TKR TRKR 10/13/23 - Moving Forward with Many Detours

[Jamie]

You can make an appointment with your GP and ask for some additional therapy. It should be approved with no problem. This may help you get a start on strengthening so you can work up to walking longer distances.

If you’re going to have to walk longer distances right now, be sure to take a cane with you to use in case you need it. Limping is never good and doing too much of it can set you back.

 

[dubloosh]

It's been a long time since I posted though I have lurked and read. My first op year ended with a ROM of 135, an extension of 0 and lots of scar tissue. How did that happen? At my annual visit my surgeon heard the crackling in my right knee that I heard and felt and said it can be removed. Not in the mood for more surgery, I told him no. That night my knee became very tight so I emailed his office and said I changed my mind. I had about 15 minutes in the morning after standing until my knee became tight. Depending upon how much NSAID I took during the day and how much I moved around, it lessened, then became tight again at night.

November 12 I had arthroscopic surgery to remove the scar tissue and am one month out from that procedure, nearly 14 months out from knee replacement. This is a different tightness as he made three incisions and inserted a tiny camera to see what he was doing and to remove the scar tissue. I watched a YouTube video of scar tissue being removed with what looked like a mini electrical saw that pulled it away. It looked like feathers; I thought it would be elastic strings. I have pain, which I expected as there'a not a lot of room in the joint. It's slowly healing.

The tight band feeling above my knee is gone yet my quad hurt for about a week due to PT. I made the mistake of getting onto a leg press for about 10 or 15 presses with a small amount of weight. I think my good (left) leg was doing all the work except a few days later (week after Thanksgiving) my op knee was sore. Had she not gone back on her word to let me use the bicycle this wouldn’t have happened. The weather was damp and clammy yet the leg press was to blame. Two days later she told me to get on; I did it with my good leg, then said no. She said do a few more then you can get on the bicycle. I said no.

I called the facility and asked to be reassigned, and was. Burke is renowned, and when my original PT was away for Thanksgiving I worked with another PT who was gentle and didn't bribe me. Yesterday I worked with someone who told me if it hurts, then don't do it - heard here - and to do gentle exercises. The session ended with 10 minutes on the bicycle. My next two weeks are with him and another PT, also gentle. My knee is in a different place now, and I don't need my quad to fire, don't need to strengthen my leg. I want to prevent the scar tissue from coming back while not creating new scar tissue as the result of the recent procedure.

 

[benne68]

Thanks for coming back with an update, @dubloosh. Sorry to read that you needed the additional surgery to remove scar tissue; I hope it resolves and your knee continues to improve. I've updated your signature to include your latest procedure.

Yesterday I worked with someone who told me if it hurts, then don't do it - heard here - and to do gentle exercises

So glad you found a therapist who understands that recovery from surgery is different from rehabbing after injury. It's unfortunate that so few PTs are trained in this!

Good for you for standing up for yourself and saying "no"! It's your knee and you are in control of your recovery.

 

[dubloosh]

@Jamie I'm sorry I didn't see your reply from months ago. You were right, though; my GP would have given me more PT yet due I was afraid to go back and let my knee heal on its own as I read here. The summer was kind; pain now and again yet I heard the scar tissue moving around. I hope removing it and going back into my knee doesn't cause more scar tissue.

Thank you @benne68 for understanding and updating my signature. My right shin feels a bit sore; that may be from last week's presses. This knee is a journey. I'm still trying to understand how scar tissue forms if activities of daily living keep the knee moving yet aggressive exercise aggravates it. My surgeon said it would be stiff for about one or two months. It was still surgery; I imagined a few quick snips, and all done.

 

[benne68]

still trying to understand how scar tissue forms if activities of daily living keep the knee moving yet aggressive exercise aggravates it.

Part of the problem is the terminology. Surgeons and PTs use the term "scar tissue" to simplify things for us, when what they are really talking about is adhesions.

True adhesions are rare, but one of the ways to develop them is to work your knee too hard. Over-worked knees get inflamed and hot, and hot tissues become drier than normal and more likely to stick together and form adhesions. This article explains the difference between scar tissue and adhesions:
MUA (Manipulation under Anaesthetic) and Adhesions

Regular scar tissue is a normal part of recovery. That's what holds your incision together, and it's part of the normal healing process. Without it, you'd always have an open wound.

 

[Jamie]

You’re right @dubloosh … .any procedure is an assault on your body and it helps to be mindful of that as you recover. I’m glad to hear you have a therapist now who understands the gentle approach. Perhaps the article Benne68 linked for you will help explain what you have experienced. There is never any guarantee that the adhesions won’t return, but there are studies out there that support the theory that it’s helpful not to overwork your knee to the point it causes pain and inflammation. You’ve got this now! Hopefully you’ll be rewarded with some gradual improvement over the next few months. I look forward to your updates.

 

[dubloosh]

Thank you @benne68 and @Jamie for this information. I read the article and was trying to relate it to my knee. It became stiff at night where the red lines were, and this is where my surgeon (and I) felt and heard crackling. I was hoping that by removing the adhesions, my knee would move more smoothly. It does when I do morning leg slides before getting up, and it moved smoothly with lots of noise prior to the second procedure. When I pinch the skin on my left (real) kneecap, I can grab about 1/2" of skin. When I do that on my right (op) knee, I can grab about the same amount yet the skin is thinner. It's still swollen and painful. I was reading that recovery from this can take two to three months; my guess is it will take me longer. I'm also hoping the small amount of leg presses I did at low weight didn't further complicate this. That I had adhesions surprised me because it didn't affect my bend yet made my knee feel very tight. Short of massage, using a roller on the scar tissue (which sounds like it would hurt) and strenuous PT (which I did not want), the only way to remove it was arthroscopically. I'm going to search for posts from others who had this procedure.

 

[dubloosh]

Adding: Mid-March 2025 will be seven years since my left hip was replaced. The same surgeon gave me a dual mobility cub, and all I did for PT was walk. It was an easy recovery compared to my knee, no scar tissue. Interesting how hip and knee surgeries and recoveries are so different.

 

[benne68]

Interesting how hip and knee surgeries and recoveries are so different.

Yes, I had the same experience. Having had the hip replacement first, I was unprepared for how much more difficult the knee recovery would be -- even though my surgeon warned me.

Please do keep us posted on your progress.

 

[dubloosh]

Hi! It's about 4 in the afternoon, and I've been a slug today. Took morning meds - trying to cut down the Advil and Tylenol - and did the laundry as I do every Thursday. I remember my early months after surgery writing about comfrey salve and wondering if castor oil will relieve the stiffness. My knee has been very happy with me doing nothing today. It's a little stiff as my surgeon said it would be; I thought it would get tight since I'm not doing much walking. I also remember posting some months ago about eliminating gluten, and that @Layla suggested peanut butter bites and @sistersinhm also suggested substitutes. After not having gluten for four weeks and seeing no difference in my knee I caved: went to Trader Joe's and bought whole wheat bread and peanut butter with the oil on top and had a sandwich for lunch. Now to see how it feels tomorrow. I'm looking into buying a stationary bicycle if Medicare will cover it. Probably need a prescription.

 

[Layla]

After not having gluten for four weeks and seeing no difference in my knee I caved: went to Trader Joe's and bought whole wheat bread and peanut butter with the oil on top and had a sandwich for lunch.

I hope you enjoyed the sandwich and feel fine tomorrow. You're not a slug, silly girl!

We often quote our colleague Roy Gardiner, when members feel they're being lazy.
Roy says - "When you are icing and elevating and watching telly you are not 'dossing around' you are 'engaging a carefully considered proactively designed heuristically programmed dynamically structured recovery programme'."

So enjoy sitting around once in awhile, you're in recovery. A peaceful evening and weekend to you!

 

[Layla]

Happy One Month Anniversary since your procedure...almost forgot!
Sweet dreams tonight.
@dubloosh

 

[dubloosh]

We often quote our colleague Roy Gardiner, when members feel they're being lazy.
Roy says - "When you are icing and elevating and watching telly you are not 'dossing around' you are 'engaging a carefully considered proactively designed heuristically programmed dynamically structured recovery programme'."

I love his way of thinking as I'm doing exactly that right now. He makes it sound like a scientific activity requiring thought and planning.

You, too, enjoy your weekend. Gentle PT tomorrow with the understanding therapist.

 

[dubloosh]

Happy One Month Anniversary since your procedure...almost forgot!
Sweet dreams tonight.

Thank you, and thank you. The same to you.

 

[dubloosh]

Yes, I had the same experience. Having had the hip replacement first, I was unprepared for how much more difficult the knee recovery would be -- even though my surgeon warned me.

I apologize for not replying sooner. Thank you for sharing this.

Part of the problem is the terminology. Surgeons and PTs use the term "scar tissue" to simplify things for us, when what they are really talking about is adhesions.

You're right, Terms are confusing. Knee, part I, is completed, and part II is underway.

 

[Jamie]

You may be able to get Medicare to cover an exercise bicycle if your GP or surgeon can write the reason as requiring it as part of your medical treatment to prevent the recurrence of adhesions. It would be worth a try.

 

[dubloosh]

Thank you @Jamie. I'll ask my surgeon when I see him December 23. Meanwhile, this morning my knee felt stiff the minute I stood up so I'll eliminate gluten again to see how it feels in one week. Today at PT the therapist (male) did myofascial release and told me to make note of how I feel tomorrow at the same time (3:45 p.m.) and if my knee feels better. I was able to walk down the practice stairs at PT foot over foot, something I was unable to do Tuesday. I don't know if this is due to my icing and rubbing my knee or today's release. I'll see if I can walk foot over foot Monday before I exercise; however, I'm not sure I want him to do that again. Because I have fibromyalgia, I felt pain on the areas where he pressed albeit gently. He kept telling me to let him know if I felt pain and was more gentle yet he was still pressing into my calf and shin. Is myofascial release beneficial for or detrimental to a 14-month-old (today) knee?

Hi, I thought of something else the PT said to me: if my knee is still tight after the release he did (15 or less minutes), then I need to talk with my surgeon about this. How can a 15-minute exercise done once relieve the tightness from a recent arthroscopic procedure that was done on a year-old full knee replacement? It's still tight after one year; the procedure probably made it more so. It may take two years for my knee to feel normal. Winter doesn't help. Just want to be sure I'm on the right track. An aside: my SO was patient and is very encouraging.

 

[dubloosh]

Good morning. It's Sunday and artificially warm in here due to heat. Yes! My knee is happy. I've been practicing using the staircase in our building and thought I'd try the one that looks steeper to see if I have an easy or difficult time. I'm very happy to share I went down the steps foot over foot and felt only a tiny twinge from my knee though not enough to stop me from continuing. It only looks steeper: each step is 7" high and 10" long; each step in the other staircase (more difficult to do) is 7-3/4" high and 10-1/2" long. The steps at the post office are shallow and very easy. I'm nervous about straining my patella as I did last year, when I stopped all formal exercise until it healed. I still have a full feeling in my knee with the familiar pain on the lateral side where the nerve was cut and wonder if that will go away.

 

[Jamie]

This is a positive report. Good for you!! Just be sure to still go easy on your knee with the stairs. It’s easy to overdo that. As long as you don’t experience any pain or swelling in the 24 hours after negotiating a stairway, you should be fine. For now, I wouldn’t attempt to do stairs more than a couple of times a day. Working up to this much stress on your knee is better.

 

[dubloosh]

Thank you @Jamie, and thank you for this information. I'm eager to walk downstairs now and would probably overdo it so I'll keep your words in mind. The myofascial release didn't seem to help yet I don't know if it was that or Tylenol that made walking down steps less painful. I'll skip the Tylenol before PT tomorrow morning to see. I'm still feeling pain on the side of my knee (is it the hamstring tendon?), especially after doing the leg press briefly and hope it will lessen with time.