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Author Topic: Arthrofibrosis after tkr  (Read 1052 times)

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Offline Doula1st

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Arthrofibrosis after tkr
« on: January 28, 2018, 12:41:57 AM »
I am 55 years old and lead a pretty active life. I am no longer athletic since I have had arthritis in knees for many years. But work on my feet and do a lot of walking. My arthritis pain and swelling were was keeping me from being as active as I wanted to be. I elected to have TKR on my left knee. Researched to get a great surgeon, he picked the Smith and Nephew product that preserved my ligaments. They also needed to replace the kneecap.

My surgery was 8/15/17. PT 2-3 times per week. Developed arthrofibrosis anyhow, had MUA on October 30th. He was able to break up scar tissue and I returned to aggressive PT the next day which was extremely painful, but I dealt with it. 

Now more than 5 months after TKR and 3 months after MUA I am stiffer and in more pain than ever.  My surgeon has not seen this often he says, said I may need another surgery in the future but wants to see me again in 3 months to check on flexion. Said I may want a second opinion.

I already did my second opinion appointment with a surgeon in Seattle. He did bloodwork (negative for infection) and also ordered a CT scan without contrast and aspirate of knee fluid. I read results but that surgeon has not reviewed them with me yet because he is out of office for another week. The CT shows 2 small bone fragments (he did xray in office and thought he saw a piece of bone, which is why he ordered CT) it also states there is a retained osteophyte on the posterior condyle. We already know I have bad arthrofibrosis. CT made no mention of that - not sure if it just doesn't pick that up.

I assume I will need surgery to clean out the fragments. Is there any significance to a retained osteophyte?

I feel like a disabled person because of the pain and not able to walk properly. I have a flexed gait because of bad extension. Flexion I am sure now is worse than 90 degrees. I am scared of not having a normal life. I need to know if there are any specialist that would clean out the arthrofibrosis after knee replacement. I emailed a specialist in CO in Vail who does not do consults on arthrofibrosis after knee replacement. :(   please help.  I live north of Seattle in Snohomish County but willing to travel if needed.

Offline mdurkin1918

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Re: Arthrofibrosis after tkr
« Reply #1 on: March 02, 2018, 05:26:16 PM »
Hello,
I too have your issues.  I had a bilateral tkr in November of 15' at age 45.  I have had 9 surgeries including 1 after my TKR.  A lysis of adhesions which was done arthroscopic-ally. 
I have found that this chronic stiffness affects about 10% of TKR's.  I have spent the past 2 years trying to increase my range of motion, with little success.  I currently have only 90% flexion in my left knee.  It's a little debilitating for me at age 47. 
The bad news is that there is no real solution to this problem.  I have worked with some really great PT's and some of the best surgeons in the world.  I had 8 of my surgeries done at HSS in NYC.  There are currently some OS's working on trial programs for arthrofibrosis and chronic stiffness.  Bur they are only in the early stages.  Again, there is no clear solution to chronic stiffness. 
The right thing to do is to rule out all the curable causes.  Make sure there is no infection, or metal allergy.  Make sure the prosthetic is properly aligned and spaced.  If those things are good, then it's probably arthrofibrosis. 
Patience is key.  Take care of your body.  Try and exercise as much as possible without stressing the knee.  don't ignore your core.  Keep your weight under control.  Try and maintain your ROM.  Keep up your hip and ankle mobility.  These things are challenging given the lack of mobility in the knee, but do your best. 
Continue to see your OS,  at least once a year.  My guys tell me there is some improvement up until the five year mark.  And hopefully, they will find a solution. 
I've also had some success with kneearthrofibrosis.com.  It's informative. 
There were some patients on there that did a scope to remove the scar tissue, then they immobilize the knee for 3 months to let it heal.  light strengthening only.  Then, after a long time, they gain mobility back. 
For my situation, I feel i will need a revision to get improvement.  But I'm 47.  I have young kids and I'm still very active.  I am waiting it out.  I stay active without stressing my bad knee.  I do a lot of yoga.  For me, i'm very worried about my surrounding conditions.  I can see the lack of ROM in the knee leading to back, hip, or foot problems.  So I try and remain as flexible and mobile as possible. 
Best of luck...
 















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