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Post-Operative Care

No matter how meticulous and thorough a scar tissue resection may be, and even if a full range of knee motion is successfully restored on the operating room table, the biggest challenge is maintaining that range of motion after surgery. New scar tissue may rapidly re-form within the joint unless comprehensive action is taken to avoid this. Unless special post-operative pain relief measures are taken, attempting to move the joint through its full range of motion immediately after surgery may simply be intolerable. Unfortunately, if the patient does not move their knee through a full arc of motion repeatedly and fairly continuously in the first 2 to 3 post-operative weeks, they are at risk of having their knee joint become "frozen" once again. Aside from knees where only joint extension is lacking (which are often best held in a maximally extended position in a full-leg cast for the first several post-op days), the key to better results following surgical procedures for arthrofibrosis is to perform them under epidural anesthesia and to maintain this or a supplemental regional, pain-relieving, anesthetic nerve block for a day or two post-operatively, so as to allow joint motion without the inhibiting effect of severe pain. I have been using this anesthetic method following arthrofibrosis surgery for well over a decade. Taking advantage of the ongoing pain relief afforded by the extended anesthetic block effect, a program of immediate post-operative physical therapy is begun and continued, utilizing special, passive stretching techniques at the extremes of the knee's range of motion. The patient is also taught how to do their own stretching therapy, to supplement their supervised treatment. A continuous passive joint motion (CPM) machine is used in between stretching sessions, beginning in the recovery room and then continuing at home. This device is a mechanical leg cradle that gently bends and straightens the knee while the patient is lying down in bed. Post-operative medication to inhibit recurrent fibrous scar tissue formation within the knee is also often helpful. Possibilities include intra-articular (injected into the joint) hyaluronate (a joint lubricant) and/or corticosteroid (cortisone) medication administered on one or more occasions in the first post-operative month or two. Faithful patient compliance with prescribed outpatient physical therapy treatment and diligent, self-administered stretching in the post-operative phase is critical. Supplemental treatment with an oral anti-inflammatory medication (if the patient's stomach can tolerate it) is helpful.

A severe case of arthrofibrosis can be an extremely difficult challenge for both patient and knee surgeon alike. In this author's experience, the comprehensive treatment program described above has met with good results in most circumstances, including cases of total knee joint replacement that still demonstrated a restricted range of motion despite one or more attempts at manipulation under anesthesia without arthroscopic intervention.


If you have a stiff or partially "frozen" knee that your surgeon cannot seem to remedy, consider getting an expert second opinion evaluation here at The Knee and Shoulder Centers.


   
 
 
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