TKR Suggestions needed for “tight band” feeling

@Bridgy: I feel for you, too. Having scar tissue and tightness/pain is beyond discouraging. Hang in there! It DID take me a long time (around 1 1/2 years) to get to a good ROM and extension. I’ve gone to PT, took a break, and then resumed PT several times. It is a journey for sure. It’s particularly frustrating because I am SO much worse than before I had my knee replaced. Sigh. And now my right knee hurts nearly every day (esp after my 30 mins of exercise) but there’s NO way anyone is touching that knee!
I am excited to share the results of my recent CT. I’d appreciate a forum advisor letting me know what all the medical jargon actually says. (I don’t have an appt w/my OS for nearly 3 weeks).

I can understand enough to think that this may FINALLY give me an answer to my tightness and pain!

I will say that I asked this doctor for more than 2 years for this test. (I had to push for a MARS MRI, too, for 2 years too, after which he expressed surprise that technology had come such a long way that provided a good image). I had to be my own advocate, even when I was beyond discouraged, had tried a multitude of other things and was just generally sick of dealing with, talking about, thinking about, my left knee.

I pray that this explains my pain but more importantly, that there is something that can be done to correct it (that hopefully doesn’t involve additional surgery). Fingers crossed!


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I know it’s going to be difficult to wait for your surgeon’s opinion of this scan, but that’s what you need to do. This report indicates that your problem may be related to tibial rotation, but since there is no loosening of the prosthesis, your surgeon needs to explain what this means in your specific case. I will be anxiously awaiting his determination of what may be done.
I too was excited to finally have a diagnoses for my problem knee. The years of knowing that something wasn’t right, and being told that all was ok, were over and my concerns validated. Hope that your appointment gives you a solution.
My visit with my OS last week was a little disappointing…he said that since my knee isn’t “dislocating,” (which I assume means that the implant isn’t loose) he said that the tibial rotation isn’t a big deal. He wasn’t optimistic that dry needling would help. (My former PT had recommended dry needling as something that might help).

Has anyone had luck w/dry needling?

My surgeon said that he didn’t think a lysis would be helpful either. The only thing he recommended was to go back in, take EVERYTHING out, put in an implant that I can’t be allergic to (ceramic?), and remove the PCL. The idea of starting all over, making the past 4 years a near waste of time/pain is hard to swallow (Altho I have learned a lot). And he stressed that there are no guarantees that it would help. I regret that I didn’t do that when I had my revision in April 2022, but I opted for a little easier recovery.

I go to the Duke doctor in a couple of weeks. Will be interested to see what he says.
Internal rotational error of the tibial component is a major cause of pain after total knee replacement
Nichol and Rowley
The Bone and Joint Journal

This paper is fully available and very interesting.
It suggests that rotation errors are a common cause of pain post TKR.
It says that more than 9 degrees of rotation of the tibia will cause pain. I think your CT scan showed more?
@EalingGran: THANKS so much for pointing me towards this article! Had never heard of this journal either.

I intend to print out and show the Duke doctor; hopefully he will give it some consideration instead of dismissing it because my knee isn’t (doesn’t?) dislocate and the implant isn’t loose.
Glad you found it useful. It does seem to explain a lot of otherwise unexplained pain post TKR. I wonder if there are a lot more people on this forum with the same issue who are being fobbed off.
Well it’s about the end of the line for my left knee. My “regular” surgeon said at this point he would recommend going back in, taking everything out and putting in a new implant that I couldn’t be allergic to.

Sadly, the Duke doctor suggested the same thing. He DID order blood work—chromium and cobalt test—but both results were in normal range. He said there are no more tests that can be done. He didn’t say much about the internal tibial rotation. My impression was that was something he’d address if he went back in.

Told him I just don’t think I could go through a 4th surgery on my left knee (have had 2 meniscus surgeries on my right knee too) both physically or emotionally. As always both doctors said there was no guarantee it would help.

I suppose I can always change my mind down the road if it gets worse (tho neither doctor thought my condition would get worse) OR I just can’t deal w/it any more. I’m still riding a stationary bike (usually) or walking on the treadmill or now, outside, for 30 mins several times/week. I don’t have pain WHILE exercising…for which I’m grateful! Afterwards it’s stiff as usual. I have started taking some additional balance/strength/stretching classes at the gym…seems to help my knee a little.

It had been a difficult, hard, painful journey…now 4 years and 2 months long. Bonesmart has been crucial to helping me deal with…everything! Thankful beyond words!
@Stiff knee NC So sorry the option seems to be more surgery. But sometime down the line you may feel you can face it. At least you have the option later on. For now it sounds like you are getting active and exercising. That's great!
I feel for you: have been following your progress. After two years struggling with similar pain and no swelling reduction, I recently had an arthroscopic procedure to remove scar tissue. I was awake and watched the surgeon dig around in the knee for 40 minutes: much of it was floating loose but he also had to cut through some tough bands. After four weeks I am still in pain, although it is slightly different, so I am hoping it’s just surgical related. Have you been offered this option? I think it is my last chance fix. I wish you all the best and hope you find some comfort.
While it’s not great to hear you need more surgery, at least you do have some options and you received the same diagnosis from two surgeons. That would indicate that you could opt for the surgery at a later date if you decided to. I’m glad about that. Hopefully your excellent exercise program will help keep surgery on a back burner for a while.
@Vida: thanks for your support! It’s bizarre but my doctor initially talked about arthroscopic surgery but once he saw the CT scan showing tibial rotation, he shifted to taking everything out.

I honestly think no one has ANY idea what to do to help me and simply default to…surgery.
Aw you are very kind. I stayed awake during arthroscopy because I wanted to see inside the knee for myself. Have had no CT imaging done. Now it’s how best to gently rehab the knee after the adhesions gummed up my soft tissue and to try and prevent any recurrence. My surgeon said he had done this for six people and five were happy long term so those are good odds! I want that for you.
@Stiff knee NC - I so agree with others here - you have some definitive direction and as aggravating as additional surgery will be, you can at least prepare for it and have a clear sense of what will be involved for recovery Better luck with the exercise protocols in the meantime.

@Vida - I'm really jealous you were able to see your procedure. After the years of pain my various joints gave me, I really wanted to see what the OS's were doing to remediate my issues. Scientific curiosity, at the very least. Alas, one said I would probably doze out from the light anesthetic; for the others I was out! They knew.... Good luck with your recovery too!
@Stiff knee NC

I have been following your progress and was curious how you are both progressing. I opted for LTKR to improve my knee tightness as a result of an injury and 4 surgeries over 15 years. I did have some OA but not bone on bone. I am week 7 post-op and so far have the same “debilitating” knee tightness. I am actually worse now than pre-op. Mentally and emotionally I am exhausted from this, even though I am early from this procedure, I was hopeful this TKR would be the game changer and provide some relief to the weight bearing tightness I struggled with for years. Anyone dealing with I understand, it is extremely uncomfortable, painful and limits your ADL.

Thank you
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