TKR Suggestions needed for “tight band” feeling

[Jamie]

I think you and your doctor’s approach to the situation is the way to go. Your knee has been through so much, it’s going to take a while for things to normalize in whatever is going to be your new “normal.” It may be better than you think in terms of result. But, because you’ve been through so much, it may take a lot longer than you expect to reach that “normal” point. I’m glad you’re willing to give your knee some time. I don’t think you’ll regret this decision.

 

[Vida]

Faced with the same potential scar tissue/adhesion removal at 12 months, if swelling was sufficiently reduced, I started religiously riding the stationary bike without tension up to an hour a day. It worked and has gradually loosened things up. The last thing I wanted was more arthroscopic surgery….I imagine you feel the same way. Wishing you all the best.

 

[Stiff knee NC]

@Moka: did you see my response? After 3 yrs I STILL don’t understand putting responses on MY thread (using the @ sign). Hope you had a good appt. I’d like to “follow” you but have no idea how to do that.

 

[Jamie]

@Stiff knee NC .... to follow someone you click on their username in their profile box and then click on the "Follow" link.

 

[Stiff knee NC]

@Jamie: THANKS!

 

[Stiff knee NC]

@Jamie: Wondering if you could weigh in…. The good news is, I am doing 30 mins on the bike at a good clip, followed by 20 mins on the treadmill, 3-4 x/week. It does NOT hurt at all while I’m exercising!

The bad news is that, after that 50 mins of exercising, I experience increased tightness/stiffness and pain for the rest of the day and into the next day. (I still have tightness all day, from when I get up until bedtime. Exercising makes it worse.)

I think it is scar tissue, just like before. (My OS found a LOT of scar tissue during my revision last April.)

Are you aware of any non-surgical ways to remove scar tissue? Sound waves (like breaking up kidney stones), injections, or those electronic hand-held muscle things? I’m trying really hard to exercise to lose weight and help my knee….but the increased tightness is so frustrating to deal with. I’m open to anything!

Thanks in advance! Btw my OS says he can go in orthroscopically after a yr to remove scar tissue (I mentioned this in a previous post). I’d like to try non-surgical options…and I read something somewhere about sound waves. I can’t be the only one who has aggravating scar tissue in there. What can be done for us?

 

[Jamie]

I wish I had better news for you, but if you have (or tend to develop) adhesions following surgery, there are no non-surgical treatments available that I know of to make them go away. When they are bad enough, a lysis of the adhesions can be performed where the scar tissue is surgically removed like your surgeon suggested. It needs to be done by a VERY knowledgeable surgeon and, even then, the result is "iffy." Many times the scar tissue just returns. If you do agree to this with your surgeon, make sure he's done a bunch of these procedures and, once it's done, don't do a lot of aggressive therapy afterwards. It's important to keep the tissue from becoming inflamed, as that dries it out and tends to create an excellent environment to more adhesions.

I know it must seem like you should be able to do this level of exercise at almost a year out. But for many people it can take a long time (like years) for swelling like this to stop occurring. Don't be in a rush to do a lysis procedure.

I did see some information out there about sound wave therapy for abdominal adhesions, but I'm not sure that type of treatment applies to joints. I've not read anything about it at all and saw no studies.

Doing 50 minutes of exercise is quite a bit. You really only need 30 minutes a day (150 minues a week) for your cardio health. What if you either reduced the time spent or split it into multiple sessions? You might give that a try. Exercise is important when you're trying to lose weight. But it's not the only important thing - and many believe it's not the main way to take off pounds. You need to control your diet as well. I've been on the Noom program for almost a year and have lost 25 pounds without any starvation dieting. The program focuses on the "why" behind your eating habits and not the particular foods you eat (although there are some daily caloric recommendations). You might check into that. I have found that my metabolism won't allow me to lose any weight if I eat more than about 1200 calories per day. I find that very difficult because I love to cook and enjoy some of the more calorie dense foods. This is my challenge - to cut down on foods in that category. I'm still working on it....lifelong habits are hard to break.

One other thing with exercise and weight loss....you need to incorporate weight training along with the cardio. I suggest you find a group physical fitness class to help you learn how to do that.

Good luck.....it's hard to lose weight and it takes time. Those pounds didn't come on overnight and they won't go away quickly.

 

[ScottieW]

That routine is too much! I had the same issue, all those squats and presses were killing my knee from recovery, at week 11 I took over, rest between workouts, no more squats except from a chair, spread out over the week, stationary bike 30” 5 days a week, and medium walks (2,000 steps). TRX to the ground! ouch! your quads are strong enough! Donkt kill yourself, all that work you did will fall into place if you back off the accelerator, alot

 

[Jamie]

@Stiff knee NC You've been on my mind, and I have another suggestion as an alternative for the treadmill/bike routine. Stick with the 30 minutes per day on one or the other (not both) and look into either yoga or tai chi. Weight training is still advisable, but you have to find something you will stick with.

 

[EalingGran]

I can really recommend pilates.
My teacher is excellent and she has a large range of free classes on YouTube.
I regularly do her 20 minute glute strengthing class. It is mainly lying on floor with no squats and specifically ok after knee injury/ surgery ( once you are able to get up and down ok)
Google Katja pilates YouTube and her classes will come up.
I find pilates is the right balance for me with stretching and strengthening without damage or pain. She really emphasises doing a small number of repetitions slowly and with perfect form over lots of reps done fast and badly.

 

[Stiff knee NC]

@Jamie, @ScottieW and @EalingGran: Thanks, all, for your suggestions! Will write more later…but I wanted to let you know that I ALSO do a 45-min “silver sneaker” class that’s abt half the time in a chair/half standing…it focuses on stretching, balance, weights and a tiny bit of muscles. It’s on a Friday afternoon and it’s my “reward” at the end of each week. I feel physically and mentally great after each session! So I’m not just pounding away on the treadmill every other day

 

[Stiff knee NC]

@Jamie: one more thing…my cousin just had a TKR. His OS had (I believe) Smith & Nephew custom make his implant. Surgery went well and so far, so good. What interests me is that his dr put in a DRAIN. Have you ever heard of a custom-made implant or the use of a drain? (Btw he had drains when both of his hips were done several years ago, too; same OS).

 

[Stiff knee NC]

@hhilltop: thanks, too, for your suggestions and prayers! I’d be interested in the vitamin K…topically? Just rub it into my knee? Or? I never feel like I’m overdoing my exercise because it never hurts while I’m doing it (for which I’m so grateful). No matter how much or how little I exercise, I still have tightness/pain after. And I’m not a swimmer but I have done water walking and loved it. As many have suggested, I need to find the balance!

 

[Pumpkin]

Have you ever heard of a custom-made implant or the use of a drain?

I had a drain after my TKR, seems to depend on the surgeon. Conformis was the first company to make custom implants.

 

[Jamie]

@Jamie: one more thing…my cousin just had a TKR. His OS had (I believe) Smith & Nephew custom make his implant. Surgery went well and so far, so good. What interests me is that his dr put in a DRAIN. Have you ever heard of a custom-made implant or the use of a drain? (Btw he had drains when both of his hips were done several years ago, too; same OS).

The use of a drain with joint replacement surgery used to be very common and it's the surgeon's choice to do so or not. It doesn't have anything to do with the type of implant used. The draining devices help to get rid of any excess blood that results from the surgery. Today's, surgical methods have improved to the point that a majority of surgeons no longer use drains....they just aren't needed. Likewise, we used to see a lot of bruising in patients' legs following surgery. That's been greatly reduced as well, along with the pain and swelling that comes with bruising.

As for the implant, a number of companies now use computer modeling to create a custom implant for each patient. Some people feel that these implants are better and the computer technology is definitely a "wow" factor. But we see great outcomes in the standard implants as well. There are multiple sizes and configurations of the implant components available to the surgeon in the operating room. A lot of testing of components is done before the final placement. And an implant manufacturer's representative is usually present to assist the surgeon in selecting the proper implant for each person.

 

[Stiff knee NC]

@Jamie: Hope you are well! A question and some feedback! Q: is Pumpkin still on the site? I think (but am not sure) that she was the person who saw Dr. David Lintner in TX to talk abt post-op scarring. I’d like to have a telemedicine appt w/him. (I took a screenshot of someone talking abt him but did not get the person’s name who posted arg.)

Second, and this was for only one week, I tried your suggestion…30 mins/day ONLY of alternating biking and walking. The tightness afterwards was a bit better. That was for 4 days. And then last Sunday it was so beautiful out that I walked 50 mins around a gorgeous, sparkling lake. Even tho I stopped two times, the tightness and pain were so bad I had to take an OTC pain reliever to be able to sleep. In 3 mos it will be so hot here that I won’t go outside. So I paid the price, learned a lesson, and enjoyed my long walk, the last for a long time

I know I’ve asked this before (but maybe didn’t specifically say “ultrasound” therapy) but would that or cortisone injections be of ANY help w/my replaced knee? I guess I just can’t believe that there is nothing that can help me. I try not to think abt it but the tightness is every day, all day, and is beyond depressing. I can’t believe that this is my life!

 

[Jamie]

Pumpkin is still on BoneSmart and is a Moderator, but she's not the person you're thinking about who mentioned this surgeon. Here is the post you're referring to:

@RunA42K isn't on the forum much anymore, but I've tagged her just in case she still gets email notifications of tags. When you have something like this you want to find, remember that the forum has a search tool. I just typed in the surgeon's last name and it popped right up. It never hurts to get a consultation withe a good surgeon when you're having challenges, so I suggest you go ahead with that plan.

You could try the ultrasound treatments, but I'm not thinking it will really make much of a difference for you. As you found during that 4 days, slowing down your activity and exercise is likely going to be the best thing you can do. Four days -- or even 4 weeks -- could still not be enough to keep things settled down. This is a chronic problem for you and it could well last for a very long time. Sorry to have to tell you that, but there are no quick fixes for a stiff knee after a TKR. It may be that you need to do no more exercising than 30 minutes in a day for an extended period of time.

While it may not seem like you did all that much with a 50-minute walk around the lake, remember that walking outside is more challenging than walking indoors or on a treadmill. You pretty much doubled your time all at once and that is what caused your problem. Your body is telling you that it's not ready for that right now. As long as you're moving around frequently during the day, it really isn't necessary that you "exercise." When the days are gorgeous, go for a 15 minute walk to somewhere and the 15 minutes back instead of the bike or treadmill. Or find a place to sit outside and just enjoy the weather. Or take a drive with the windows open (or the top down, if you have a convertible). Plan a picnic lunch with someone - or just take a fast food sandwich to enjoy in a nearby park. Sometimes you have to find creative ways to get the same results (like enjoying great weather) you would get from your old habits that involve extended periods of exercise.

Cortisone injections are for inflammation and it's usually not a good idea to do anything like that because of the risk of infection.

You really need to ask a surgeon both these questions since this is the person who will have seen your images and medical history and can give you a better assessment of what to try, if you want something beyond what I'm recommending with an exercise and activity moderation.

I know all this is frustrating for you and you want it to just be over. We'll always be here for you to vent and ask questions. Believe me....people here understand what you're going through and will support you.

 

[Stiff knee NC]

@Jamie: oops, I see that Pumpkin commented on my post in February. Pls disregard my comment…I will msg her directly.

 

[Stiff knee NC]

@Jamie: thanks for setting me right on the Dr. Lintner post.

 

[Jamie]

You're welcome. If possible, tag Pumpkin and ask your questions on the public forum, please. That way, others can benefit from your discussion. Usually we like for members to reserve the Private Messages for things they don't feel comfortable posting about on a public forum.