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TKR Second TKR - First had Arthrofibrosis

I can understand your reluctance to say this. Thank you for letting me know. I can also understand using a ramp if that's an option for you to carry on. I use the stairs too often in my house to be able to settle for this option.
 
@Ms.fixit , I've been searching for 15+ minutes to find the conversation I invited you to. You told me about the procedure someone you knew had that killed the nerve pain he'd been having. I'd really like to share it with my doctor. I hope you can copy and paste it to my thread where I can find it.

Thanks.
 
Hey Martha! I am now 2 yrs and 5 mos post surgery. I am doing well with my knee replacement. Its not perfect, but it is functional. Last June I had my bad knee (no surgery yet) injected and my ortho said my range had moved to 120 & 5 on the bend. I was quite pleased with that.

I still get stiff on occasion but from what I understand that is to be expected and normal.

I have one of my super good friends who has had both her knee's replaced. The first one was easy peezy for herm the second gave her permanent problems with her hamstring. So much so, she has retired now.

On the good news front for me, I was finally approved for disability in April 2014. Not sure if you remember, but I have Crohns Disease, Fibromyalgia and pretty significant arthritis. Not working anymore has really been a blessing for me. Hugs to you!
 
Bonnie's new title is @Never give up, keep trying, don't settle - that's me, Bonnie
 
Below is what I wrote to my doctor over the weekend.

I've had good ROM in my right knee for awhile. It was about a month ago now. I had been to the pool the day before and just felt like, oh, if I could only push from another angle, I know something in there will snap. I told my PT that - I also said - don't ask me how I know - it just feels that way - so.. she was working it and doing something that hurt and my hands were bouncing up and down to deflect the pain - and she told me she heard a snap. I didn't feel or hear anything, but from that day forward, I noticed great improvement in my ability to do stairs. I can now do it normally while holding on to a handrail, though there still is pain. It seems like there's still more to be "broken up" inside. However that one snap seems to have been crucial. So, much more often - not always, I can do stairs normally while holding the handrail.

She also tested the range of motion for my shoulder. We really haven't done much with it - mostly just checking in on it every once in awhile. I had continued to notice improvements at the pool. Tossing the ball further - even half the length of the pool. Reaching back and pulling on the noodle... And reaching things in the car - the radio controls, the seatbelt, the controls for the sunroof... And yes, I've been using the pitchfork a lot cleaning out the barn/barnyard. So yes, I'd been noticing improvement.

It came as a surprise to me, though when I could fully lift my arm directly in front to straight up overhead - without a cringing halt 2/3 of the way up. What was even more surprising was lifting my arm fully extended to the side - I went up 2/3 of the way there without balking. I think I stopped more in fear of pain than actually encountering pain. I've gotten it fully extended that direction, too, though there is a point where I pass through pain.

It definitely was not that strong when I saw Dr. Macy, an orthopedic surgeon specializing in shoulders, a month ago. Perhaps the two times I've had communion since then have had some impact??? (Note: about 10 years ago my very painful torn rotator cuff suddenly had a healing warmth cover it at the communion rail and that afternoon was the first in 2 months I'd lifted it over my head.)

Now my left knee - it has not appreciated the dig and twist motions of cleaning the barn. I've come in and had to elevate, ice, rest and take ibuprofen. Where before, I rarely heard from my left knee, now, I frequently have some pain there. I do hope to consider PRP in the left knee to deter another TKR.

As for my right knee - I decided the bicycling, step up routines, and ionto weren't really getting at the tight scar tissue issues. I opted to put my knee as often as I could reasonably arrange into long sustained stretches. I'd sit in a chair with my knee tucked back so it would create initially a gentle stretch and then leave it there for 15-20 minutes - when I was using cruise control, when I was sitting at a lecture, when I was sitting at my job... It would hurt by the time I pulled it out of the tension. I do this sometimes 2-3 x a day, others 2-3 x a week. That's been going on for about 4 months. I'd go to the pool and wrap a noodle around my ankle and pull up on it and hop around in the shallow area for 10-15 min. That is what led up to the snap described above. I still feel like there is more to be snapped, but it needs a different angle and I haven't figured out what that is, yet.

Bottom line - there can still be continued improvement for those with TKR approaching 3 years post op!! Let's snap that aggressive scar tissue and take back our abilities!!!
 
I am glad that the snap worked. I know that others have felt a piece of adhesion snap loose and have felt freer motion afterwards. Be careful though, keep those long stretches gentle on the knee.

However, I am really happy that things are looking up for you.
 
Good to hear you are still making progress, I hope you are able loosen the remaining tethered areas.
Thanks for the update, wishing you continued healing.
 
Hi Martha- great update, thank you for posting about your progress! At six months out my stair ability is still variable. It's comforting to know that my bend will improve with time.
 
I stretch on a daily basis---it is just part of the morning routine.
 
Hello Bonesmart friends,

It's that time, I guess. The left knee has waited 4 years at this point to follow suit on my right knee. I'm being told that the MRI I had this week says it is time, though I truly had hoped I might postpone this further with injections...

I'm writing to all of you who know about aggressive scar tissue/arthrofibrosis issues that a few of us at Bonesmart have encountered. I know Dr. Frank Noyes has written a book on this. I will attempt to contact him in Cincinnati and see if he has any orthopedic buddies that attempt to work on these issues.

I don't know that my second knee will respond in this fashion or not, but I'd like to consider finding a surgeon who is well experienced and prepared for what can happen and hopefully know something about telling my body not to slap on unneeeded scar tissue. I'd love for it to be New England based, near my home, but I have people I might stay with elsewhere, so please if you know of doctors with a solid reputation and good with this issue, please, please, tell me about them so I can consider if it is a good fit. Others at Bonesmart might find this a helpful resource, too.

I'll thank you in advance.
 
hhilltop,
Wise to seek someone familiar with arthrofibrosis, skigirl has a lot of information and give you some other helpful names of surgeons. You can download Dr Noyes book on Amazon.
Curious, have you been tested for metal and bone cement allergies?
Hoping this second TKR goes smoother for you,
 
@skigirl - can you advise hhilltop about arthrofibrosis, please?

Another person who has had some experience with it is @RunA42K
 
I just had a friend who had a stiff knee go through a replacement with a Smith and Nephew knee. When they tested the old prosthesis, they did a 14 day culture on it instead of a 7 day. They discovered that she had had an infection for five years. After treatment for that infection, ( six weeks of vancimycin) and with the new Oxinimimum knee she now has a rom of 120---her former rom was 65.Here is info on that infection:





Biomed Res Int. 2013;2013:804391. doi: 10.1155/2013/804391. Epub 2013 Nov 6.
Propionibacterium acnes: an underestimated pathogen in implant-associated infections.
Portillo ME1, Corvec S, Borens O, Trampuz A.
Author information

Abstract
The role of Propionibacterium acnes in acne and in a wide range of inflammatory diseases is well established. However, P. acnes is also responsible for infections involving implants. Prolonged aerobic and anaerobic agar cultures for 14 days and broth cultures increase the detection rate. In this paper, we review the pathogenic role of P. acnes in implant-associated infections such as prosthetic joints, cardiac devices, breast implants, intraocular lenses, neurosurgical devices, and spine implants. The management of severe infections caused by P. acnes involves a combination of antimicrobial and surgical treatment (often removal of the device). Intravenous penicillin G and ceftriaxone are the first choice for serious infections, with vancomycin and daptomycin as alternatives, and amoxicillin, rifampicin, clindamycin, tetracycline, and levofloxacin for oral treatment. Sonication of explanted prosthetic material improves the diagnosis of implant-associated infections. Molecular methods may further increase the sensitivity of P. acnes detection. Coating of implants with antimicrobial substances could avoid or limit colonization of the surface and thereby reduce the risk of biofilm formation during severe infections. Our understanding of the role of P. acnes in human diseases will likely continue to increase as new associations and pathogenic mechanisms are discovered.

PMID:

24308006

[PubMed - indexed for MEDLINE]
PMCID:

PMC3838805

I also have a list of docs who are specialists in arthrofibrosis: one of them, Dr. Gill works at Mass General in Boston. If he is too far, perhaps he can recommend someone. I try to keep the list updated, os if you find a new doc be sure to let me know and I will add it to the list. Kelly

Dr. Colin Eakin, Palo Alto Medical Foundation, California

Dr. Steadman, Steadman-Hawkins Clinic, Vail, Colorado

Dr. Peter Millet, Steadman Hawkins, Vail (as of 10/1/05)

Dr. Lonnie Paulos, Salt Lake City

Dr. Frank Noyes, Cincinnati Sports Clinic, Ohio

Dr. Wojitys, Ann Arbor, Michigan

Dr. Jason Folk Steadman-Hawkins Clinic of the Carolinas Greenville, SC

Dr. Shelbourne, Indianapolis, IN

Dr. Flandry, Hughston Clinic, Georgia, Alabama

Dr. Gill Boston Mass. General Hosptial and An asst. Prof at harvard

Dr. Tomas Sculo HSS

Dr. Answorth Allen HSS

Dr. Henry A Finn Weiss Memorial Hospital Chicago

Dr. Charles Bush-Joseph---Rush University Med Center.

Dr. Michael A. Terry Northwestern U Feinberg School of Medicine

Dr. Juan J. Rodrigo Baylor Schott and White Hilcrest Medical Center Waco, TX

Dr. Thomas N Lindenfeld Cincinnati Sportsmedicine and Orthopaedic Center

Dr. Friedrich Boettner HSS New York and the United Kingdom

Dr. Ajai Cadambi Texas Hip and Knee Center Forth Worth, TX






Dr. (Mr) Glyn Evans London Orthopedic clinic

Dr. Simon Tan St. Vincent's Sprotsmed Darlinghurst, Australia

Dr. Philipp Traut Bad Oeynhausen, Germany
s
If you google Frank Noyes, he has a series of articles on Adhesions. (scar tissue) . Also Peter Millet is one of the men who does not think you should have an open Lysis of adhesions. Steadman treats arthrofibrosis, but they will not treat it after a TKR

Also Dirk Kokmeyer, Pt wrote tutorials on Arthrofibrosis Rehab that I found really useful
 
@skigirl

I am looking again at your list. Decided I should revisit my page after checking in with @kneewords who is also wrestling with arthrofibrosis and contemplating an MUA after surgery in late July. You might leave her more information about Dirk Kokmeyer, Pt who wrote tutorials on Arthrofibrosis Rehab and I'll look them up, there, too. Does it include things for 4 years post op still having trouble with stairs?

I just looked up Dr. Thomas Gill at Mass General. I would like to know more about what you know of his work with AF and perhaps how you came up with the list that you have compiled.

My sister has been 3 weeks at Mass General and I've spent probably 2 weeks there with/for her since I am her closest relative and she was very seriously injured in an auto accident. I could have been looking Dr. Gill up one of those waiting room sessions. She is about to graduate to acute rehab to Spaulding-Cambridge, but I at least owe one more visit to the Trauma ICU unit with a big thank you goodie bag. They saved her life. Just asked her nurse if she knew of him, but she didn't. It is a HUGE facility - filling up a whole city block with 20+ floors to some of the buildings. It is a maze...

Might be worth me having an evaluation session with him. Hope you've enjoyed your summer.
 
@hhilltop
I have read a lot of your posts, my gosh you sure have been through a lot with your knee!
I too have had stiffness and delayed ROM. At 6 weeks, my ROM was only 90...OS recommended MUA, I balked and decided to forego it. I'm finally at 115/0 after 5 months out. I found I needed at least 110 to comfortably do steps and ride a bike. I didn't do anything special to increase my ROM except ride the ex bike everyday, leg raises and wall slides. I hope you find a good specialist for AF. All the best to you :console2:
 
I found Dr. Gill by googling medical articles on AF. He trained at Steadman---where there is a lot of research about AF. Steadman Clinic (which is in Vail, Colorado) does not treat post tkr. Whenever I read a post anywhere about AF, I look for doctor names and then I look up the doctor and his training. My husband is a doctor, so I have pretty good access to medical articles.

Martha, I know that you said you are allergic to nickel. I would only have a Smith and Nephew knee if I were allergic to nickel. Have you had metal allergy testing done? I think that will be critical for your second knee.
a
I know that @maryo52 had an arthroscopic removal of adhesions and she felt that it was well worth the trouble. I had an open lysis of adhesions (removal of adhesions) because my doc replaced my spacer.

I had pain for two or three days---the worst thing was the long recovery because my doctor stressed that when you are prone to adhesions if you exercise a hot, inflamed knee you cause more adhesions to form. So, in my case no PT until 4 weeks and then very gentle PT until after 8 weeks.
 
I've been away from BoneSmart for a few years - for better or for worse. I'm replying to a message that Pumpkin seems to have sent Stiff knee NC. It's getting close to ten years since my Right TKR put me through a maze of arthrofibrosis issues.
Bionickneegirl, brentsmith, skigirl, Celle, and Pumpkin

I've been getting PRP and ozone injections in my left knee trying to stave off another TKR, but my activity is being limited and the combination of covid and limited activity isn't boding well with trying to get weight off and keep my knee moving.

I've seen the list that Josephine submitted before retiring of arthrofibrosis doctors. I know the other knee doesn't need to be riddled with arthrofibrosis issues, too, but... it makes sense to me to go to a surgeon that does know the ins and outs, to better the chances of no repeats. Unfortunately, none of the doctors on the list are in the New England region.

I did a search on arthrofibrosis and your names surfaced. Have any of you had to have a second knee done after AF affected a prior TKR.

For those of you who are recent AF cases, my heart goes out to you. It's not a fun struggle. I started improving with a PT who said we are going to put you on a take it easy treatment, rather than a lot a hefty workout of stretches. I did get back a good ROM eventually, though not as soon as I'd like it to be. It is and has been my stronger knee for sometime.

Cheers.
 
Last edited by a moderator:
:welome: back!
@hhilltop,
Copied your most recent post to your thread, a copy remains in stiff knees thread.
The arthrofibrosis list was updated last year.
Arthrofibrosis: Names of US surgeons with experience in arthrofibrosis

You would like to change your thread title, just post it here and a moderator will change it for you.

Good to see you again,
Chris
 
Greetings.

I hope I can find and copy and paste what I just put into a report. In short for now.

I'm 5 days post op after my LTKR. I begged to stay overnight and was glad I did. The nerve block wore off, the stiffness, pain, and slow mo were part of the picture before I headed home. What a difference that night made and then having experts on hand to assist and prep me for home care...

It's been 10 years since the other one. I know I am moving about much more this time around. I still fear arthrofibrosis setting in. I hope most of you on Bone Smart skip right on past this without giving it passing thought. I do know those struggles and wish them on no one...

More later.

LTKR - March 7, 2023
 

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