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TKR Second TKR - First had Arthrofibrosis

I know that fear of arthrofibrosis. I had it big time for my first TKR. I came out of it believing that, personally, less PT is better. Let me explain.

I had to have arthroscopic removal of scar tissue because although the MUA worked, in 2-3 days I was losing ROM. Even after the removal of scar tissue (they found a 1/4" band that was tethering the quad muscle) it was a month before I got past 90 degrees. Eventually I got to 110/120. Fast forward eight years and I had revision for aseptic loosening. I was terrified of arthrofibrosis. But after the revision I had about 1/10th the pain I had during the original TKA. I needed just 1/2 tablet of oxycodone in the evening for two weeks. PT wise I would do quad sets and I would bend my knee once in the morning and once in the evening slowly and gently only to the point of tightness. I gained ROM slowly and was all good. I had to have another revision due to infection and applied the same technique and again did very well. My PT mainly massaged the knee during the 2-3 times I saw her. Also, the difference was I took Aleve twice a day during the 2nd and 3rd surgeries but not the first due to being on blood thinners. I find that NSAIDs help greatly with pain. So that's my 2 cents worth as someone who got past arthrofibrosis but I'll never forget how aggressive and frightening dealing with arthrofibrosis over a six month period after my first TKA.
 
Welcome back @hhilltop,

If you would like to update the title to your thread, let us know and a moderator will change it for you.

Wishing you an uneventful recovery, glad you insisted on staying the night for the additional care you needed.
Slow but sure to let your knee heal.

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
​
rest​
ice​
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
​
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these
​

5. At week 4 and after you should follow this
​

6. Access these pages on the website
​


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 
Hello again, Pumpkin.

I'm now 2 weeks out from my left TKR. I'm nervous - I'm not making much ROM progress - stuck at about 75 for the past week. My PT pushed hard to get it to 75 an improvement from 70 the week before when she didn't push. I'm supposed to see 90 within 2 weeks, but I have a hard time seeing how that will happen. It's like a brick wall that doesn't want to budge.

I did try pushing it by hanging out at the stretching limits. Ohhhh that led to a restless day. Yet my PT says that's what is needed.

My TENS equipment from 10 years ago gave out so I ordered a new one - vague directions - but I'm presently giving it my first 20 min. massage. My doctor said if I wanted to use it, go ahead.

My Stiff Leg Doesn't Like Stairs - probably should change - maybe Second TKR - First had AF
 
@hhilltop Please do not let anyone force your knee. ROM will come with time and patience. Forcing only results in more swelling and more limits to increasing ROM.
hhilltop said:
I'm supposed to see 90 within 2 weeks
Click to expand...
Says who? There are no milestones for ROM. It will happen when that knee is ready.

Here's an article from our Library on TENs that might be of interest. TENS machines for pain management
 
Jaycey,

I think we met up in my first round, too. Thank you for the TENS article. I will revisit it for details next time I use it. Is Josephine still active or was her article in the archives. I remember her from the first round, too.

Eden Teddy.jpg
 
Yes, I have been on BoneSmart many years now! Josephine retired just before the first lockdown. But her legacy lives on in the form of so much information she contributed here.
 
hhilltop said:
My PT pushed hard to get it to 75 an improvement from 70 the week before when she didn't push. I'm supposed to see 90 within 2 weeks
Click to expand...
All that pushing can cause inflammation, given your history, can lead to arthrofibrosis.

Here is a gentle flexion activity you can to to promote ROM,
Heel slides and how to do them
When you have a gentle stretch, hold it there for awhile, 1 to 2 minutes. Discomfort is OK, pain should be avoided.

90 degrees in two weeks seems unrealistic to me, given your history. Take it slow but sure, letting your knee heal, swelling will go down and your ROM can start to emerge.

My surgeon was in no rush for 90 degrees, if you got there at 3 months that was OK.
 
I had stiff knee -- stuck at 85 degrees and never gained one degree past that. After successful MUA, within days my ROM went back to 85. PT pushing gained nothing but it did cause me a great deal of pain. Finally the scar tissue was removed arthroscopically, but even then it was another 3-4 weeks before I passed 90. That final stretch I did NOT go to PT. I did my own gentle stretching -- a sustained (30-60 seconds) bend to the point of pressure and not pain. I did five in the morning and five in the evening. Just sharing what worked for me. And BTW that knee got revised and I got nickel-free components because I did a lab test at Orthopedic Analysis that found I had nickel allergy (an internal form that is different from dermatologic allergy). I had NO scarring with the second knee surgery and about 1/10th of the pain.
 
Thank you Jacey, Pumpkin and Maryo,

I've been questioning things about the exercise routines. The PT said I had to push past the pain - no pain no gain. I tried the next day to push and hold the limits myself. Oh, did I pay for it - I could hardly move my knee the next day. It seemed like I had no chance - I was looking into the face of arthrofibrosis again.

Fortunately, my PT was told by the surgeon - do not push. And I decided I should try more gentle stretching and holding the limits. I'm doing better - not great - but maybe I can gently push the limits further. I'll be very surprised if I can reach 90 in 2 weeks, but at least my head and heart are in a better place.

I tried the TENS equipment that came the other day - I can't say I noticed any difference.

I am starting to get cabin fever, so we did get to a doctor's appointment about 30 min. from here and then used a wheelchair to do a bit of shopping. By the time I got home I was pretty worn out.

I did a little walk and work on the outside back porch - felt good to breathe fresh air and see our animals out back - bunnies and goats.

The links to Josephine's articles about gentle stretching was so affirming and gives me hope for going forward.

I don't remember 10 years ago what I was or wasn't able to do, but I do think I can twist and turn my knee better than before and there's no cracking sounds.

Thanks for touching in.
 
Think or ROM this way: what if you gained one degree a day? Or one degree every other day? Set your sights low (and BTW "past the pain" is in IMO an ER visit!!). One degree a day is 15 degrees in two weeks. There are those among us who are slow gainers. My second TKA surgery (a revision), I remember the home visit PT giving me this look because I refused certain exercises, and then various verbal warnings which prompted me to call the agency and cancel the PT service. What I'm saying is that it's very hard to stand up to our hired professionals, and I realized then that I could not comfortably do things my way (slow, no pain) I'd have to get rid of that critical voice. Best of luck. But please keep in mind it will be slow. Your tissues are super inflamed now and will need calming down to move forward. Are you able to take NSAIDs? If so and you're not taking, I'd highly recommend it.
 
Hi there :wave:
Happy One Month Anniversary. Glad you're feeling hopeful.
Best wishes with your recovery!
@hhilltop
 
Well I sat at a ROM of 75 pretty much since I got home from surgery until last week it was 83 and then last Thursday is was 90.

Weather has been inticing me and I tried to go on a walk on sidewalks around the silent college campus. I'm paying for it today with a very stiff knee. Hope it stretches back.

Any comments - should I let it rest, or should I go through my workout routines?

I see the surgeon on Wed. I'd like permission to drive and get in the pool for exercise.

Does anyone know of a good resource for PT pool exercises?
 
Continuing trying to work through an angry knee is counterproductive. Ice and elevate to keep the swelling under control. Still very early days for you.

Please be very careful doing any pool exercise. It is very easy to over do when you are weightless. Do ask your surgeon's permission to get into a pool. The surgical wound needs to be totally healed.
 
Happy Two Month Anniversary!
I hope your visit with the surgeon went well.
Have a great week! @hhilltop
 
I see my surgeon at my 3 month date. Two weeks ago I hit 102 flexion, but something happened last week and I've lost some of that.

I'm out and about doing farm jobs - two new goat kids - probably a dozen new bunnies(they free range and free loading. I'm getting about putting up fences and prepping to build a greenhouse. A steep hill incline for the fencing is what made my knee angry, swell, and regress.

Today's PT was 97 flexion. I'm doing what I need to on the outside work and that is important to me. Last time with the other knee 10 years ago, it took 6-7 months with my arthrofibrosis issues to be at this point. So it is what it is, and I live with it, stretch and challenge it, and look forward to having greater ROM without so much challenge and pain.

I'm doing much better with sleep than I was a month ago. I've decided I should use the knee brace at night. It is nice to get to sleep back on my stomach, but I need to reign in my bent knee pattern. I'm playing with the knee braces - one soft, one solid. The soft one is easier to sleep with it on. I'm incline to see if an 8" wide ace bandage would also work.

I am so glad to not be repeating my arthrofibrosis issues I had with my right knee ten years ago. It's no piece of cake, but I am getting about and doing most of what I want to do.

Hoping someone who had arthrofibrosis issue can be encouraged to know the second round doesn't have to be a repeat performance.
 
As you heal it is perfectly normal for your ROM to fluctuate. Swelling will cause that, not an unfit knee. It's great that you are doing as much as you're doing, but you will see swelling because of your activities. You can ice and elevate whenever you can sit or lay down, and it will help with the swelling.
 
Happy Three Month Anniversary!
Best Wishes for your three month post op.
I hope you have a nice rest of the week!
@hhilltop
 
So I'm now at 5 months and I'm still struggling to get up. I do alright once I'm up, though I still feel every step. How normal/abnormal is this?

I'm willing to shrug and say - it is what it is and plod along as my first knee did this, too. Then they refused to consider surgery to remove arthrofibrosis scar tissue until a full year was up. That knee needed an MUA at 2 months. By that time I was doing enough better that it made no sense to consider a second round of surgery.

Should I be more concerned than I am?
 
Hi, I too had arthrofibrosis on the first knee. It never got past 85 and at some point the ROM declined. The MUA failed and so I had arthoscopic removal of the scar tissue, and still it took 3 weeks to get to 90 degrees (with me doing tno more than 5 slow slow gentle gentle bends twice a day).

What can happen with a troubled knee is what's called "arthrogenic muscle inhibition." I had that. The body registers "knee in trouble" and spares the quad, which results in the quad becoming weak. In other words it's a matter of weak nerve impulses to the quad to do its share of the work. I still am careful to keep stimulating my quad. Initially I did straight leg raises and quad sets. Also bicycling either stationary or otherwise.

What is your ROM now?

PS After nine years my components came loose and I had a revision, and for that I chose the top surgeon at Mass General. No problem with arthrofibrosis although I can tell there's a bit of scar tissues in the knee which I don't worry about.
 
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