Losartan & upcoming lysis of adhesions again

I'm wondering how long someone is tentatively on Losartan after surgery? I had a knee scope done last September with no issues, then this March had a partial knee replacement. In May I had removal of lysis of adhesions and now I have to have another surgery due to arthrofibrosis this week. I've been using Dynasplints daily since July but It hasn't helped a great deal as I feel it was too long after surgery that I started using them. This time I will have them right off and also a CPM. I'm also a PTA so I've been doing my own PT at home. I never thought I was too aggressive as I've been working with patients for 24 yrs with no issues but haven't really had patients with arthrofibrosis. I will back off on strengthening and focus mainly on gentle ROM. I do wonder though approximately how long after surgery to gently start strengthening and more active stretching? My surgeon will also be using Seprafilm off label to put over the implant to also help prevent scar tissue. In the past Prednisone was the only thing that helped with edema. I'm very surprised to read the literature stating it can actually cause edema. My surgeon is thinking of prescribing Losartan for me, I'm wondering how long is someone tentatively on this medication after surgery? I'm in the US in Florida and there are not a lot of surgeons who are trained in arthrofibrosis.

Jessica

7 answers0 replies

7 Comments

Jessica Gagne

Nov 12, 2023

Is it better to take my Losartan at night versus the day? It doesn't say on my prescription it's only one pill a day but I'm wondering if it would be more effective before bed if our bodies tend to make more scar tissue when we're sleeping?

kayleyusher

Nov 13, 2023

Replying to

Hi Jessica,

I don't know for sure, but I doubt there would be much difference in terms of scar tissue and the different timing, so long as you take Losartan at the same time each day. Losartan down regulates the activity of myofibroblasts, which includes scar tissue and adhesions, but these can occur at any time. Although I guess that adhesions are more likely to occur overnight due to immobility, so an evening dose might be better, but several hours before bed because it might increase urine production in the short term.

Kayley

Jessica Gagne

Nov 07, 2023

Do you happen to know if one works better then the other between Losartan & Metformin?

kayleyusher

Nov 07, 2023

Replying to

Hi Jessica,

There isn't research to test this question for the treatment of arthrofibrosis. However, I understand that people can be on both at the same time.

Kayley

Jessica Gagne

Nov 07, 2023

Replying to

Your responses are very appreciated. I wanted to share this link in case it can help anyone and see if you have heard of Bromelain.

Potential role of bromelain in clinical and therapeutic applications

I started taking it in September but have stopped for the last week prior to surgery only because of certain supplements being needed to stop to prevent bleeding with surgery. I plan to continue with it. I originally started taking it for my Hashimotos hoping it would help with the edema and puffiness I have throughout my body and the inflammation in my knees. I'm hoping it'll work in conjunction with whatever med he puts me on after surgery to keep the scar tissue away. It also lowered my cholesterol too in only a month of taking it. I took 500 mg twice a day.

Jessica

kayleyusher

Nov 08, 2023

Replying to

Hi Jessica,

Thanks for the link, that looks like an interesting article. As you're aware, there are a lot of possible products out there that might help (and I haven't had time to look at this paper in depth) so I did a quick check on ConsumerLab. They say that there is not good evidence yet that bromelain works as an anti-inflammatory. That's not to say bromelain doesn't work, and I'm not trying to put you off!

It's definitely best to keep your Hashimotos well controlled with medications, since thyroid problems are a known risk factor for arthrofibrosis.

All the best,

Kayley

kayleyusher

Nov 07, 2023

Hi Jessica,

Thanks for your post. It would be best to ask your prescribing doctor about the duration of Losartan treatment, but the post-op inflammation and healing that drives arthrofibrosis would likely take a minimum of 3 months to settle down, given that your knee has a history of scar tissue. This would suggest that at least 3 months on Losartan would be helpful. You might also want to enquire about metformin, this is very safe and reduces fibrosis, while some people on Losartan have their blood pressure reduced too much. As you've probably read on this site, aspirin can also help if it's tolerated.

I’m glad that you’re backing off strengthening the affected leg! Obviously, you can still exercise other parts of the body, so long as your knee is OK with that. As mentioned, given that your knee has arthrofibrosis I would expect that it would take at least 3 months for it to settle after the next surgery, but as you know, this varies greatly. The main message is not to rush into it, a lack of quad strength is a natural result of surgery, and when your inflammation subsides, the quads will naturally regain strength. If it was my knee I would leave exercising the post-op knee/leg for 3 months and then gradually start exercising it, and see how it goes. I would take it very slowly and carefully, and immediately back off anything that upsets the knee and wait a good while before trying again. Perhaps the hardest part of post-op recovery for people who are used to being very active is staying off your feet for long enough to allow the Hoffas fat pad (IFP) to recover. The use of crutches for 4 to 6 weeks post-op, or longer, is recommended by PTs who are experienced in treating arthrofibrosis.

If you haven’t read the section about surgery, and the surgical checklist on this site, that could be helpful as well, as surgical technique for treating arthrofibrosis can impact recovery.

Please feel free to ask more questions.

Kayley