Tim
14. Okt. 2025
After suffering from left knee pain for two years, and receiving three monthly steroid injections that became progressively less effective, I underwent a total knee replacement in August 2024. The operation was carried out in Portugal, where I live for most of the year. Following the surgery, my knee was painful and stiff, as expected. My consultant prescribed two months of daily physiotherapy. During the first month, things appeared to improve well, but then progress seemed to stall. My physiotherapist insisted on increasing the exercises, but they became very painful, and the stiffness did not improve.
As a keen cyclist, I had hoped to be back on my bike within three months, but this was impossible — I didn’t have the range of motion (ROM) needed for a full pedal revolution. I decided to change physiotherapists, and the new one was much more considerate. She worked hard to improve my ROM. My consultant ordered further investigations — X-rays, echo scans, and blood tests — but could not find any problem. He insisted that the surgery had been successful and that I just needed more time to improve.
At that point, I began doing more detailed research into my problem. I couldn’t understand why everyone else I spoke to who’d had the same operation seemed to recover well. During my research, I came across a condition called Arthrofibrosis, and a support group called the IAA. Everything I read, and all the videos I watched, convinced me that this was what I was suffering from.
By coincidence, I discovered that Dr. Kayley Usher, who runs the IAA, is based in Perth, Western Australia — where my daughter lives. I contacted Kayley, and she was extremely helpful. She suggested I have a Cytokine Panel Blood Test, which could help diagnose the condition. I couldn’t find a lab in Portugal to do this, so I arranged to have the test done when I next visited Perth. However, the results were inconclusive.
At my next appointment with the surgeon, I told him that I believed my problem was due to Arthrofibrosis. He disagreed — I suspect he was not familiar with the condition. Instead, he suggested a skin patch test to see if my symptoms were due to metal sensitivity. After contacting the manufacturer of the prosthesis (Smith & Nephew), he found that the joint was 80% titanium, which is normally considered hypoallergenic.
The skin tests showed a reaction to titanium salts. Based on this finding, my surgeon said revision surgery might be necessary — my worst fear, as I know how difficult that operation can be. I did more research and contacted Kayley again. I discovered that skin patch tests for titanium are often inaccurate because titanium salts don’t penetrate the skin, and any reaction is usually caused by the acidity of the chemical.
Kayley told me about a newer and more reliable test for metal sensitivity called the MELISA test. The nearest lab that offered it was in Spain, about 350 km away. I arranged to have my blood taken by an affiliated clinic in Portugal, and the sample was couriered to Spain. The results showed no sensitivity to titanium.
By this time — ten months after the operation — my symptoms were still the same: stiffness, general discomfort, pain on stairs, pain and locking at night, and limited range of movement. I continued with weekly physiotherapy, and my physiotherapist — now familiar with Arthrofibrosis through the IAA website — managed to improve my ROM slightly, but we couldn’t get it beyond 105 degrees.
I had now narrowed down the possible causes of my symptoms.
The prosthesis was correctly fitted (confirmed by X-rays and scans).
I did not have metal sensitivity (confirmed by the MELISA test).The only remaining possibility was a low-grade infection.
To test for this, a needle aspiration of the synovial fluid was required, followed by a two-week culture to check for bacterial growth. My surgeon refused to do this, convinced there was no infection and concerned that the procedure itself might introduce one. While visiting Perth again, I arranged to have this test done there — the result was negative. This process of elimination confirms to me that I am suffering from Arthrofibrosis — not a severe case, but enough to disrupt my normal activities and reduce my quality of life.
From the excellent IAA website, I’ve learned that another operation — arthroscopic lysis of fibrotic adhesions — can help, but I haven’t been able to find an orthopaedic surgeon in my country experienced in this procedure. I will not risk having it done by someone without expertise, as I fear it could make the fibrosis worse. It may be that I have to accept my knee as it is. At least I can still walk and ride a modified bike for short distances. My current dilemma is that my other (right) knee has now become very painful when I walk. I had three months of relief from a Synvisc-One injection, but the benefit has now worn off. One thing is certain — I will not be having another total knee replacement!
In conclusion, I am deeply grateful to Dr. Kayley Usher and the contributors to the IAA website for helping me understand and diagnose my condition, and for giving me the knowledge to question what I was told by my surgeon and my first physiotherapist.