KNEE ARTHRITIS - Total Knee Replacement :
Revision Surgery? - - Posted by tmlf959 (tmlf959), 26 October 2004
Hi all, my first time here 
Had tkr of right knee May/04. Pt for 12 weeks, 4 times a week. Knee was extremely stiff and painfull and poor rom due to excess scarring. Had manipulation mid August, doctor couldn't break scar tissue, had to go in with arthroscope and cut scar tissue. 6 more weeks of pt 5 times a week, knee continued to stiffen and lose rom and more scar tissue formed. I'm now booked Jan 31/05 to have revision surgery. Can you tell me if this revision surgery is like the tkr surgery? Will I be in hospital as long as first time, do they cut the muscles again, will I need as much pt this time etc. Any help would be GREATLY appreciated. Thanks very much, Terry
Posted by Sandy_F (Sandy_F), 26 October 2004
I will know about the surgery in a few days. I am scheduled for October 29. I will at a minimum have the spacer changed and scar tissue removed. If the metal has problems, it will be a full revision. I am scheduled to be in the hospital the same amount of time as I was for the original TKR. It will be the same type of incision, probably using the same scar. I expect PT to be the same or even more extensive because of using a larger spacer (more work for rom).
Posted by Jan_L. (Jan_L.), 12 November 2004
A revision is a bit more involved than the original surgery. I had my TKR 12/04/04 and am also about to have a total revision.
Posted by hmaxwell (Heather M.), 12 November 2004
Just a quick question....why would you need a revision of your TKR if scar tissue is the problem? Does the doctor think there is a faulty component or infection in there?
Just curious, as I've been fighting the scar tissue demon for some time. It can explain a variety of problems and symptoms, and can be disabling in the worst of situations.
Heather
Posted by tmlf959 (tmlf959), 15 November 2004
Hi Heather. I'm not exactly sure why he is doing the revision. When I saw him last he felt that it was the only option for me as the manipulation and arthroscopic surgery didn't help. I did six weeks of daily therapy one and a half hours a day following the removal of scar tissue, and still had no improvement in ROM. He did say that there was no quarantee the scar tissue wouldn't return after the revision, but that he felt this was our only hope.
Terry
Posted by hmaxwell (Heather M.), 16 November 2004
Terry,
I really urge you to look into arthrofibrosis and methods to rehab to keep it from coming back. It actually is possible for the scar tissue to come back even when you've done gentle PT--this is either because it wasn't all taken out in the first place, because there might be a low-grade infection, because heat and swelling in the knee were not controlled post-op, etc. The mechanisms for scar tissue formation are very poorly understood, and very few surgeons see a lot of severe cases. There are a few surgeons in this country who have done a lot of research and who might be able to give you a second opinion. Before you take out what might be a perfectly good knee prosthesis, I'd seriously consider seeing one of them to see if you have any other options. I was told by my surgeon (who specializes in scar tissue cases) that it might take two or more scopes to get all the scar tissue out and keep it from coming back.
Anyway, I'm not a doctor, but before you do a MAJOR procedure like a revision--when the original was never working right in the first place--I really urge you to get some other expert opinions. There are doctors who specialize in scar tissue/arthrofibrosis in OH, MI, NY, IN, CO, UT, CA and a couple other places in between. Please consider seeing one of them. I stayed with my original surgeon--who didn't know how to deal with the scar tissue, despite being an excellent and in demand OS--way too long. If I'd gone to see an expert earlier, I might be back hiking right now. I didn't know that I had a choice.
Posted by Jan_L. (Jan_L.), 16 January 2005
Hello Terry,
I am pretty much in the same situation you are in. I had a TKR 12-3-03 and developed a stiff knee despite two MUA, I still have limited range of motion.
I spent last weekend researching medical journals to try and understand why my doctor suggested a full revision instead of just dealing with the scar tissue. What I found out is that the scar tissue can be the result of a problem with the implant, such as the implant is the wrong size, mal-rotated.... My doctor is going to use a different brand of implant when I have my revision, how about you?
I have changed doctors for my revision, I am seeing a doctor who's practice is limited to joint replacements, that's all! I am only 49 so I wanted to be sure that whoever did my revision was an expert.
There are several of us here in your situation, stiff knee following a TKR. We have been exchanging info under the "Soft Tissue Healing problems" section, sub-topic is "TKR/arthrofibrosis". If you would like more info take a look there.
I was also wondering, how old are you?
Good luck with your surgery!!
Jan
Posted by tmlf959 (tmlf959), 17 January 2005
Hi Jan, I am 45 years old. Yes my doctor is going to use a different type of implant this time. He is not sure what caused the scarring problem and is going to start up some type of study with a couple of other ortho docs in our area to try and figure out what the problem is with all the excess scarring. I am not changing doctors as he is the top guy in knees and hips in our area and I have 100% confidence in him. Part of my problem is that I am diabetic and I heal differently than most people, but he doesn't think that that is the whole problem, it just contributes to it. Thanks for the info about the soft tissue healing problems section, I will be reading up as much as I can in the next few days. I am feeling very anxious about my upcoming surgery (Jan 31) and am not sleeping very well, so I'll be doing a bunch of late night reading on the forum. I'm off to donate blood for my surgery so bye for now. Thanks again, Terry
Posted by Teresa_S (Teresa_S), 18 January 2005
Terry, I had a tkr on 10-07-03 and a partial revision on 10-08-04. One year and one day later. My initial problems is that the knee would not bend well, and it kept swelling and being hot to touch, and constantly hurt. I could not sleep, and it kept getting worse. My OS tried to convince me I had RSD, and I just laughed and told him , that seemed to be the cop outdiagnosis whenever they really didn't know what was going on. I kept feeling these deep ropelike adhesions, and knew,from experience that I form really dense thick adhesions. I had an mua on 01--04, after the tkr, and it was encased inscar tissue. If you have read some of the artrofibrosis articles, and seen the pictures, my knee looked exactly like those in the scope pics. Everything was white, covered in scar tissue, and none of the landmarks were identifiable until the scar tissue had been cut away. IT turned out there was a problem with the prosthesis itself also, as the months went by. After Jan, 2004 MUA I rehaved the knee to being pretty good for several weeks, then it just went backwards like it had right after the tkr, and the therapist could not force it to bend.It got worse and hurt more, and IN April, the OS told me there was nothing wrong with it, and basically ignored me for months. I saw three other DRs. who told me it was the wrong implant, and needed to come out, but did not want to touch me because the original had done so much surgery. In July, I felt something in the knee break loose, and called the OS, but no call back, and a couple of weeks later, felt it moving around especialy when I tried to bend the knee and called him again, but no call back. The knee was extremely hot and swollen, and he finally ordered a scan that showed possible bone infection. In Sept. he finally took a plain xray that showed that the safety screw had broken off and was lodged in my knee. So IN Oct. 2004, I had the spacer replaced, a couple of screws, and several larger areas of scar tissue removed, AGAIN, and since then it has actually had greater flexion than after the original surgery. The recovery room where I awakened, was a nightmare, as I could not get the pain under control. I used the CPM and was up on it the next day. Once I got up and down several times, the actual recovery of walking on it, etc. was easier than the first time. BUT THE QUAD has been extremely difficult to rehab, after being cut and sewn together again twice in one year. I have huge knots in the quad and the operated kneeis about twice the size of my other. I asked my physical therapis if they were all like this and he told me no, mine was the only one he had seen that has so much difference in size. I didn't donate or get blood the second time, but did drop my hemaglobin 3 grams, THE surgeon told meblood loss was less than 50 cc. but I watched the nurses empty the cell saver of 100-250 cc every shift for the two days, before they knocked it loose and out of my knee. MY stay was surgery day, the next day, the next day, and home on the third post op day.I had not masteded stairs, and my flexion was around 75 degrees.The surgeon never has rechecked my blood workYou do not drop from 13. 4hgb. to 9.0 with a 50 cc blood loss. I have been tired and wore out.I was weight bearing to tolerance. I have really been rehabing the quad. NOW a dr. at Columbia MO and an engineer from the UNIVl of MO have developed instruments to go and do a total knee through 2 small incisions, sparing cutting the quad and making the recovery much quicker as the quad is the hard part. Best of luck, if you want to ask me anything else, feel free. Teresa
Posted by Jan_L. (Jan_L.), 18 January 2005
Hi Terry,
I am so glad to hear you have a doctor that is top in his field when you are having a revision, that is so important. It's also important to trust your doctor, so I think you are off to a good start. I wish you the absolute best with your surgery. I was also pleased that your doctor is talking with other doctors. My doctor told me that 2 years ago he would not have been able to help me but just in recent past there has been new info on how to deal with this (stiff knee). I know there is a lot of stories of surgeries going wrong here but keep in mind that those that do well after their surgery don't go to knee web sites, there off living their life with the new knee. So there is every reason to believe you will do well!! I will be following in your footsteps, my surgery is scheduled for March 18th. I would appreciate it if you kept in touch. Good luck!
Jan
Posted by Teresa_S (Teresa_S), 19 January 2005
Terry, I apologize as I didn't notice at first, that your original post was in Oct. You must be getting close now, and I wish you the best. I really didn't know when I went into surgery if I was to have a scope , open surgery, or partial or full revision. But awoke in so much pain, I knew right away that the quad had been cut again. Whether or not, it was because I had done it before, or whatever, recovery moved faster as far as being able to get in and out of bed, etc. up and down from the toliet, etc. but it is now three months later, and am still stuck in PT and not making any great progress. I hopeyou have a better, more caring surgeon, as mine walked into the room and said"Why don't you just sue me and get it over with?" DUH? Best of luck, in your surgery and recovery. Teresa
Updated Mon Dec 1 2008