Continuing pain and ROM problems 7 month after TKR

[GordieO]

I'm an 85-year-old male who has been active with racquet sports and golf most of my life until the last 3 years. I had TKR (L) in Sept. of 2023. ROM, particularly extension, was problematic after three months and remains so today. Apparently, I grow scar tissue rapidly, and together with swelling that hasn't improved, have subsequently had two MUAs, on Nov. 9, 2023 and the latest on Jan. 23, 2024. The latter included being in a full leg cast to hopefully result in improved extension. The surgeon said I would be in the cast for 4 - 6 weeks. Actually, it was only 2 1/2 weeks because I was complaining of discomfort in my heel. Removing the cast revealed a severe wound slightly above the heel, which I'm still being for. Until today, I was going faithfully to P/T 2 -3 times a week as well as exercising at home. I changed from the clinic's group of therapists to a private company that I thought might be better, yet I'm still struggling because of the swelling, the knee pain and the wound on my heel. I made the decision to stop P/T and also limit my home exercising as well until I can get the pain and swelling under control, if that's possible. I met recently with the PA who said that one option might be complete revision of the surgery. She may have said some other things, but the thought of doing this all over again prevented me from listening attentively any further. So, I am getting a second opinion from another orthopedic surgeon on May 2nd. I am asking you all for help in what specific questions I need to ask him regarding viable options other than a revision. There’s been no imaging done, so I plan on asking about that. I would really appreciate any help you could provide.

[The_KNEEguru]

I refer you to this article, which is easy to read - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836076/ - "The stiff total knee arthroplasty: causes, treatment modalities and results"

Firstly, you should find out from your medical team your status apropos diabetes, as any diabetic tendency will likely interfere with the healing of your heel wound.

The two MUAs were done within a decent timeframe and don't seem to have helped much, so it is possible that we are talking now about arthrofibrosis. So you can ask the surgeon if the problem is likely to be arthrofibrosis and if so ask about how this might be managed at this stage.

Dr Noyes' course will give you information - https://www.kneeguru.co.uk/KNEEnotes/ar ... management. So you could ask if it is likely that localised arthrofibrosis might be tackled with a 'lysis of adhesions' - where scar tissue is sort of 'melted' via an arthroscopic procedure. Also read about 'posterior capsulotomy'.