My husband developed arthrofibrosis after TKR. He went in to remove some scar tissue to improve his range of motion and developed a deep tissue infection from the hospital. This led to a debrinement procedure to remove the infected tissue along with several pounds of scar tissue. After six weeks of IV antibiotics and six months of oral antibiotics the infection was still present. Then they removed the hardware, infected tisssue and put in a temporary knee. We then discovered that his original knee was too large and not placed properly causing his leg to face outwards. The surgeon reshaped his tibia and femur and corrected his gate. After six weeks of IV antibiotics the infection was gone. Three weeks ago they removed his temporary knee and put in the permanent revised knee. Under anesthesia they were able to get his knee to 110 degrees. They did adjust his patella and removed scar tissue from his quadricep. We had met with several surgeons before the first tweaking procedure and had decided it was worth the risk to remove a small amount of scar tissue to improved range of motion. On the bright side he would not have been able to under the care of the revision specialist to correct the implant if he hadn’t developed the infection. He is currently using the continuous passive motion machine and will be graduating from home pt to in person pt next week. We are worried that if we do not push the movement in these first few weeks he will develop more scar tissue and never regain his range of motion. We are looking advice on how to use the continuous passive motion machine and pt to help him regain maximum range of motion without aggravating his arthrofibrosis.
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Hi Joanna,
Thanks for your message, your husband has has been through so much!! You're probably aware that I'm not a clinician, and I can't give medical advice, but I can share my thoughts based on the science and my experiences.
I'm glad that your husband is using CPM, the more that he can do this in the early post-operative phase, the better, some people sleep on it to prevent the adhesions and contractions that are particularly strong in the early post-op phase. However, it is Really important to do CPM in the pain-free range, it's not intended to force range of motion, and if it makes the knee unhappy he should back off. Some discomfit is OK, you'll find more about what I mean and other good info about CPM on this page https://www.arthrofibrosis.info/cpm
Your husband has likely been advised to keep icing and elevating as well, and to use crutches to support the healing joint. The period of time that people need to use these therapies varies with the individual, and how the knee feels is the best guide. Some people need to be on them for several months, and there is no downside to this, apart from inconvenience.
Please don't be tempted to rush or force the knee in any way, his biology is in total control and the best approach is to keep it as happy as possible. It will take time (many months) to settle the knee and this can't be rushed. I suggest that anything that makes the knee unhappy during, or afterwards, is stopped for a time. It's not possible to build muscle while there is a lot of pain and inflammation, and exercising the affected leg will likely cause worsening of symptoms, at this point in time.
Scar tissue is a normal reaction to surgery and your husband should expect that some will return, along with some reduced range of motion, but this is normal. Please don't let anyone try to forcefully bend the knee (or straighten it), even minor tissue tears are a powerful stimulus of fibrosis. The IAA believes that the only one who should have "hands-on" should be the affected person, because only they can feel the limits of their range of motion.
Your husband may benefit from a telehealth consultation with one of the most experienced arthrofibrosis physiotherapists in the world, Sebastiano Nutarelli. His contact is info@eukafcenter.ch
Many other physiotherapists don't understand arthrofibrosis pathology and believe that they have to force "compliance" of the joint, which I feel is a very dangerous approach, and we're trying to counter this idea.
All the very best, and please feel free to ask more questions.
Kayley