When The Scar Heals
- Push & Pull: Imagine that you have divided the scar into sections 2 finger widths apart. Place 2 fingers in the left most section and move it in all directions of a clock . Where ever the scar feels stuck hold this position for 60 seconds. You will feel a strong pulling or light burning. Then move to the next section until you have massaged the whole length of the scar. When the top layers of skin move more freely try to press a little deeper to get to a deeper layer of the scar.
- Skin Rolling: Pinch the skin on either side of the scar, lifting the skin up. Start at either end and move forward and backward, rolling and raising the skin as you move. A free scar bulges upward, a stuck scar will dimple.
- Stroking along the Scar:Massage the scar tissue by working it with a rubbing motion along the grain. You can move your fingers apart along the length of the scar as if you are trying to make the scar longer.
- Plucking: Put your index finger on one side and thumb on the other side of the scar. Try and lift scar up, separating it from the underlying tissues. If the skin slips out of your hands, you may not be ready for this stage.
The sensation you feel when you massage your scar is one of strong pulling or light burning, NOT sharp pain. Sharp pain is as if you cut your fingers with a knife. Scar massage should NOT feel like that.
Massaging scar tissue has many benefits. Here are of the main reasons to regularly scar massage :
What Causes A Stiff Knee After Tka And How Can It Be Prevented
Dr. Jesse Otero answers ICJRs questions about the most common causes of knee stiffness after total knee arthroplasty, what to do if a patient presents with stiffness, and when to consider a revision procedure.
ICJR: What is the definition of a stiff knee after total knee arthroplasty ?
Jesse E. Otero, MD, PhD: The goals of TKA are to relieve pain and restore function in patients with moderate to advanced osteoarthritis who have exhausted conservative treatments but still have knee pain that interferes with their activities of daily living. In most patients minds, the ideal result of TKA would be a knee that moves and feels the way it did in a more youthful time.
Before discussing stiffness after TKA, it is essential to first review normal native knee motion in relation to the activities patients routinely perform. Laubenthal et al presented a quantitative analysis of knee motion required to achieve normal activities of daily living. In this classic article, the authors used an electro-goniometer to show that on average:
- 83° of flexion is required for climbing stairs
- 93° of flexion is required for sitting
- 106° of flexion is required for tying a shoe
- 117° of flexion is required for squatting to lift an object
The widely accepted target after TKA, based on this study, is 120° of knee flexion. In objective terms, therefore, knees that fail to achieve 120° of flexion after surgery are commonly considered to be stiff.
ICJR: What are the most common causes of knee stiffness?
Knee Replacement Pain A Year And Beyond
The goal of knee replacement surgery is to help you get back to the activities you love. Your doctor will encourage you to stay fit through activities like swimming, cycling, and even golf. This type of exercise will help you stay limber and pain-free.
On the contrary, there are certain activities that could negatively affect the prosthetic joint materials in place. Even normal use will begin to wear out the implants, but excessive weight or activity can cause your knee replacement to loosen and become painful. You may need to avoid running, jogging, high-impact exercises, and contact sports for the rest of your life following surgery.
The good news is that studies show more than 90% of total knee replacements are still functioning properly 15 years after surgery. Staying healthy and following the advice of your doctor will help you achieve these long-term benefits.
While its possible for pain to persist for a year and beyond, it shouldnt be debilitating. Scar tissue can continue to heal, as well as the muscles in your knee, but if youre suffering from ongoing pain after a year, always talk to your doctor.
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How Long For The Tightness In My Upper Thigh To Go Away After A Full Hip Replacement
I am 48 and had a full hip replacement on Dec 27,2017 as an outpatient procedure. The success has been remarkable. I was able to walk without any support about a week after surgery. I did physical therapy for four weeks after and even my therapist said I was healing very quickly and my progress was great but not normal. I was in severe pain before the surgery as I thought the pain was coming from sciatica and was making it worse by treating it like a back injury. Once I was diagnosed and had the surgery the relief was so great that I believe that is why I have healed so well. My only lingering problem 4 weeks post op is my upper thigh on my replacement hip leg is still tight. I know it’s from months of limping along on a bad hip but now that it’s fixed any idea how long until it loosens up? My PT says it could take month’s to fully stretch out and gain flexibility. Is there anything I can safely do to help it along. It is the only thing left from keeping me from feeling “normal” again. Thanks.
How Long Does It Take To Recover From A Knee Replacement
For most people, it will take three months after surgery before they can do their regular activities again. It may take six months to a year before your knee regains full function.
How quickly you recover from surgery will depend on your:
- how strong your knee was before surgery, and
- whether you have other health problems like diabetes or rheumatoid arthritis.
These diseases weaken your immune system and can slow down healing.
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Should I Still Have Pain 6 Weeks After Hip Replacement
In fact, a program of physical therapy exercisesbegun immediately after surgeryis a critical component of your rehabilitation. Up to 6 weeks after surgery, you can still expect discomfort at night and when you move about, although it should not stop you from performing most activities of daily living.
Looking For Alternatives To Total Knee Replacements
We’re also funding research which is investigating alternative approaches to total knee replacement. For example, total knee replacement is not recommended for many young people. This study aims to develop a new method called ToKa®, which uses images of the patient’s joint and specially designed software to design a patient specific implant that will be made via 3D printing. If successful, this technique could prevent osteoarthritis patients from needing total joint replacement.
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Pain After Knee Replacement: Six Months
If you are still experiencing pain six months after surgery, you may be wondering how long it will be until you feel normal again. Unfortunately, there is no easy answer.
In some cases, it may take up to a year for all of your swelling to completely go away. Your knee will continue to recover for years to come, as scar tissue forms and your muscles become stronger with continued physical therapy and light exercise.
As previously mentioned, if you are still experiencing debilitating levels of pain at this stage, you could be suffering from chronic pain. While you may be tempted to tough it out, its important to talk with your doctor. Together, you can find what is causing your persistent pain and come up with a plan to fix it.
Why Is Knee Warm After Total Knee Replasment
Basically, the body increases blood flow to the knee region to support the healing process. This increased blood flow results in the warmth, swelling and redness often experienced by the patient. As the healing process progresses, the warmth, swelling and redness dissipate. The warmth can take 6 months or longer to resolve.
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Possible Benefits Of Total Knee Replacement Surgery
Regardless of whether a traditional total knee replacement or a minimally-invasive partial knee replacement is performed the goals and possible benefits are the same: relief of pain and restoration of function.
The large majority of total knee replacement patients experience substantial or complete relief of pain once they have recovered from the procedure. The large majority walk without a limp and most dont require a cane, even if they used one before the surgery. It is quite likely that you know someone with a knee replacement who walks so well that you dont know he even had surgery!
Frequently the stiffness from arthritis is also relieved by the surgery. Very often the distance one can walk will improve as well because of diminished pain and stiffness. The enjoyment of reasonable recreational activities such as golf, dancing, traveling, and swimming almost always improves following total knee replacement.
Infections Of The Surgical Site
By 2030, experts estimate that there will be up to 3.48 million knee replacement surgeries in the US alone. They also say that a rise in knee replacement revisions will contribute to this growth. All in all, they project knee revisions to grow by 601% from 2005 to 2030.
Infections are some of the possible causes behind knee replacement revisions. Most infections occur within the surgical wound itself. However, harmful germs can also invade the area around the artificial knee implant.
Researchers say that infections can affect between 0.4% and 2% of primary knee surgeries. This goes up to 3.2% to 5.6% in patients who undergo knee replacement revisions.
In any case, an infected knee replacement can result in both swelling and sharp pain. If you experience these two together, make sure that you let your doctor know. Your surgeon can determine if your knee has developed an infection.
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How Long Does Stiffness Last After Total Knee Replacement
3 months6 monthssix monthsRead More…
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Why is my knee so tight after TKR?
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Why is my knee so tight after knee replacement surgery?
Reasons Why Scar Tissue Management Is Important
Once scar tissue develops, its essential to work on promoting healthy tissue as soon as possible before possible problems arise. Remodeling the scar makes it so the injured tissue can tolerate the stress and forces the body encounters every day from regular activity. Tissue remodeling can help in three ways:
- Improve range of motion in surrounding joints and muscles
- Restore normal mobility and function
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The Stiff Knee: A Frustrating Post Tka Challenge
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Douglas W. Jackson, MD, poses 4 Questions to Alejandro González Della Valle, MD, about knee stiffness occurring after total knee arthroplasty.
One of the most frustrating surgical sequelae for both the patient and surgeon is the development of a stiff knee following surgery. While, this may occur unexpectedly after almost any knee procedure, it is not an infrequent problem after a total knee replacement. For this interview, I have asked Alejandro González Della Valle, MD, to share his insight and approach to this problem.
Douglas W. Jackson, MDChief Medical Editor
Douglas W. Jackson, MD: What is the prevalence of stiffness following total knee replacement?
Alejandro González Della Valle, MD: It is between 5% and 7% and in my opinion it is the most prevalent early local complication of total knee replacement surgery, surpassing the combined prevalence of infection, thromboembolism and early mechanical failure. Pariente et al. recently reviewed 5,714 TKRs performed in 4,106 patients between 1997 and 2003. Manipulation under anesthesia was required in 399 cases . Similarly, Yercan et al. recently reported that among 1,188 consecutive TKR patients, 63 developed stiffness. Of the 56 patients available for analysis, 46 patients required manipulation and 10 required revision surgery for stiffness.
Jackson: What is the definition of stiffness?
How Long Does It Take For Soft Tissue To Heal After Hip Replacement
In general, most surgeons prefer that you avoid certain positions of the hip that can increase your risk of dislocation of the hip for about 6 weeks following surgery. After 6 weeks the soft tissues involved in the surgery have healed and restrictions are often lifted allowing more vigorous activity.
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Knee Extension Stretches And Exercises
Expect to perform a variation of these knee extension exercises:
- Quad Sets
- Seated calf stretch with towel/belt
- Standing TKE
Some patients will use a continuous passive movement machine that will repeatedly assist bending and straightening your knee slowly for hours each day for a couple weeks until they have reached a desired range of motion.
Physical Therapy After Knee Replacement Surgery
Outpatient physical therapy is typically prescribed after discharge and will usually begin within a week of surgery. A physical therapist will teach the patient:
- Knee strengthening exercises
- Knee exercises to encourage range of motion and reduce scar tissue
- How to use assistive walking devices, such as a walker and cane
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Flexion And Extension Contracture
Contracture is a shortening of the muscle itself. So, fibrosis is something that sets up, like we talked about, as a spiderweb, and it connects bone to bone. Contracture is an actual shortening of the muscle, the tendon, because its been in a short position for so long. You know that whole use it or lose it? Thats real. That really happens. And so if you dont move that muscle, its going to contract, its going to stay short, because thats all it ever had to do. And thats why sometimes strengthening after a knee replacement takes longer, because you most likely didnt have that range of motion before surgery.
If you had a knee, and that knee was only bending to 70 degrees, then the quadriceps knew that it had to work from 70 to zero, and thats all the quadriceps had to do. And the hamstrings only pulled the knee back to 70 degrees. They didnt pull it back any further, right? So, those muscle fibers that exist after 70 degrees on either side of the joint, theyre on vacation, and they like being on vacation.
And when you ask them to start working again it takes a little bit of time for them to remember what their goal was, what their target was, what their job is.
Scar tissue and swelling after knee replacement are the biggest challenges for most patients. Do your homework and make a plan for your recovery. With a good physical therapist and the right approach to recovery you will get back to your life in no time.
Initial Swelling And Pain Management After Knee Replacement
Most patients have moderate to severe swelling for the first few days after knee surgery. Some patients may also experience this degree of inflammation for several weeks. However, this should ease down within the third to sixth month from the day of the procedure.
You can help your knee recover from the swelling faster with the use of ice therapy. Icing can help reduce inflammation, so long as done immediately after an injury. In the case of knee surgeries, you may have to extend the cold treatment for as long as you have swelling.
Aside from cold therapy, it’s also best to elevate the leg wherein you’ve had knee surgery. This will help prevent too much blood from flowing to the surgical site. The reduced blood flow, in turn, can help reduce swelling.
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Looking After Your Knee Replacement
Your new knee will continue to improve for as much as two years after your operation as the scar tissue heals and you exercise your muscles. You’ll need to look after yourself and pay attention to any of the following problems:
Stiffness Sometimes the knee can become very stiff in the weeks after the operation for no obvious reason. Try placing your foot on the first or second step of the stairs, hold on to the banister and lean into your knee. This should help to improve movement and flexibility in your knee. Its very important to continue with the exercises you were working on in the hospital.If the stiffness doesnt improve after about six weeks your surgeon may need to move or manipulate your knee. This will be done under anaesthetic.
Pain Pain caused by bruising from the operation is normal in the first two months, and you’ll probably still need to take painkillers at six weeks to help you sleep through the night. You may still have some pain for as long as six months. If you still have pain after this, speak to your physiotherapist or GP.
Infection You should speak to your GP or hospital if you notice any signs of infection, for example:
- breakdown of the wound with oozing/pus or sores
- increased pain
- redness and the affected area feeling warmer than usual or smelling unpleasant.
You should also look after your feet see a doctor or podiatrist if you notice any problems such as ingrown toenails that could become infected.