The REHAB DEPARTMENT > Soft Tissue Healing Problems - Arthrofibrosis

A question about scar tissue after TKR

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kiddthekatt:
Good morning all;
    I've been around here for a while and I've grown close to a lot of people on this sie, and I trust their input greatly. I have scar tissue in my TKR knee that the doctor wants to force manipulate. I decided against it at this time until I can find out more about the prcedure, and if the chances of scar tissue returning after the truama of being torn out will make it come back faster. I've already had 3 surgeries on this knee this year, starting with a PKR in March, a revision in May and the TKR in October, and to be honest with you, I'm tired of being cut on. I asked my OS the question about returning scar tissue after the MUA and he said that he wouldn't know until he got it loosened up, well, something set off red lights on that answer. I cancelled the procedure that was to take place this morning.
    I had a hoorible feeling so deep inside and was on the verge of actually being terrified about having it done after he answered me with his answer, and I could not go into surgery feeling like I did. After reading a lot of the posts here about Arthrofibrosis, I am very hesitant about having the scar tissue removed. I am not up to having scar tissue removal done every time it comes back, I am 52 almost 53 years old and I don't want to spend the rest of my years in and out of the hospital having scar tissue removed. My flexation is 85-90 and my extension in better than it was before the first surgery, and I get around pretty good now. Some days I have to use my crutches because the knee acts up, but other wise I do ok.
    What I'm asking is, is it an absolute have to, to have the MUA when the chances of it returning is so high? The OS didn't want anything to do with my questions, he is dead set on tearing this scar tissue out, and I'm dead set on him not.
   Any help would be greatly appreciated.

Thank you and I hope you all had a wonderful Christmas.
Angel

jathib:
I'm a little confused by your post. It sounds like your doctor just wants to do a manipulation. This does not involve any cutting at all. They just bend your knee while you're under anesthesia. They don't "cut out" the scar tissue, there's no incision involved. So I'm a little confused as to what your doctor is really doing. Is he just doing a manipulation or actually trying to remove scar tissue? I know that some people have had great success with MUA.

My Sister Sam:

--- Quote ---  What I'm asking is, is it an absolute have to, to have the MUA when the chances of it returning is so high?
--- End quote ---


To answer your question.... No, it isn't an absolute that you must follow through with the MUA. However, you should be prepared to accept ROM limitations in the event you aren't able to break through the adhesions sans the procedure.

This is a decision only you can make. I surely feel your pain, as I went through an MUA following a TKR myself. To tell the truth, I would NEVER have been able to tear through those adhesions of my own strength (or will). I know it's a tough decision to make. I wish you the best.

Jaci:
Hello Angel,

It's important to keep in mind that most of the people who post in this particular ection of the baord have not had a TKR. Doctors approach treatment of excess scar tissue following TKR a bit differently thn how they approach it following other types of injury/ surgery.

Doctors are hesitant to do open or even arthroscopic surgery on a knee that has had a TKR because of the risk of infection. They don't want to expose the TKR knee to that risk, thus MUA is preferable. In any case, the MUA should be done fairly early following the initiating procedure-- in your case the TKR-- because the scar tissue  becomes more fibrous and stronger the longer it remains in your knee.

Have you read through some of the MUA threads in the TKR section of the board? You may want to take a look at Janet's thread on her TKR and recovery. She had an MUA and very specialized pain control to get her through. It took a while but she has had a good recovery.

You're wise to learn what you can about arthrofibrosis and ask lots of questions. Just be sure you are taking into consideration the type injury or surgery that initiated the excesive scar tissue response and subsequent treatment. You really can't compare TKR to anything else.

Best wishes,

Jaci

missmyknee:
Depending on where the scar tissue is located , will make a difference on whether an MUA will help. In my case with scar tissue and TKR, an MUA would not have been of any help. My scar tissue post TKR has been to areas where I needed open debridement several times to remove it all. MUA won't do any good when it is attached to my collaterals, compressing nerves, under and on patella tendon, under patella, etc.The improtant thing is I had all these open debridements by one of the arthrofibrosis experts , so he knows what he is doing with open surgery, post-op protocals and treatments with anti-inflammatories, CPM,epidural pain control,cortisone medrol dose paks , and proper, gentle rehab.

There are no guarentees it won't come back....that's the nature of the beast.

Pam

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