TKR Suggestions needed for “tight band” feeling

[Stiff knee NC]

Well, some answers but no surprises. MRI results mention “scar” or “scarring” 5 times. I’m amazed that the radiologist commented on the scarring because I’ve been told for years that MARS MRI doesn’t show scar tissue. So either that was incorrect or my scarring is so obvious/so prevalent that there was no missing it.

I go to see my OS on Thursday to go over the results. (I’ve attached them; there’s a lot of medical terms in it!). I’m praying he can come up w/something(s) to help me. I am desperate for relief.

@indie: thanks for the tips! I will try them ALL!

Would appreciate any thoughts of an advisor on the MRI results. Thanks in advance!

 

[Jamie]

That is frustrating not to have something jump out at you. But hopefully your surgeon an offer some detail for you.

 

[EalingGran]

Interesting how much detail can be seen even after an implant. Thanks for posting.
It looks as though your tendons are intact and your muscles are good. Will be interested to see whether the surgeon thinks the tendinopathy and scarring are significant. Also whether that oedema in the patellar fat pad may be an issue.
Do let us know what he says.

 

[Rain Dancer]

I’m so sorry that the MRI did not offer a clear answer, especially when you are in so much pain. My issue did not show up on an MRI, but it would have shown up on a dynamic ultrasound. Hopefully, your surgeon is open to more testing.

 

[Stiff knee NC]

@Rain Dancer: what is a dynamic ultrasound (as opposed to a “regular” ultrasound) and what does it look for?

 

[Rain Dancer]

A dynamic knee ultrasound looks at muscles, ligaments, and tendons as the knee goes through a range of motions. In my situation, for example, it would have shown that the implant was impinging on the popliteus tendon when I flexed the knee. The impingement did not occur when my leg was straight.

 

[WillB]

I had left knee surgery in early August as a last resort to pain and arthritis. (I tried cortisone and gel shots, PT, and even had a meniscus surgery, to no avail). I am 14 weeks and 1 day out and it has been a VERY difficult recovery. What I’m struggling with the most is “tight band syndrome” from one side of my knee, across the front of my knee, to the other side. I can’t stand more than 30 minutes without pain...and my knee gets tighter and tighter the longer I stand. ROM is 115 (120 w/a push from my OT). My OS told me to do the stationary bike, elliptical, and use the hip abduction machine. I have been icing, elevating, and resting every day. In the gym 5 days/week. Got a deep-tissue massage, which didn’t help much but I have a few more scheduled. I’ve read the BS info on my tight band problem. Went to PT 3x/wk initially but am nearly done (my 40 insurance-approved sessions are almost done). May try water therapy. I am NOT getting better and am beyond discouraged. My surgeon says it just “takes time.” My experience seems very reminiscent of patient 99’s (Carol)....how I would love to hear how she’s doing all these years later. Please, if you have any suggestions, I’d be grateful if you could share them!

If the tight band feeling is upper knee, might it just be a really tight quad muscle? I’ve been dealing with this for quite some time now. 4 months post op!

 

[Stiff knee NC]

Update: My PT and I both agree that my 8 or so sessions of ultrasound did not help at all and she released me early. During my sessions she also taped my kneecap with Leukotape so it is slightly pulled to the left. It DOES seem to help…but I have no idea why. (see photo).

I see my OS on Tuesday to go over what his colleague recommended (the colleague, the other senior surgeon at the practice) said he ALWAYS recommends “resurfacing the patella”… is this the same thing as getting a “button”? Additionally he talked about some sort of ligament but used so much medical jargon (even after I asked him to repeat it) that I just didn’t understand. So will get clarity on that…as well as MARS MRI results, which he mostly dismissed.

And then, next Friday, I see a “fellow” at Duke Ortho. Am hopeful he has some insight and pain relief suggestions. My regular OS only offers to go in arthroscopically to clean up scar, and says, and I’m quoting exactly, that the “medical profession is just not smart enough to figure out what’s wrong with you.” Perhaps some fresh eyes will!

Sometimes I think that the answer is that… there IS no answer. That no one will ever figure out what the heck is wrong. The PT said she thinks I need to get someone to look at nerves in my leg…or focus on pain management.

I’m still doing my 30 mins on stationary bike one day, 30 mins on treadmill the next, etc about 4 days/week. Have lost some weight, too!

I’m nearly at the 4 YEAR anniversary of my initial TKR and it saddens me to be no closer to relief than I was after surgery.

Would appreciate any thoughts and/or questions to ask next week. Thanks!

 

[Vida]

I feel for you. At 18 months I am still having unexplained pain. An x ray required to get a referral back to my surgeon showed a small floating piece of bone. My OS said a ct was not needed ….that it’s more likely to be scar tissue and I am finally on the list for arthroscopy. He says he has done this for five patients and four were happy. Hopefully I will take my chance by September. You seem to be doing everything right. The stationary bike really helps with mobility, I do an hour, then I ice and lie with my legs up the wall for 20 mins. I do it twice a day. That seems to help reduce the swelling. Sending best wishes.

 

[Jamie]

Getting a button is the same as resurfacing the patella. I’m glad you are getting some specialists involved who seem to be giving you good options. Your original surgeon is just wrong about his approach. No one knows everything, and it’s always a good idea to continue to seek new opinions from surgeons with a lot of experience with problem patients.

The fact that the taping gives you some relief would seem to me to indicate the possibility of a patellar tracking issue (it can be VERY slight and still be painful) or arthritis there if it didn’t get a button in the original surgery. Exploring that option makes sense to me. It also could be a ligament issue. Balancing a knee during the replacement process is the most difficult part of the surgery. And, again, just a slight imbalance can cause your knee to not function properly.

I sincerely hope this works for you!

 

[Stiff knee NC]

Update: the Duke “fellow” doctor had me get blood work AND was glad to hear I have a CT scheduled for Tuesday. Concerned about fluid that appeared on the MARS MRI. Feels it may be related to a patella tracking problem and not to any scarring. Felt lysis would not help. Hmmmm. I go back to Duke in September.

 

[Layla]

Best Wishes for your CT scan on Tuesday.
Please keep us posted.
@Stiff knee NC

 

[Stiff knee NC]

I meant to share this photo of the new brace to help with my patella. I’ve worn it once and found it bulky, uncomfortable and tremendously unattractive I did ask someone at the gym who was wearing one if it “breaks in” and she said it did feel better the more she wore it and said she couldn’t imagine living without it.

 

[Jamie]

I've not seen a brace like that before and it does look a bit uncomfortable. I hope the person you talked with is correct and it gets better with time. If it helps, it will be worth it. And I do hope it works well for you.

 

[Stiff knee NC]

That cumbersome brace is from Donjoy and is called a Reaction Knee Brace..

 

[Jamie]

Thanks for the information. In reading about it, the brace actually seems like it might be more comfortable than some of the other braces with more metal components and webbing in the knee area. Let us know how you do with it and whether or not you use the sleeve when wearing it. It comes in colors too….did you get a fun color? Sometimes it helps to be a little crazy with these “helpful” devices and the colors help with that. This particular device is designed to help support a maltracking patella.

@Jockette you might be interested in how this works for Stiff knee NC.

 

[sistersinhim]

I wish I had had this brace years ago when my kneecaps kept 'popping-out-of-place!

 

[Jockette]

@Jamie My 3 second opinions have said that my patella tracks fine. It was during my PKR surgery that it didn’t (though it never did before my surgery) which is why my surgeon did a lateral release during my PKR, and I think this (possibly poorly done) lateral release is the cause of all my problems.

I’ve worn it once and found it bulky, uncomfortable

I doubt that I have the patience to try this brace, especially since my issue is more nerve related, and the discomfort of the brace will make that worse.

Thanks for thinking of me, though!

 

[Layla]

uncomfortable and tremendously unattractive

It looks like a knee mask at first glance, or a mean face. It may scare animals and small children.
We have to make light of some of these things in order to get by, right?
Actually, most importantly, I hope it does break in quickly / easily for you and brings the same relief as the the girl at the gym is enjoying. That's what you're going for.
Best Wishes and lots of comfort to you! Let us know how you fare with it. Will be watching with interest.

 

[Bridgy]

I read all 32 prior pages on the knee journey of @Stiff knee NC. I feel for you and all the others with post TKR stiff knees. I will be at a year from LTKR in September 2023. I restarted PT in June due to continued stiffness and poor ROM. I am, on a good day, at 98 with 0 extension. However I can walk 15,000 steps about once a week without pain afterwards (im not trying to walk farther or more to protect my other knee). The current PT has helped with going down stairs which is the most bothersome ‘activity of daily living’ with my poor ROM. I go to my surgeon’s one year follow up appt in September. I don’t expect anything good to happen bc he blamed my early lack of ROM on my being too anxious about pain. Anyway, I think maybe I should learn to live with the ROM issues and be happy I can walk now. We are currently adding a railing to the landscaping steps on the hill in front of my house. I think I will always be at risk for falling on stairs or tripping on uneven surfaces but I can modify my environment and keep active to maintain a healthy lifestyle. It seems that modern medicine does not have the answer for scar tissue.