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TKR Second TKR - First had Arthrofibrosis

@skigirl, Dhare63,maryo52

Thanks for your replies and encouragement to pursue my "knee vacation." I wanted to know if you needed to have a revision when you had your scar tissue removed, or were they able to keep everything sterile enough that you could continue with your initial TKR pieces.

Yes, I have ROM, but still can't do stairs because it still feels like there's something in there and it hurts every step. I was doing strengthen exercises in the gym with the leg presses, but that was sidelined when my new PT said, let's be gentle with this knee.

I dread the thought of getting to my 1 year mark and finding there's still scar tissue that might need to be surgically removed. Would this then also require a revision?
 
The removal of scar tissue does not require a revision. I had a spacer exchange--the smaller spacer was allowing movement in the knee, which contributed to the adhesions. A spacer exchange is technically a "revision" but the femoral and tibal components were not replaced.

So, the scar tissue or adhesions can be removed with an "open" surgery which involves reopening your original tkr scar or with arthroscopic techniques with involve opening only a "keyhole" smaller opening in the knee. The latter is less traumatic to the knee and the recovery is quicker.

I always try not to imagine the worst case situations---find out what is causing your pain and then deal with that problem instead of worrying too much about the surgery you might have!!! There is plenty of time to worry after you find out what the problem is---but many problems can be solved with a more minor surgery than the original one. You can always make an appt earlier than one year to discuss the problem with your OS.
 
MUA's don't require anything regarding hardware, unless they decide to replace the spacer. The only time they remove hardware, is infection, loosening, and other problems in that line that involve the metal itself. I hope things get better for you!
 
Thank you. My reservation about taking a "knee vacation" has been that I might have regrets if the whatever is still causing pain was some scar tissue that might still need to be removed down the way. I just wanted to know if a revision might be needed in that scenario. Sounds like your answer is no. Now I can take my knee vacation without worrying about that. So again - thank you.

Last time I tried to get in to see my OS to talk with him about all the cracking noises at the prompting of my PCP it took 2 months to get in. They'll be scheduling me for my 1 year post op in 3 months. I think I'll just wait and see how it is doing then. Maybe with some added swimming, biking, good walks, and summer gardening - it will work itself into shape without needing another attempt to see my OS.

Had twin goats born this afternoon. Their mother is the ancient one of my girls. We hadn't planned to breed her, but somehow she had made other plans.
 
Hi Martha, ditto what Kelly said!

skigirl, how do you know exactly what I would say in reply....are we related some how!! Love it!

Congrats on the twins, sounds like fun! I was up in your neighborhood this afternoon in Northfield, it was a nice day to be on the road. Maybe you could post pics of the babies, that would be great!

Be well,

Dawn
 
Martha, I am glad to help you be relieved!! Summer is here and it is time to think of other things than knees--at least for a little while.

I had a goat when I was in college in Ann Arbor, MI. Her name was Natasha, we lived on a little farm. She kept the grass down for us.
 
I'm checking back in. I fear I need to come out of knee vacation. I've been weedwacking to put up electrical netting to confine the goats on a steep hillside, working in the garden, throwing hay bales around and swimming. My other knee has taken a dislike to all of the added activities. It doesn't like playing strong leg, for a weaker leg. I see my orthopedic surgeon for my one year post op visit tomorrow. I'm nervous about what he may tell me about my other knee. I'm still not doing well with stairs - some of this is due to the other leg, but my right leg's muscles are still weak. I've been put on a strengthening regime by my PT. How common is it to still not have mastered stairs by the one year out date?
skigirl
 
Hang in there Martha, I suspect that you may have overdone it.

I hope the OS has suggestions for you. I can imagine you are frustrated. Just know we are here for you.

Keep us posted,

Dawn
 
Most of my time at my one year post op was spent with my surgeon's intern. She went over my xrays with me, listened to my concerns and did leg evaluations. My OS really didn't have much to say to me, other than he didn't want to consider operating again and the xrays look good. He acknowledges it has been a rough recovery and says it is very likely to be a rough recovery for the other knee when it is time. He said if my body responds to surgery with aggressive scar tissue with one knee it will likely do the same with the other knee. In the meantime prolong the time before it is needed. The xray of the other knee doesn't show it to be of eminent concern, though I've had a lot of painful ordeals with it this summer. It does recover, with rest, though. We discussed various injection therapies and hoped for at least 5 years before the other knee needs anything - my OS said 15. That would be fabulous. It was encouraging to see the real differences in the xrays and to see that this isn't entirely unrealistic to hope for.

I'm up to 118 for ROM and somewhere between 0-5 for extension. After a long time hanging out at 105, it is good to see 118. I'd like to see 125, and maybe in time that will come. I'm still not doing well with stairs, largely because of unstability. My atrophied right leg muscles are still weak. My left leg muscles have been rebelling because of the extra workload I've been giving them weed whacking, moving electrical netting fences, throwing hay bales around, weeding gardens... So, I vary day to day. If I can give my sore muscles a break, I can be pretty good. If my muscles are rebelling, I have to haul myself upstairs and stabilize myself going down.

Does anyone have any reports to share about aggressive scar tissue issues repeating or not in a second surgery?
 
Your ROM is fine. So no worries there. Yes it will continue to increase. I went to a physiotherapist about my weak quad and he had me doing leg lifts with ankle weights (starting with small weight). Then he had me do an exercise with my leg lifted (plus ankle weight) where I bent my knee slightly (15 degrees), straightened, bent, straightened.

Martha, the scar tissue thing is not well understood and "experts" disagree on many aspects of this condition. My ortho told me one knee could scar horribly and the next knee have no problem at all. I do know that my next knee surgery will be with a highly skilled ortho because the more traumatic the surgery is, the more likely that scar tissue will form. It's a risk factor and not necessarily a cause.

You aren't really on knee-cation doing all that work, but then again at some point we have to say "good enough" and go on living. I'm betting things will continue to improve. At some point I decided to ignore the knee and put knee thoughts out of my mind. Hard to do when climbing stairs is difficult I suppose.
 
Thanks maryo52. It means a lot to have a prompt thoughtful reply. Yes, I've had a PT recommend leg lifts to me, too. I couldn't find the weights that are buried somewhere around here, so I was using my kryocuff wrapped around my ankle.

It's encouraging to hear that there's hope that I might not have to face another round of aggressive scar tissue issues. My OS is probably up there among the experts, but lightning struck twice. In addition to my aggressive scar tissue issues, he also did my husband's hip replacement that became infected and it had to be redone 2 years later. I told him up front - lightning doesn't strike twice. You are a good surgeon and I have confidence in your confidence, will you do my knee? So, he did. My knee looks great! The scar line is minimal, beautifully straight and I have made it through to a reasonable ROM, but I can't blame him for not wanting to risk another round of OR with either of us. His infection rate was meniscual. When it is time, I will look for an OS with experience with aggressive scar tissue and pray that I don't have to draw upon that experience.

You're right - knee cation - was really time to retreat from the doctors, PT's and outside voices. Time to get out and tend the garden.

Martha
 
Let me ask you this: is it hard for you to do stairs, or does climbing or descending stairs make your knee hurt or feel odd/stiff?

Because what happened in my case, having arthrofibrosis, is that the synovium is thickened, I have an effusion, and everything is a little fibrotic, so although I have good ROM, my knee feels reluctant to do stairs. It's constantly stiff. Just something I've learned to live with.

When I sought second opinions, one of them recommended I wear a brace because of the laxity I have (separate issue). I bought a hinged brace off the web and love it. It fits perfectly and I hardly notice it. What's amazing is that the sensations of wearing the brace mask my sensations of knee stiffness. I do everything throughout my days without thought, but at night before bed when I take my brace off, I tend to take stairs one at a time, or use my upper body more by pulling myself up the rail. I have come to the conclusion that most knee braces make our knees feel better by changing the sensory experience.

Might you experiment wearing a neoprene knee brace, if it's just the sensations that bother you, and see if that makes any different at all?
 
I took time to analyze last night. Yes, my knee feels stiff doing stairs always. There's a bit of stiffness even at rest, but it is ignorable. As I put weight on it going up it sort of goes from stiff to it hurts, too. It isn't a major hurt, but there is a flinch of pain. So, yes, I do have ROM, I can do it. It just doesn't feel comfortable.

How do you know about the synovium being thickened? Is that something that shows up on xrays? a scan? swelling? I still have a little swelling to my right knee.

Right now going downstairs, it is my left knee I most notice. That varies daily. With rest it can be fine. If I've overdone something, and I rarely know when I'm doing that, then I pay - sore muscles in my calf and foot usually - sometimes it is my shin and it has even been in my thigh. And, yes, sometimes below my knee cap. It varies daily. I have designed a chart to record things to help me notice patterns. I need to be more faithful using it. Charts have helped me before. I will get to it. I MUST.

I have a couple of knee braces around here - an old elastic one with a hole over the knee cap. It is from 30 years ago when I didn't weigh as much. I'll have to dig to find the other. Thanks for the suggestion.
 
The thickened synovium is part of the adhesion issue. A thickened synovium causes effusion (excess joint fluid), which is different than tissue swelling. I understand they can identify this using ultrasound, and certainly an arthroscopy can be diagnostic.

I don't know how this plays out for others. My ortho anticipated it would clear u but instead it became chronic. They call it "recurrent synovitis." My doctor actually did a fellowship at the Steadman Clinic in Colorado and adhesions is one of the issues they specialize in. He mentions that he's had two other patients whose adhesions were so aggressive they were left with ROM less than 90. So I consider myself lucky.

I underwent a repeat arthroscopy 2 years post-TKR hoping that would resolve the constant stiffness. I also begged my ortho to try an experimental intra-articular injection and he was willing but then probably started thinking about the liability issue. The arthroscopy gave me some relief but then things more or less went back to being stiff and so I finally accepted my situation 100%.

One thing I don't do is any exercise intended to improve my knee except I did do some quad strengthening this year and was able to make my TKR quad almost as big and strong as the left and I trust that with time it will continue to improve. I pretty much just let the knee do its thing. Fortunately, I rarely have pain in my TKR knee.
 
Hi, I haven't been posting for quite some time. I also have problems with aggressive adhesions (scarring). Today, I'm 8 months post and seem to be progressing as well as can be...... I still have not reached 120 flexion but I can pretty much do everything I need to do.

I think I will post my progress under my posting since I have not been posting for awhile.....

Take care everyone & have a blessed day!!!!!! :angel:
 
Well, I'm home after a real vacation. Lots of car travelling time between Florida and Vermont. You'd think my legs would thank me for such an extended time off of them. Not so. I'm not sure what's going on, but my good leg has become the bad leg.

It isn't the knee that hurts. It is usually in the calf. It hurt to lift that leg into the car. It took a bit once I stood up to have confidence to walk. Once I got going I was mostly all right for a few blocks. We tried to walk the boardwalk and even though I could pause, rest, even sit if I wanted to, there was a point that I ached in pain and had to quit and then limp. Can't do stairs up or down normally.

Oh, I really dread thoughts of another procedure anytime soon.
 
I went in yesterday and was able to rule out blood clot issues causing my left leg calf pain. My PT must be right. It is muscle issues and they can rebel to overdoing it as well as being still for a prolonged time while travelling, too. There's still some strangeness in what is going on. I also set up an appointment with a new ortho. Tanks for your concern maryo52. The nurse practitioner I saw yesterday thanks you, too.
 
I'm glad it was helpful. I hesitated. But I've seen some unfortunate things happen to people who ignored their calf pain.
 
Yes, I was glad to get it checked out and definitively rule it out. Again, thank you from both me and my hospital.

My other leg pain is all over the place with pain in the calf. Last 2 weeks have been mostly horrible despite minimal use. Though I had a 2 day reprieve, today I'm back to painful steps and I didn't do that much that was different. I've been using the heating pad when I can. I'm now scheduled to see an OS in about it in a month for a consultation about my other leg to try and get some answers to what's going on there. I have okay days and horrible ones where it hurts every step I take in the calf muscles, not the knee. Don't think injections will be able to help.
 
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