even move to take pain meds from my nightstand! I occasionally take Ambien (Zolpidem) at night, but I don't like the way it makes me feel in the morning - I feel like a Zombie for 2-3 hours!
 

Josephine

NURSE DIRECTOR EMERITUS
Nurse Director
Joined
Jun 8, 2007
Messages
84,940
Age
78
Location
The North
Gender
Female
Country
United Kingdom United Kingdom
Oxycodone 10-324 (with Acetaminophen), 1-2 pills every 4-6 hours. However, this past weekend, I did feel it was longer in between pills
So let me guess, you generally take 1 pill every 6 hours, yes?
My worst pain is actually at night because I can't seem to find a comfortable position. When I wake up in the morning, I'm actually in so much pain that I find it hard to even move to take pain meds from my night stand!
It's not about finding comfortable, it's about managing pain, so get that right and you shouldn't need to take any Ambien. Take 2 Oxycodone before you retire and 2 more 4 hours previous to that. Also set your alarm clock for 4 hours into the night and take one more pill or take the oxycontin. That way you shouldn't find yourself in such pain in the morning though you may still feel a little zonked! But this is good as it prevents you from being too active!!
 

maryo52

big-cheese
Joined
Dec 5, 2010
Messages
3,644
Age
68
Location
Maine
Gender
Female
Country
United States United States
Wow. That seems to be a lot of pain for this far into recovery. I feel bad for you.
 
OP
OP
Zoie

Zoie

new member
Joined
Apr 9, 2013
Messages
13
Age
71
Location
Los Gatos, California, US
Gender
Female
Country
United States United States
Josephine, hi - I tried your method the last two nights. I didn't take the Ambien and took two Oxycodone before bed and then at 2 am, I took one oxycontin and one oxycodone. That worked well and I wasn't in as much pain when I woke up in the morning around 7 am. Think I will trash the Ambien and just stick with the Oxycodone and Oxycontin. The pain level has rather dramatically improved in the last week during the day - probably because I've reduced my activity and am doing a lot more icing and resting!
 

maryo52

big-cheese
Joined
Dec 5, 2010
Messages
3,644
Age
68
Location
Maine
Gender
Female
Country
United States United States
Hey! Improvement! Very nice.

You oxycontin and oxycodone are the same drug. Oxycontin is time release. Why not take that at bedtime, maybe with one oxycodone, or even earlier? It has a 12-hour effect. What are your med instructions? I think the oxycontin is every 12 hours on a regular basis, then oxycodone in addition as needed. I don't know about you, but I had a hard time keeping everything straight when I was taking narcotics.
 
OP
OP
Zoie

Zoie

new member
Joined
Apr 9, 2013
Messages
13
Age
71
Location
Los Gatos, California, US
Gender
Female
Country
United States United States
maryo52, hi - yes the Oxycontin-20 mg. is a time release med which I take every 12 hours pretty continuously. I usually take the Oxycontin-20 mg. with my morning dose of Oxycodone and then before I go to bed at night (sometimes earlier). I find that the Oxycontin really does help quite a bit. I was on pain meds for about 6 mos. before the surgery (just Oxycodone but a lower dose at 5 mg). I really waited too long for the TKR because I knew that I had problems before and was afraid of the same problems re-occurring (as they did). I also think my body might be building up a tolerance to both Oxycodone/contin which I guess is pretty normal. I'm just starting to back off them a little because I'm resting more and the pain has improved. : - ))
 

Josephine

NURSE DIRECTOR EMERITUS
Nurse Director
Joined
Jun 8, 2007
Messages
84,940
Age
78
Location
The North
Gender
Female
Country
United Kingdom United Kingdom
Zoie, you don't need to quote a post to reply to it, especially when it's the post right before yours.
Just go on down to the bottom and start typing in the message box.
 
Status
Not open for further replies.

BoneSmart #1 Best Blog

Staff online

Forum statistics

Threads
50,600
Messages
1,368,664
BoneSmarties
31,764
Latest member
Little Bee
Recent bookmarks
0

Top Bottom