Physical Therapist, Lisa Alarcon, explains how to manage and minimize swelling and scar tissue after knee replacement in this essential interview.

An Interview with Lisa Alarcon, Director of Physical Therapy

Understanding Swelling and Scar Tissue After Knee Replacement

The composition of the swelling that occurs in the knee depends on how long it's been there. The longer the swelling is in the knee the more likely you will have to deal with stiffness. If you've ever noticed you can push on someone's skin and it stays 'dipped', those patients have a lot more protein in that fluid. And so what happens as you get that fluid in the knee structure that supports it (the joint capsule,) it swells like a balloon. Swelling and scar tissue after knee replacement are the two biggest challenges you will face.

So the more swelling that's in that knee, the tighter the balloon gets. Once that balloon gets too tight, you have a significant limit in how much you can move your knee. When that happens, you don't move your knee because it hurts, it's uncomfortable, so you keep it still. Keeping it still only creates kind of this vicious cycle. Now it doesn't move, so you can have scar tissue start to set up.

Anytime you put your body in a certain comfortable position and then you start to move out of that position, everything's like, oh wait a minute, that doesn't feel so good. And that's also what's happening in a fresh knee joint, especially immediately following surgery. Those structures are not happy that they've been disturbed. They like to be where they are. They don't want to be cut, and that has all happened with the surgery. The body's natural system says, "I'm going to limit how much motion I want this knee to have, and so I'm going to send the swelling in."

Fibrosis

Fibrosis is another way to look at scar tissue. It's 'scar tissue plus.' You can kind of think of the tissue surrounding the knee like spider webs. And so we can move the knee joint a little bit, or the shoulder, or whatever joint it happens to be, and we can break those spider webs, and we can get some range of motion back.

With fibrosis the tissue is more like duct taping the joint. The components that make up something that's fibrotic versus something that's strict scar tissue is that the tissue is a little bit more intense. The tissue is stronger, the tensile strength is stronger. It's thicker. So fibrosis compared to kind of what I would consider normal scar tissue is just really kind of 'scar tissue on steroids,' and it's a lot harder to break through. Usually those with this thicker scar tissue are the people that need the Manipulation Under Anesthesia (see: Julie Avoids an MUA) because they've had that fibrotic tissue start to set in, and so that's the difference really between kind of general scar tissue and something that's gone fibrotic.

You may have seen people that have those really big, bumpy kind of gnarly looking scars. Those patients are more likely to have that same kind of body response on the inside. Fibrosis depends on genetics, it depends on how long you want to sit still for, it depends on things like: 'I had a knee replacement, and then I had an injection, and then I had another knee replacement.' So if you have some or all of these other factors, that limit your ability to move that joint, you're going to get that fibrosis a lot faster.

An Interview with Lisa Alarcon, Director of Physical Therapy

Understanding Swelling and Scar Tissue After Knee Replacement

The composition of the swelling that occurs in the knee depends on how long it's been there. The longer the swelling is in the knee the more likely you will have to deal with stiffness. If you've ever noticed you can push on someone's skin and it stays 'dipped', those patients have a lot more protein in that fluid. And so what happens as you get that fluid in the knee structure that supports it (the joint capsule,) it swells like a balloon. Swelling and scar tissue after knee replacement are the two biggest challenges you will face.

So the more swelling that's in that knee, the tighter the balloon gets. Once that balloon gets too tight, you have a significant limit in how much you can move your knee. When that happens, you don't move your knee because it hurts, it's uncomfortable, so you keep it still. Keeping it still only creates kind of this vicious cycle. Now it doesn't move, so you can have scar tissue start to set up.

Anytime you put your body in a certain comfortable position and then you start to move out of that position, everything's like, oh wait a minute, that doesn't feel so good. And that's also what's happening in a fresh knee joint, especially immediately following surgery. Those structures are not happy that they've been disturbed. They like to be where they are. They don't want to be cut, and that has all happened with the surgery. The body's natural system says, "I'm going to limit how much motion I want this knee to have, and so I'm going to send the swelling in."

Fibrosis

Fibrosis is another way to look at scar tissue. It's 'scar tissue plus.' You can kind of think of the tissue surrounding the knee like spider webs. And so we can move the knee joint a little bit, or the shoulder, or whatever joint it happens to be, and we can break those spider webs, and we can get some range of motion back.

With fibrosis the tissue is more like duct taping the joint. The components that make up something that's fibrotic versus something that's strict scar tissue is that the tissue is a little bit more intense. The tissue is stronger, the tensile strength is stronger. It's thicker. So fibrosis compared to kind of what I would consider normal scar tissue is just really kind of 'scar tissue on steroids,' and it's a lot harder to break through. Usually those with this thicker scar tissue are the people that need the Manipulation Under Anesthesia (see: Julie Avoids an MUA) because they've had that fibrotic tissue start to set in, and so that's the difference really between kind of general scar tissue and something that's gone fibrotic.

You may have seen people that have those really big, bumpy kind of gnarly looking scars. Those patients are more likely to have that same kind of body response on the inside. Fibrosis depends on genetics, it depends on how long you want to sit still for, it depends on things like: 'I had a knee replacement, and then I had an injection, and then I had another knee replacement.' So if you have some or all of these other factors, that limit your ability to move that joint, you're going to get that fibrosis a lot faster.

Knee Replacement Failure, Revision Surgery, Recovery

By Robert Douglas

Seven or eight years ago I decided to start working out, so I started running. Through the time I was running I had multiple meniscus tears. I would go in and have them scoped to have them cleaned out. Little did I know what was ahead. I was in for a two year knee recovery.

The real trouble started in September of 2016. I was playing flag football, and I ended up tearing my meniscus again, but I also tore the articular cartilage that lined the surface of my femur bone. I had a scope in January of 2017 to clean that out. It really wasn't doing well: I had a lot of pain still. I talked to my surgeon about it and he basically said "You're just gonna have to live with it." I went to another orthopedic surgeon to get a second opinion and he said, "Well, I agree with him, but we could give you a steroid injection if you want." That was in February. I said, "Sure, why not? It couldn't hurt."

A Steroid Injection

Well, exactly 24 hours after I got the steroid injection, my knee just got swollen and stiff, and I really didn't know what was going on. I thought it might have been a reaction to the steroid shot at first, so I thought, "Well, I'll give it a couple of days and see what happens." It was a Friday when it swelled up, and so I just waited throughout the weekend: it never got better. I went into the emergency room on Monday, this was the 20th of February, 2017, and told them, "Look, something's going on with my knee." I told him I had steroid injection, 24 hours later it got stiff. What's interesting is when I went in I really didn't even present with any outward symptoms that you could tell. However, I had developed a septic knee.

Getting Tested | Finding The Problem

They were actually going to turn me away. My temperature was normal. My knee was not obviously swollen, maybe a little bit. It wasn't red. It wasn't hot to the touch. I said, "Something is wrong, just please get some testing going." They did a CBC and an x-ray and they did a CRP, and it was just a little bit elevated. They came back to me and said, "You know, it's a little bit elevated, your white blood count. Not really a lot, but the only way we're going to be able to tell is tap your knee." So they did that procedure, and you could tell right away. They had a hard time pulling it out, actually.

Time in the Hospital

I spent a week in the hospital. I had two surgeries back-to-back to clean out my knee. Then, out of the hospital, I was at home on IV medications. The physical therapist that came out and told me there wasn't anything that they could do for me, so I was without therapy for six weeks. I finally went to outpatient rehab after I got off the IV antibiotics. The other thing about my knee is that the infection actually got into my femur, so I got osteomyelitis as well. My knee was shredded. All the soft tissue was gone. I was bone-to-bone, and I was in a lot of pain. I could not walk. I had to buy a mobile wheelchair to get around. After a septic knee you have to wait so long to make sure it's totally eradicated before you can have a knee replacement.

The surgeon told me 12 months, but he said, "If you're good in eight months we'll try to do it then."

My First TKA

In November of 2017, I had my initial TKR, a total knee replacement,

Knee Replacement Failure, Revision Surgery, Recovery

By Robert Douglas

Seven or eight years ago I decided to start working out, so I started running. Through the time I was running I had multiple meniscus tears. I would go in and have them scoped to have them cleaned out. Little did I know what was ahead. I was in for a two year knee recovery.

The real trouble started in September of 2016. I was playing flag football, and I ended up tearing my meniscus again, but I also tore the articular cartilage that lined the surface of my femur bone. I had a scope in January of 2017 to clean that out. It really wasn't doing well: I had a lot of pain still. I talked to my surgeon about it and he basically said "You're just gonna have to live with it." I went to another orthopedic surgeon to get a second opinion and he said, "Well, I agree with him, but we could give you a steroid injection if you want." That was in February. I said, "Sure, why not? It couldn't hurt."

A Steroid Injection

Well, exactly 24 hours after I got the steroid injection, my knee just got swollen and stiff, and I really didn't know what was going on. I thought it might have been a reaction to the steroid shot at first, so I thought, "Well, I'll give it a couple of days and see what happens." It was a Friday when it swelled up, and so I just waited throughout the weekend: it never got better. I went into the emergency room on Monday, this was the 20th of February, 2017, and told them, "Look, something's going on with my knee." I told him I had steroid injection, 24 hours later it got stiff. What's interesting is when I went in I really didn't even present with any outward symptoms that you could tell. However, I had developed a septic knee.

Getting Tested | Finding The Problem

They were actually going to turn me away. My temperature was normal. My knee was not obviously swollen, maybe a little bit. It wasn't red. It wasn't hot to the touch. I said, "Something is wrong, just please get some testing going." They did a CBC and an x-ray and they did a CRP, and it was just a little bit elevated. They came back to me and said, "You know, it's a little bit elevated, your white blood count. Not really a lot, but the only way we're going to be able to tell is tap your knee." So they did that procedure, and you could tell right away. They had a hard time pulling it out, actually.

Time in the Hospital

I spent a week in the hospital. I had two surgeries back-to-back to clean out my knee. Then, out of the hospital, I was at home on IV medications. The physical therapist that came out and told me there wasn't anything that they could do for me, so I was without therapy for six weeks. I finally went to outpatient rehab after I got off the IV antibiotics. The other thing about my knee is that the infection actually got into my femur, so I got osteomyelitis as well. My knee was shredded. All the soft tissue was gone. I was bone-to-bone, and I was in a lot of pain. I could not walk. I had to buy a mobile wheelchair to get around. After a septic knee you have to wait so long to make sure it's totally eradicated before you can have a knee replacement.

The surgeon told me 12 months, but he said, "If you're good in eight months we'll try to do it then."

My First TKA

In November of 2017, I had my initial TKR, a total knee replacement,

With a long history of knee problems and surgeries Richard replaced two knees (2011, 2018). He used the bicycle and The X10 Knee Machine to make his most recent surgery a huge success. Richard reports in detail on his surgeries and recoveries in this full interview.

Two Knees and The X10 Knee Machine

The Great Knee Replacement Recovery of 2018

By Richard Pospiech

I grew up in Des Plaines, Illinois, and I moved to Michigan in 1982. I worked in the electric utility industry for 35 years, and I retired in 2017. My hobbies include cycling, hiking, kayaking and golf.

I had a catastrophic knee injury when I was 16, and I tore my acl, mcl and cartilage in my left knee. I continued to play sports after my knee surgery, and my knee paid the price. When I was 24 a doctor told me I had the knee of a 90 year old! That’s when I started cycling to strengthen my muscles surrounding my knee joint.  The cycling worked well until age 51, and it was then that I realized the next step to maintaining my quality of life was to schedule my first TKR surgery in 2011.

My Surgery

The surgery was complicated, and it took 10 weeks of PT to regain my ROM and strength. My second TKR on my right knee was in October of 2018. The main cause of the degeneration in my right knee was due to being bow legged. From October 2011 to October 2018 I performed all my outdoor hobbies with one straight leg, and one bowed leg. That sure did take a toll on my body.

I found my surgeon by reviewing orthopedic surgeons on the Internet. I was impressed with Dr. James J. Verner. He is trained to perform both knee and hip replacement surgery, and all of his patients gave him praise. He is also in high demand due to his expertise in his field of practice.

Learning about The X10

When I visited Dr. Verner for my second TKR, I was informed about the X10 Knee Recovery System. I immediately started reading patient testimonials regarding the X10, and I couldn’t believe that Patients were regaining ROM in a 4 week period without going to outside PT.

It was comforting reading success stories regarding the X10. I was shocked when Dr. Verner informed me that I could go home the same day as my surgery. Being at home in your own bed is definitely more comfortable.

My recovery had been going very well. Having the X10 in my house for the first 4 weeks post op was priceless.

Three Milestones

It was a constant reminder that kept me focused on dedicating my time towards rehabbing my knee everyday. I achieved three major milestones and they were: achieving 0 and 115 degrees of extension/flexion in 2 weeks, and the next was achieving 130 degrees flexion in 4 weeks. And then the icing on the cake was being able to ride my indoor exercise bike by week 4. Accomplishing these three milestones assured me that I was on the road to full recovery.

Working with the X10 at home was incredible . I was able to plan my workouts at my convenience, and I didn’t have to make travel arrangements to an outside physical therapist. My coach was fantastic. He answered all my questions and he was available 24/7. At one point during my healing process I was concerned about pain in my lower leg and foot, and he was there to provide guidance.

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Two Knees and The X10 Knee Machine

The Great Knee Replacement Recovery of 2018

By Richard Pospiech

I grew up in Des Plaines, Illinois, and I moved to Michigan in 1982. I worked in the electric utility industry for 35 years, and I retired in 2017. My hobbies include cycling, hiking, kayaking and golf.

I had a catastrophic knee injury when I was 16, and I tore my acl, mcl and cartilage in my left knee. I continued to play sports after my knee surgery, and my knee paid the price. When I was 24 a doctor told me I had the knee of a 90 year old! That’s when I started cycling to strengthen my muscles surrounding my knee joint.  The cycling worked well until age 51, and it was then that I realized the next step to maintaining my quality of life was to schedule my first TKR surgery in 2011.

My Surgery

The surgery was complicated, and it took 10 weeks of PT to regain my ROM and strength. My second TKR on my right knee was in October of 2018. The main cause of the degeneration in my right knee was due to being bow legged. From October 2011 to October 2018 I performed all my outdoor hobbies with one straight leg, and one bowed leg. That sure did take a toll on my body.

I found my surgeon by reviewing orthopedic surgeons on the Internet. I was impressed with Dr. James J. Verner. He is trained to perform both knee and hip replacement surgery, and all of his patients gave him praise. He is also in high demand due to his expertise in his field of practice.

Learning about The X10

When I visited Dr. Verner for my second TKR, I was informed about the X10 Knee Recovery System. I immediately started reading patient testimonials regarding the X10, and I couldn’t believe that Patients were regaining ROM in a 4 week period without going to outside PT.

It was comforting reading success stories regarding the X10. I was shocked when Dr. Verner informed me that I could go home the same day as my surgery. Being at home in your own bed is definitely more comfortable.

My recovery had been going very well. Having the X10 in my house for the first 4 weeks post op was priceless.

Three Milestones

It was a constant reminder that kept me focused on dedicating my time towards rehabbing my knee everyday. I achieved three major milestones and they were: achieving 0 and 115 degrees of extension/flexion in 2 weeks, and the next was achieving 130 degrees flexion in 4 weeks. And then the icing on the cake was being able to ride my indoor exercise bike by week 4. Accomplishing these three milestones assured me that I was on the road to full recovery.

Working with the X10 at home was incredible . I was able to plan my workouts at my convenience, and I didn’t have to make travel arrangements to an outside physical therapist. My coach was fantastic. He answered all my questions and he was available 24/7. At one point during my healing process I was concerned about pain in my lower leg and foot, and he was there to provide guidance.

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Dr. Ronald Lederman received his undergraduate and medical degrees from the University of Michigan in Ann Arbor. He is a board-certified orthopedic surgeon with an additional one year of fellowship training in lower extremity orthopedics.

Orthopedic Spotlight: Dr. Ronald Lederman

Lederman Kwartowitz Center for Orthopedics and Sports Medicine

Dr. Ronald Lederman

Lederman Kwartowitz: Center for Orthopedics and Sports Medicine represents the finest care you are likely to find for a long list of treatments. Located in SouthEast Michigan this practice cares for patients from all over the United States.

This orthopedic practice is dedicated to providing you and your family with the finest orthopedic care available, including fractures, athletic injuries, and chronic conditions. We serve patients ranging from pediatrics to geriatrics in West Bloomfield and Farmington Hills, Michigan and the surrounding areas of Oakland County such as Commerce Township, Walled Lake, Farmington, Southfield, in addition to travelers from other states.

LKO specializes in arthroscopic surgery and joint replacement of the knee, hip, and shoulder, using minimally invasive surgical procedures and MLS laser therapy to reduce pain and recovery time. MLS laser therapy kick starts the healing process after surgery and benefits patients with chronic pain and swelling. Additionally, the staff has extensive experience helping patients with automobile-related injuries.

The LKO team includes three orthopedic surgeons with a reputation for excellence – Dr. Ronald S. Lederman, Dr. Mark Kwartowitz, and Dr. Collin O'Keefe. The doctors work in conjunction with the physical therapy team that is located in the same office to provide the most comprehensive care.

Dr. Ronald Lederman

Dr. Ronald Lederman received his undergraduate and medical degrees from the University of Michigan in Ann Arbor. He is a board-certified orthopedic surgeon with an additional one year of fellowship training in lower extremity orthopedics.

Practicing since 1994, Dr. Lederman is a leader in general orthopedics, including sports medicine, arthroscopy, and joint replacement surgery. He specializes in foot, ankle, and knee surgery, including minimally invasive total and partial knee replacements, and he has extensive experience treating shoulder and hand conditions, including rotator cuff tears and carpal tunnel syndrome.

Dr. Lederman uses the latest technology and minimally invasive surgical procedures to reduce downtime and pain and return patients to the activities they enjoy. He and Dr. Kwartowitz are the first orthopedic surgeons in a major metropolitan area throughout the country exclusively providing MLS laser therapy.

Here is a brief interview with Dr. Lederman

The Surgeons at Lederman Kwartowitz have prescribed the X10 for their patients for many years. Dr. Lederman speaks about X10 for knee replacement recovery here.

Stem Cell Treatment Innovations

Many clinics offering Stem Cell Therapy, or Regenerative Medicine,