TKR Suggestions needed for “tight band” feeling

[Stiff knee NC]

@judgar: you are so sweet to remember that today was my second opinion day!

A mixed bag. This doctor thinks I have a soft tissue/scar tissue problem (as compared to my doctor, who thinks it’s a nerve issue) based on my description of tightness and pain. Thinks it might be a bit too early for a bone scan (scheduled for next week and I will proceed w/it) but says it MAY show a greatly enhanced blood flow around the kneecap, which would be helpful to know. Other options he suggested: a one-time-only cortisone injection to see if it will help; the injection of novacaine to see if that will help temporarily...if it does, then proceed w/nerve block, which he said wasn’t a permanent fix.

If those things don’t help, then arthroscopic surgery to remove scar tissue (if that is deemed the problem) and, worse case, getting my kneecap replaced. Obviously I do NOT want the last option.
He was rather unimpressed w/my range of motion and “straightness,” calling it a functional range of motion.

My surgeon did not replace my kneecap
because it looked fine; this doctor said that arthritis could have affected it since my surgery 9 months ago.

Thought acupuncture was okay to try.

So will get bone scan and see what that shows.

Hope a moderator/forum advisor sees this and comments!

 

[NightQuilter]

Hi @Stiff knee NC - just found your thread. It sounds like you have had some challenges, most likely originating with that extreme early-on PT designed for an athlete, not someone who just had really invasive knee surgery. It can be so frustrating to feel like that tight band feeling isn't improving. At 7+ years, I still occasionally get that, but it is not severe and easily remedied with massaging it and movement and some deep stretches. But you're not there yet. A comment you made about it intrigued me - that the band feeling was from side to side, but also felt like it went under the knee cap. I have no medical training, but I recall after a fall on my right knee many years ago which ultimately required arthroscopic surgery - the issue was some little growths - essentially bone spurs or debris - had developed under the kneecap and were irritating the track the kneecap moves through at the base of the femur which needed to be roto-rooted out. I don't know if a bone scan would determine that, but if you get some relief from the cortisone injection, it might be worth just asking if there might just be some debris in under there irritating the nerves and tissues which is causing the pain. It is interesting too, that you noted when you laid off of exercise through January, the pain eased up, then flared up again in February, after you started building up your exercise program again. An arthroscopic procedure to clean off and out would be less invasive than a kneecap replacement. Your doc knows best and so glad you are seeing someone who is considering different possibilities! Wishing you well!!

 

[Stiff knee NC]

@NightQuilter: thanks for responding!

Actually my “tightness” goes side to side across the top of my kneecap AND up and down on the TOP of my kneecap. (Causing pain underneath the kneecap). But, interestingly, he did say that sometimes a piece of the kneecap/knee can come loose and cause problems. So what you mentioned is in line with that. Debris, as you mentioned. I really need to find out the problem but I sure don’t want kneecap surgery! Several things to try before that depressing idea so keeping ! Stay well and, again, thanks!!!

 

[NightQuilter]

Thanks for the clarification. I like that the OS is looking at options to be sure he finds the best diagnosis and solution for you.

 

[Stiff knee NC]

@NightQuilter: me, too!

 

[judgar]

Hi. What was your range of motion.and your straightness. Just curious, my motion isn’t real good but I can walk And get around.

 

[Stiff knee NC]

@judgar: I think it was 100 degrees (eyeballing it); when I had an appointment with my surgeon a few weeks ago, it was 115, using the tool that they measure it with. It couldn’t get really flat on the exam table yesterday either but he didn’t say what that measurement was. I wear my compression sock all day long and it’s been REALLY helpful. But by the end of the day, it’s so tight I can barely bend it. And I didn’t see the doctor until 5 pm.

 

[Stiff knee NC]

@judgar: clarification: by the end of the day my knee (NOT compression sock) is so tight I can barely bend it. So having a late afternoon appointment practically guaranteed that I wasn’t going to have an impressive ROM!

 

[judgar]

Why do you wear the compression sock? Does it help swelling or something? You were saying you cannot lay your leg flat to touch the bed . I have never been able to have the back of my leg to touch the bed or dr. Table. Even before my surgery. They tried to force it in p.t.. I told them never to do that again. Hope all is well

 

[Stiff knee NC]

@judgar: maybe one of the moderators/forum advisors can say from a medical viewpoint exactly WHY the compression sock helps but it has been a lifesaver!!! If you want I can give you the brand and the company I ordered it from. (it’s really important to get the right size! I ordered a 1 but it was way too tight...am now in a 5!). Have been very happy with it! Regarding “flatness,” I haven’t had very good luck with that either. And, like you, I had overly aggressive PT pretty early and had to put my foot down. We were both wary of each other after that but so be it! Have my bone scan on tues...will keep you updated! Is anything YOU’RE doing helping?? Please let me know. Take care!!

 

[Sara61]

@judgar usually compression stockings are placed prior to surgery- this is to stop blood clots, depending on each case and previous histories sometimes one is required to use for several months after ( which happened in my case as I had previously been operated on varicose veins )
Compression stockings can also relieve swelling but it is important to be measured for the correct tightness - your pharmacist or orthopaedic shop can best advise you.
Here in Portugal as we are a warm climate our stockings come with open toes ( for the use with flip flops) these are also easier to get on and off (with the use of a plastic bag) also here it was recommended for daytime use only again your physician will advise you on this xx

 

[Stiff knee NC]

@Sara61: Tks for comments! Had forgotten you were in Portugal...my youngest daughter was in Mallorca for 2 yrs, then did her first year of grad school in Grenada. I went over and visited her...so beautiful! How lucky you are to be in such a gorgeous area of the world!

 

[Sara61]

Yes it is a beautiful part of the world to live in I've been here neatly 40 years we live in the South, our climate is very similar to California. Mallorca & Granada are fabulous too, in the past we used to go to Sierra Nevada skiing.

 

[Summer2020]

@Stiff knee NC I’m sorry that you’re going through this, but at the same time I’m just a little excited to see someone going through something very similar to me.

I had a right TKR the middle of January. So I’m about 4 months out. I deal with stiffness every day! In the mornings I’m so stiff I can barely walk after getting out of bed. I still use a walker to get from my bed to the bathroom in the morning. Once I walk a bit it loosens up. At work, if I sit more than an hour, my knee is stiff and it hurts standing up and my first 10-15 steps. It’s so frustrating!!

also I have the tight thick rubber band feeling you describe. But mine goes around my kneecap like a donut. And my knee is tight behind my knee. I kept putting ice on it thinking it was swelling. I too had a very aggressive PT for 8-10 weeks after my surgery. I finally ended up quitting formal PT. When he put a 10 lb weight on my knee and then pushed down on it to try to get it straight and I was writhing in pain I knee it was time to stop.
These are the things I found that have helped that band to slowly go away. I started using a heating pad on my knee. I thought hey I might as well try if it makes it worse I’ll stop. It helped so much! I started to realize this was stiffness not swelling and the ice was making the stiffness worse. I use a peddle machine sitting on the side of my bed for 5 minutes before I even get out of bed. I walk half way around the block each night if I’m not hurting too bad. I think the heating pad might be getting blood circulating in the soft tissue. Up until a week ago my circle around my knee was down to just a quarter of a circle at the bottom outer part of the knee where the permanent numbness is. Now a week later, I’ve been really sick And sleeping a lot and not moving much and the tight rubber band feeling around my knee is almost all the way around my kneecap again! So disappointing. Shows I definitely need to keep moving but not too much. Finding that balance is so hard.
Hope you get some answers from your doctor. When I told my OS he wasn’t at all concerned. Said it was normal in the recovery and would eventually go away.

 

[Stiff knee NC]

@Summer2020: Tks for writing! The second opinion I had this week specifically said use ice, not heat! It just goes to show the many different schools of thought. I think you were smart to give it a shot.

Out of curiosity, did you get a new kneecap as well? That’s practically the first thing the second opinion dr pointed out (that I had my original kneecap).

I remember that stiff knee feeling after sitting for an hour or so. I expect that that will get much better for you in the coming months! And I expect you will be able to stand longer (I could only stand for one hour for months and months before that tight band would cause a lot of pain).

Did you ever use a CPM...Continuous Passive Motion machine...you strap your leg into it and it bends your knee (it’s electric). I did it for 6 hrs/DAY for 1 1/2 months! I don’t know if you could do it now...but I noticed my tight band feeling started when I maxed out on the machine and didn’t use it any more.

You probably saw that I really advocate for a compression sock (kind of an elastic knee brace thing). I wear it all day but not sleeping. I have a pretty basic pedal thing too... I don’t use it as regularly as I should. It doesn’t hurt but really don’t think it helps! I haven’t done ANY exercises in 2 months. I also “taped” my knee with Rocktape and it helped, but not as much as the compression sock. I also had 5 “therapeutic massages” w/cupping...not sure it helped too much...but it relaxed me so that is a good thing! Tried a prescription gel and a “muscle stick“... thought they were useless. Have also tried Celebrex, prednisone and Lyrica...they did not help.

I’ve been saying for 9 months that this “tight band” feeling (mine’s abt a 180 from the “numb” side to the other side, on top) can not possibly be normal and typical...no one would EVER get this surgery. Tellingly, when I asked my second opinion dr this week if he’d had any patients with my problem during his 30-yr career, he could think of just...one!

I hope you’re feeling better and can move around more comfortably. Like you, I appreciate hearing from others who are experiencing this.

You probably saw that I have a bone scan on Tuesday. Kind of holding my breath...I want to find out what is causing this but I don’t it to be something that requires surgery!

I’ll post an update. In the meantime, if you find something that helps, I’d love to hear about it. Take care and thanks, again, for taking the time to write!

 

[Tykey]

Ice or heat? Good question.

According to theory, you should always use ice to reduce swelling. If we use heat, we increase blood flow and hence increase swelling.
If we want to improve healing, we use heat because increased blood flow improves the rate of healing.

This is a complicated issue, because is the tight band caused by swelling or by the need to heal? Or both? Or neither?

My personal take on it is that if it lasts for months and months, its scar tissue, so neither heat nor ice will make any difference. Mine is gradually disappearing as my body adjusts and stretches/mends the tissue.

I told you it was a good question, didn't I!

A British saying is "you pays your money, and you takes your choice"

 

[Summer2020]

@Stiff knee NC i am pretty sure I got a new kneecap. But my OS never specifically said. He did say that he would be replacing everything so that might mean knee cap too. I guess I just assumed they would replace it. I didn’t know that sometimes they don’t.

what I do know is my biggest problem was with my patella. The OS said the cartilage behind my kneecap was completely gone he said. I was also told that my knee is shaped different. That my knee caps are way too high and that after the replacement I would need to learn how to walk with that new knee because it will feel different than the other one. I can definitely say that my knee caps are different shapes and positioned differently. The TKR knee the kneecap is a bit lower.

I never used the motion machine. I was told by my PT that every doctor is different and that my doctor believed in getting moving right away and keep moving. They had me take my first steps out of bed the afternoon of my surgery. (Surgery was at 7 am, out of bed by 4pm). They wanted to try even sooner but I had terrible nausea with the anesthesia which is a norm for me

it was actually my PT that suggested to try heat. I Was having a hard time getting my extension to zero and I kept telling him it was really pulling on the back of my knee and I felt that was part of the reason I couldn’t straighten all the way. He thought maybe my muscles were tight back there and suggested I put heat on the back crease of my knee. It helped a lot! Within a week I had full extension to Zero. That’s what made me think to try the heat on the top of the knee for this tight band feeling.

I honestly don’t think it’s scar tissue. At first I thought it might be but now that I almost had it gone and now since I’ve been in bed a lot sleeping it has come back. I really think it has to do with the tissue and muscles. Scar tissue I wouldn’t think would go and come back like that.

I’m thinking moderate exercise or at least keeping that knee moving is the key. But nothing strenuous to bring swelling back.

it will be interesting to see what your bone scan says. I’ll be eagerly waiting. I hope too that it doesn’t require surgery.

 

[Stiff knee NC]

@Tykey: Ah you succinctly nailed it! To further this debate, my doctor early on suggested alternating between heat and cold!

My husband (an athlete) has been pestering me for months to use heat; even bought me a fancy wrap -around heating pad. I tried it and it didn’t do much. Maybe I need to drag it out again!

I see you had surgery 11 years ago...did you have “tight band” issues then that are still bothering you? Did/does stretching help?

Did your doctor determine it was scar tissue (and, if so, HOW?). My second opinion doctor said arthroscopic surgery could remove some scar tissue. Did you ever consider that? I sure don’t want any more surgery, but being scoped is SO much easier than TKR.

Thank you for answering my questions and taking the time to write! I always get excited when I see you’ve responded

 

[Tykey]

I've still got a little bit of a tight band remaining on my 11 year old knee, and a moderate amount on my 9 month old knee. I've no idea what causes it, but a clue might be that it seems worse when the swelling is worse, especially after I kneel down.
Of course I can't compare mine with your problem, which might be a lot worse.
My normal approach to things is to ignore them, and they feel better.
But I also resort to eating jam roly poly and custard, which might not improve it, but it cheers me up no end.

 

[Stiff knee NC]

@Tykey: jam roly poly and custard??? Have no idea what it is but it sounds sweet and yummy and I’ll need a spoon to dig in!