TKR Second TKR - First had Arthrofibrosis

[maryo52]

I used Andrew Freiberg. He's at Newton Wellesley now. I found out the hard way he's not the surgeon to pepper with questions. I returned to him in 2021 with an artificial knee infection. I had what's called a DAIR procedure. Basically they powerwash the inside of the knee with antibiotics, put in a new spacer, and then it's 6 weeks of intravenous antibiotics and a year of oral. I recently went back for a two year followup with Freiberg and the ID doc. They have taken great care of me.

 

[WFD]

Thanks, @maryo52 .

 

[hhilltop]

I live in Vermont, and considered Mass General in Boston, where my sister lives, but went instead to an orthopedic who dealt successfully with another BoneSmart patient in Lebanon, NH, who contended with arthrofibrosis ten years ago.

I haven't had my ROM tested recently. A month ago it was 103 and 3. My guess is I'm about 115ish in flexion and 2ish in extension. I turn sideways and do stairs one at a time.

 

[hhilltop]

I've been going to an osteopathic for the past few years. He actually talked to me, explained procedures, and made documentation available to me.

It is a shock to my system to be back in the orthopedic world where the doctors say as little as possible, seem in a rush, and want to keep it all upbeat.

 

[hhilltop]

So here I am 5 mo Post op on my second TKR. I can make my knee do what I need it to do except stairs better than one at a time. I still feel like I have a tight band about 3-4 inches above my knee. Am I alone or there others still complaining about why I can't forget being reminded that I had a TKR every day?

What recommendations does anyone have for winning exercises???

 

[sistersinhim]

At 5 months you aren't even halfway through the normal healing process. The stiffness you are feeling is inside swelling. There isn't a lot of space inside that knee capsule and a little bit of fluid will make it feel tight. You can not exercise that out. What you can do though, is to ice and elevate more. The ice will help to reduce the inflammation, your cause of fluid, and your elevation will help to flush it out.

 

[hhilltop]

Thanks for the comment. My first TKR was off the charts NOT normal. I really don't know what to expect of my second knee. I really felt I was lagging - good to know I'm not. Also good to know I gained 8 degrees in my ROM this past week after revisiting the PT.

My PT did a major round with a cupping device that I'd never seen before. I really hurt the next day, like I hurt now after another round today. She said it gets down below the surface layers and helps move things around. She also had me doing some leg lifts and going up and down a stair. I warned her, I'm not good about doing a long series of exercises. I did do those two things 10+ times daily along with my own methods - like trying to bend to get my knee up on the top of the footrest on the lazy boy, rubbing the tight rubber band feeling at the top of my incision...

I do agree - I should consider doing some icing more often. I do elevate it to recliner height a fair amount. Thanks for checking in on me.

 

[Jockette]

In addition to swelling you still have, the tight band feeling is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue has been disturbed and is healing...and full healing takes a full year or more.

 

[Layla]

What recommendations does anyone have for winning exercises???

The Activity's of Daily Living will work. Kill two birds with one stone. Complete what you need to accomplish in a day and exercise your knee at the same time.
As sistersinhim advised, continue icing and elevating, it’s not too far into the healing process to obtain relief from discomfort and swelling through this practice.

While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. Give it time.

A wonderful weekend to you!

 

[hhilltop]

Well the last PT I had used a cupping device in a tight band at the top of my incision. It was fine in the process, but my goodness it hurt that night. I felt like I was back in my first month of recovery that night. No position was comfortable enough to fall asleep. That lasted a couple of days. I did extra step exercises that week along with leg lifts. Nothing that hard or long - first or last thing at night and when I went up the stairs. The combination was an added 7 degrees ROM in one week.

There was a second round of cupping along with some heavy stretching bending my knee as much as possible for a long 3 ish minutes. That was followed by walking over a series of rungs on the floor that I wanted to swing my leg over rather than lifting my leg up and over and I needed walking sticks for stability. OH my, my leg hurt immediately after that workout and continued to hurt for 3 ish days - and nights.

I didn't want another round before I traveled and would need to navigate long airport walks to the gates... so I cancelled the last appointment before our travels.

Since returning from our travels. I have been daily busy working on a DIY home construction project.

So we all were surprised at my next orthopedic appointment this week when my ROM had again jumped to 120. The surgeon was ready to run a victory lap. I still have some pretty serious - oh it hurts after a day with a lot of walking, or standing... He says it can take the muscles time to catch up to what the joint is capable of doing.

So, time will tell whether I'll ask the PT for more help, or just continue plugging away on my DIY construction project. Honestly with it, I don't have time for daily exercise routines and weather changes require my dedicated efforts.

The cupping treatment wasn't fun, but it sure seemed to help!!! and was very worth a couple of bad sleep nights, given I'm retired and can sleep in as needed.

 

[maryo52]

Wow, my hat's off to you. You are one tough lady. I would not have gone along with all that but hey, we're all different, and what works is what works.

 

[hhilltop]

Good to hear from you again Maryo52. I'll let you know if I go back, or maybe just pick up my swimming routines once my construction project is done - hopefully another week, maybe two.

 

[WFD]

@maryo52 , whatever happened with the Anakinra injections you considered so many years ago? What conclusions did you draw and what did your doctors think about it?

Dealing with my own arthrofibrosis and searching for potential treatments.

Thanks.

 

[hhilltop]

I didn't try Anakinra injections, though I'm interested in hearing about them. I did get PRP platelet rich plasma and ozone injections for 8 years. It did keep me going, but the bottom line - I got tired of constantly limping and bit the bullet to come back for a second TKR despite deep fears about an arthrofibrosis rerun. I beat arthrofibrosis, this time, but I'm having to make up for 8 years of muscles that were trained to limp. I'm told I'm only half way through recovery with this knee. I make it do what I need it to do, but I still have spells where it doesn't want to bend much at all after I've moved 50 bales of hay...
@maryo52

 

[dotski]

Thank you for sharing your story. They are so helpful to read and learn from. Lifting 50 bales of hay? Wow! I grew up on a farm and spent summers haying but I can’t imagine it now. That must be so good for your bone health. You are amazing! I hope recovery continues to progress and the day soon comes where you can forget the knee.

 

[hhilltop]

So the cupping experience definitely helped break adhered tissues at the top of the scar. My PT says that is common. However, it has taken me a bit to get back to feeling "normal." I won't go into all of it, but I've bowed off any additional cupping treatment for the foreseeable future. I did 3 treatments - two in August and one in the side of my knee - that one really through me into a painful tizzy. It may just be my body. I have reached 3/120 ROM. But it is still quite painful doing stairs - almost always going down. Sometimes I can go upstairs pretty freely.

So I'm wanting to know - anything routines to recommend? Is doing stairs and getting up from a chair the only routines that can get to the muscles around the IT Band?

I feel fine as I play water volleyball with beach balls. It is mostly treading in deep water with a life belt on helping with buoyancy. I feel fine playing, but a bit whipped out the next day - more a brain drain than anything in my knee.

I can walk, do arduous farm chores... but I don't do getting up very well, or stairs.

I'm 8 months post op. How common is it to still be struggling like this? 4+

BTW - I was asked to comment on someone who is considering LOA in S. California. I can't find it to post a reply. However, since I didn't have an LOA on my first knee, though I did consider it, I felt I was not the best to comment - other than to say, I was told to wait until the 12 month mark before I decided. By that time, I was doing well enough that the LOA wasn't reasonable.

I suppose this is what keeps me from wondering about LOA on this second knee. I am better than I was at this stage with my first knee.

 

[Pumpkin]

Hi @hhilltop
Since you are doing well, allowing your knee to continue to heal in this year+ recovery may give you a smoother recovery. Your ROM is great and may well improve over time as the soft tissue remodels. I would give it a year before considering a LOA.
It took me well over a year to recover from my revision, it takes time and patience.

Is doing stairs and getting up from a chair the only routines that can get to the muscles around the IT Band?

Swimming, cycling, standing ex with leg out to the side can help with the muscles around the IT band. Be sure to stretch after exercising.

 

[maryo52]

I too had arthrofibrosis the first time. When I had a revision on that knee I was so so worried of having it again. But I didn't. I held onto my Bonesmart-given faith that my knee would get ROM and it did, but more slowly than others.

You have perfectly fine ROM. Think about what those tissues have been through. If you're having pain that is the tissues way of saying "Enough!" Why not give that knee nothing but TLC, some gentle massage, soaks in the tub, ice packs,etc.?

 

[hhilltop]

Thanks for the prompt reply, Pumpkin.

You said - Swimming, cycling, standing ex with leg out to the side can help with the muscles around the IT band. Be sure to stretch after exercising.

Sorry, please explain - "standing ex" - is that standing for an extended time?

What does stretching look like after the exercises?

Also is there a way I can find the post from the person in S. CA that was contemplating LOA and wondered about waiting versus a lesser experienced doctor? When I went to write my reply, I couldn't find it.

 

[hhilltop]

My PT says I should be giving my knee more focused attention. Honestly, I haven't had time to do that. I've been building a greenhouse and it has taken my time and energy, but truly has been a great exercise arena akin to a gym. Since the greenhouse is finished for now, I've been considering the more focused attention - thus the swimming and wondering if I need to concede and do the repetitive exercise routines, that I do not like doing.

I have some wiggling, twisting, and move in any and all direction spells while sitting every so often, though I hardly consider it exercise; maybe I should. It definitely is focused attention on knee movements.

Good to hear from you. Maryo52 and Pumpkin, I think both of you were part of my recovering coaching team 10 years ago, too. Thanks again.