TKR Suggestions needed for “tight band” feeling

[Stiff knee NC]

@Jamie: I apologize for these separate messages: what abt a nerve block or ablation? I tried them both a few years ago but don’t think the dr really knew what he was doing. The way I figure, my knee could be tight but I just wouldn’t feel it. Thoughts?

 

[Jamie]

I suppose that's a possibility. But, it's not always good just to block out the pain. If your body is not ready for that level of activity, you wouldn't know when you are overdoing things and it could make your condition worse. The body signals pain for a reason, you know....it's telling you something. Blocks are just that and they don't really resolve a problem. This also is something to discuss with a surgeon.

Knee "stiffness" is a common complaint people have after a knee replacement. Each of our bodies reacts differently to the implant and recovery. Some people just take longer than others. And in those cases, if the person tries to push things, it just sets things back. I'm not saying this is your problem. Only you know how much you are trying to normalize your knee and if it's really not ready to go there. But....I have to say, since you believe it was somewhat better with the reduction in exercise you did for those 4 days, that would be something to try on a longer basis. There are really no quick fixes for a chronic stiffness issue.

 

[Stiff knee NC]

Is a lysis of adhesions the same thing as a synevectomy? Tks in advance!

 

[Jamie]

No, they are two different conditions and procedures. Lysis is the removal of scar tissue that has grown where it shouldn’t be and is inhibiting movement. A synovectomy removes normal synovial tissue that has become inflamed and is causing pain.

 

[Stiff knee NC]

Have had just a hellish last five days. Didn’t exercise but was active…ran errands, etc. i can’t be on my feet for ANY amount of time without tightness and pain. It is CONSTANT, located primarily in the front of my kneecap, on the bottom, dead center. I can feel a slight “tugging” on both sides of my kneecap, too.

I go see my OS in 3 weeks. He will x-Ray me because it will be one yr since my revision. 1. Will an X-ray pick up issues like loosening? 2. If an X-ray won’t, what will? 3. I’d like to get a MARS MRI but he always vehemently says that it won’t show anything because of the metal. Can you point me to info that I can show him (or reference to him) about MARS (I did find the explanation by Josephine in 2017) and 4. Is there anything to be gained by having a THIRD set of labs (sed rate, c reactive protein) and a THIRD bone scan? Frankly I feel desperate for something that will explain WHY I’ve been feeling so bad for the past 3.5 years.

I am worse than before my TKR and also before my revision in April 2022.

 

[Jamie]

The x-ray should show any loosening that might be occurring. It is possible to get an MRI with a knee implant, but it must be done by a radiologist who understands how to do it properly. The blood work would be called for if the doctor thought infection was a possibility or if he just wanted to rule that out.

 

[Stiff knee NC]

A thought: I have the Operative note and wondered if I could show it to the BS staff? I will remove ALL identifying info (my name, surgeon’s name and surgical assistant’s name, etc)…maybe something will jump out…

 

[Jamie]

Sure....it's up to you if you want to post it. But.....remember that we may not be able to tell much from just that one piece of your story.

 

[Stiff knee NC]

Here is the Operative notes from my Aug. 2, 2019 total knee replacement. Not sure if this post will be “too big” so am doing a separate entry for my revision.

 

[Stiff knee NC]

Here is the Operative Note from my April 11, 2022 revision. See anything out of the ordinary?

 

[Jamie]

I sure don't see anything odd. It does appear you had significant scar tissue and it's always possible for that to return.

 

[Stiff knee NC]

@Jamie: Yes, my OS and his PA discussed my scar tissue with me. Is there ANY way scar tissue could be the result of a metal, cement, suture, etc allergy? I was skin tested for nickel—negative—but a blood test showed highly reactive.

 

[Jamie]

I do not know of any science that supports the idea that scar tissue could develop from an allergy. The reaction is usually tissue irritation and inflammation. Metal allergic reactions are actually fairly rare as the reason for problems with a joint replacement. So, I won’t go so far as to say it’s impossible….just highly unlikely.

 

[Stiff knee NC]

Anyone struggling with excessive scar tissue may be interested in reading the March 14, 2016 article in The Wall Street Journal entitled, “Did Your Knee Surgery Create New Pain?” I did not have to subscribe to read it…I simply Googled it and was able to access it.

Very interesting to read that some of us may be predisposed genetically to creating scar tissue after surgery. Since this article is from seven years ago, doctors and researchers may be further along to understanding this surgical post-op problem.

 

[Stiff knee NC]

Update on my renewed effort to find out why I still have pain and tightness: x-rays and blood work continue to look fine. A new, anti-inflammatory drug (Etodolac) doesn’t seem to be helping. I’ve been to a new PT two times…the first time she did ultrasound therapy AND “cupping.” Knee felt different but still tight the next day. Sticking w/cupping for the time being since that’s something I can do at home. MARS MRI tomorrow and a consult w/my OS’ colleague next week.

The PT showed me one of those electric, hand-held devices that has a “ball” at the end and said we will try that, too.

None of this may give an answer… honestly I think it’s scar tissue, again… but I mentally feel better exploring/trying anything I’ve read about.

I had a meltdown earlier this week following 30 mins on the bike that left me having to ice/elevate. After nearly 4 years of dealing w/this, I’m getting more frustrated than ever. Fingers crossed that the MRI shows something!

 

[Stiff knee NC]

Looks like my msg did not post. Just an update on my renewed quest for WHY my knee is still tight and sore: x-rays and blood work fine. Anti-inflammatory meds (Etodoloc) don’t seem to be helping. MARS MRI tomorrow and a consult w/my OS’ colleague next week.

My new PT tried “cupping” AND ultrasound therapy; focusing on cupping because that’s something I can do at home. We will also try the electric, hand-held device w/the “ball” at the end at a later session.

Still doing just 30 mins of exercise abt 4 days/week (alternating between bike and treadmill…but I’m quite sore after the treadmill so may switch to water walking). Had a meltdown after the bike this week, so much pain I had to ice and elevate.

I’m much better emotionally trying new/different non-invasive things…it’s frustrating to just “give it time”…it will be 4 years in August and that’s a long time to be in pain every single day.

My next steps will be related to pain management if the MRI doesn’t give answers.

 

[Layla]

Hello @Stiff knee NC
I am sorry for the pain you're dealing with. I hope you find answers and relief soon.
Let us know how your appt goes. We're here for support always.

 

[Stiff knee NC]

@Layla: Thanks! The BS staff has been helpful in SO many ways!

 

[EalingGran]

Hope the MARS MRI provides some answers. I am sorry you have had such a horrible last few years.
Would be interested if you are able to post the report- to see how much detail it is possible to see given the interference of the metal from the implant.

 

[indie]

A new, anti-inflammatory drug (Etodolac) doesn’t seem to be helping.

I had very very tight ironish feeling in 7 inch area above knee, If i tried to bend the knee, it would be more tight, and prevent bending. Had very low ROM of 80.

I took 12 hrs Aleve 250 mg. 2 per day at 12 hr, interval.

Drank turmeric tea. 1 teaspoon in 1/2 cup hot water.

Soaked 6 cloves, 10 black pepper and 1 inch cinnamon overnight in hot water. After breakfast, boiled them with 1 inch scrapped ginger. Prepared 2 cup tea out of this mixture, drank it twice, once before bed.

My tightness was resolved in 3 days. ROM now improved to 95.

I’ve been to a new PT two times…the first time she did ultrasound therapy AND “cupping.” Knee felt different but still tight the next day. Sticking w/cupping for

1. went for deep tissue massage by RMT,

2. Light massage at inner side of knee with knuckle.

2. broad pinching of thigh area to loosen that iron grip.

The PT showed me one of those electric, hand-held devices that has a “ball” at the end and said we will try that, too.

theragun on light setting also worked

None of this may give an answer… honestly I think it’s scar tissue, again… but I

I too thought its scar tissue, but it was resolved, without much efforts

Wishing you early relief.