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Author Topic: TKR - limited ROM, arthrofibrosis, swelling, warmer  (Read 285 times)

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Offline Mike from Tasmania

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TKR - limited ROM, arthrofibrosis, swelling, warmer
« on: June 10, 2021, 01:27:27 AM »
Hi

As a result of osteoarthritis degradation, I had a left total knee replacement in July 2020.  Initially, I had about 10/90 - 95 ROM. At my first post operative consultation with the surgeon, we agreed the ROM was unsatisfactory and he suggested MUA.  I agreed.  About three weeks later at the next consultation, the ROM was no better, so he suggested another MUA.  He further suggested the use of a CPM.  I agreed. I spent two days in hospital after the MUA strapped into the CPM for about 12 hours +/- per day.

After the first and second operations (TKR & MUA), I carried out the exercises as instructed in the documentation provided after the TKR.  After the second MUA and CPM I went to see a physiotherapist (who had considerable experience in treating knees at a well known major Australian hospital) who has been working with me on a regular basis since.  However, whilst some improvement may have occurred in ROM, it has reverted to about 10/80, now.

The Physiotherapist says we are “breaking up the scar tissue” - very slowly.  I am not convinced I will ever get back the ROM required to get back on my bike, or drive a car with manual gear change.  (I am 68 years of age, recently retired (comfortably), starting riding a mountain bike at 65, and have an old (manual) Porsche 911 requiring work, that was to be my retirement project.)

Further I suffer from Dupuytrens Contracture in the hands.  This is a “scarring type disease” and may indicate some sort of immune problem (causing scarring) as part of my genetic make-up.

To complete my story and add to my ROM problem, I recently had a fall (from 2.5 metres) and landed on the left side of my back braking 11 out of 12 ribs. No further injury to my left knee!!  It has taken several weeks to get over the ribs which appear to be (nearly) healed up.  Moving about during this period has been a bit difficult, and I have obviously been holding myself badly which has resulted in sciatica pain down my left leg.  Wow, what fun life has been over the past 10 months!

During my period(s) of recovery, I have watched a lot of YouTube, including Knee Guru videos.  I also saw an arthroscopic debridement of knee tissue from a knee (Surgical Treatment of the Arthrofibrotic Knee/Orthopaedic - shoulder specialists - dated 7 years ago??!!

Can anyone advise if arthroscopic removal of this scar tissue will result in increasing my ROM, not result in more scar tissue replacement (and therefore reduced ROM again!), and if such operation is carried out by surgeons in Australia - hopefully Tasmania?

Thanks for any contributions, I am getting desperate!

Offline vickster

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Re: TKR - limited ROM, arthrofibrosis, swelling, warmer
« Reply #1 on: June 10, 2021, 08:10:53 AM »
Sorry to read about your issues.
There’s a list of surgeons with an interest or expertise in arthrofibrosis here. Just one in Australia, in Sydney.
He might be able to connect you with others?
https://www.kneeguru.co.uk/KNEEnotes/primers/whos-who-knee-surgery/whos-who-arthrofibrosis-surgery
Good luck :)
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline DogfacedGirl

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Re: TKR - limited ROM, arthrofibrosis, swelling, warmer
« Reply #2 on: June 10, 2021, 09:57:55 AM »
Hi Mike,
Are you still having pain after exercise? If so, you are likely still in the inflammatory phase, and need to do everything you can to reduce inflammation. This phase can become permanent if the inflammation continues for too long. There is a new webpage to help people with AF it's at https://arthrofibrosis.info

It's based on best evidence and has references for the info.
If you're in the residual phase - that is, no pain but only stiffness, then the scar tissue can slowly break down over time, but it might take be years.
However, exercise increases inflammation so if you have pain after exercise you need to back right off, it will make your knee worse. CPM in the pain-free zone should help to reduce inflammation and slowly increase ROM, but you'll need to do it every day. It's passive, so it's  not considered to be exercise.
Your fall would have increased systemic inflammation and would not have helped. 
An arthroscopy (and MUA) will be traumatic and will definitely increase inflammation, and there is a real risk your knee will become worse. This risk is perhaps more significant for you because you have a genetic predisposition to scar tissue formation. However, nobody can say for sure how any individual will respond to surgery.
I'm not aware of any surgeons in Australia who actually have a good understanding of the pathology of AF, although many will "have a go". Please let us know if you find one.
All the best,
Kay (from Australia)
1999 Osteoarthritis both knees, chondroplasty
2004 MACI graft L knee
2005 MACI graft both knees
2007 MACI graft R knee
2007 Patella baja
2011 TKR both knees
2011 arthrofibrosis

Offline John42

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Re: TKR - limited ROM, arthrofibrosis, swelling, warmer
« Reply #3 on: June 10, 2021, 04:36:53 PM »
Hi from Manchester UK


The only contribution I can offer is two fold

1)  change to an automatic geared car, otherwise you will miss so much after a short period of time.
2) Sleep with a pillow/cushion between your knees - this aborbs the pain and gives you a better nights sleep.
Otherwise, am afraid you are on a very long road to full recovery - just listen to your knee.   JohnK/Manchester UK 
Ruptured Patella Tendon January 9 2003
Slipped on black ice.  Manchester UK

Complete Ruptured Tendon















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