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“Life goes on, but the scar remains” rings true any time someone undergoes surgery to correct a medical issue. Scars come in all shapes, lengths, widths, directions and colors. Total knee arthroplasty or replacement (TKA) is one of the surgeries where the scar is especially visible. As you can see from the picture, the incision from a TKA can also be accompanied by effusion, or swelling.
People are often surprised to find that skin care and post-surgical effusion management are important parts of their rehabilitation process. About 3-8 weeks after TKA surgery, or once the incision is healed, a physical therapist can begin scar massage. Scar massage consists of manual application of direct pressure to the area around and over the scar to promote healing and smoothing out of the incision. This pressure can be uncomfortable in the beginning, but the therapist can make adjustments as needed. It’s important to have this as part of your therapy for several reasons. Promotion of proper incision healing can prevent sensitivity, improve scar strength, and keep the scar more mobile over time. In most cases, once your therapist demonstrates scar massage, you can begin performing it at home with a skin emollient of your choice.
It’s also important to monitor effusion, or swelling, in the joint, which can be controlled with exercise and movement. Typically effusion is in the form of visible swelling, but it can also appear as stiffness in the knee and tenderness to touch, especially at night. A physical therapist can help with range of motion exercises, soft tissue mobilization, and ice in the early rehabilitation phases. The good thing about these treatments is that they also help promote incision healing. If you have persistent effusion, you may need to avoid aggressive stretching and over pressure to the knee. Your therapist will also thoroughly track effusion, and inspect for any complications such as deep vein thrombosis (DVT).
Keep in mind, soft tissue healing takes time. Post-surgical effusion may be present for months, even up to a year after your surgery and full scar maturation may take just as long. It’s easy to become exasperated with the negative cosmetic effects or perceived slow progress of healing. This healing is all part of the normal physiologic process, and soon enough you will be back to activities that may have been impossible due to pain before your surgery!