Scar Tissue After Total Knee Replacement Surgery

Scar Tissue After Total Knee Replacement Surgery – Sadat-Ali M, Al-Mousa SA, Al-Tabash KW, Abotaleb MM, Al-Anii FM. Can we suppress excessive post-surgical scar formation: A case report.World J Orthop2023;14(3): 166-170 [ PMID: 36998386 DOI: 10.5312/wjo.v14.i3.166]

Mir Sadat-Ali, FRCS, FRCS (Gen Surg), MBBS, MS, Full Professor, Department of Orthopedic Surgery, Imam Abdulrahman Bin Faisal University, POBOX 2114, Dammam 31142, Saudi Arabia. drsadat@hotmail.com

Scar Tissue After Total Knee Replacement Surgery

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Scars Are Tattoos With Better Stories

Mir Sadat-Ali, Sulaiman A Al-Mousa, Khalid Waleed Al-Tabash, Mohamed M Abotaleb, Fawaz M Al-Anii, Department of Orthopedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam 31142, Saudi Arabia

Author Contributions: All authors contributed equally to the work; Literature search, writing performed by Sadat-Ali M and Al-Mousa SA; Hosted by Al-Anii FM and Al-Tabash KW; The patient was followed by Abotaleb MM, Abotaleb MM was blinded to the wound used after suture removal; All authors read and approved the final manuscript.

Informed consent statement: Informed consent was obtained before the operation and the publication of the data and their images.

CARE Checklist (2016) statement: The authors read the CARE Checklist (2016) and the manuscript was drafted and revised according to the CARE Checklist (2016).

Knee Replacement Surgery Statistics You Should Know

Open Access: This article is an open access article selected by an internal editor and reviewed entirely by external reviewers. It is distributed under the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which allows others to non-commercially distribute, remix, adapt, build upon, and license their derivative works under various terms. the work is properly cited and its use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Author: Mir Sadat-Ali, FRCS, FRCS (Gen Surg), MBBS, MS, Full Professor, Department of Orthopedic Surgery, Imam Abdulrahman Bin Faisal University, POBOX 2114, Dammam 31142, Saudi Arabia.

Hypertrophic scar (HS) formation is a complication of secondary wound healing by intention and occasionally after clean surgical incisions. Many treatments are now in vogue with varying degrees of success. Although the mechanism or mechanisms that cause HS are not clearly understood, one thing that is clear is that no intervention will be successful once the scar tissue has matured. In this article, we report a case where a patient known to develop HS was treated with a new combination of components (Phyto-chemicals + Silicone JUMI) to suppress the formation of HS.

A 68-year-old woman of African descent presented with severe HS post total knee replacement (TKR), which the patient described as itching and painful. Because of complications from the scar, he was afraid to undergo TKR on his other knee. However, after removal of skin clips after contralateral TKR, JUMI anti-scarring cream (JASC) was used to prevent excessive scar formation.

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JASC appears to be potent and effective in suppressing excessive scar formation. We believe this warrants further studies in larger patient groups and different surgical areas.

Key Tip: Hypertrophic scars are common after surgery and often result in social, emotional, and psychological effects. Many treatments have been tried and the most prominent is silicone gel. But this form of treatment has complications related to hot weather. JUMI Anti-Scar Cream is a phytochemical-based silicone gel that has been found to be highly effective in reducing post-surgical scarring.

Hypertrophic and excessive scarring are common phenomena that often result in social, emotional, and psychological effects[1], in addition to the exorbitant costs of managing such complications[2, 3].

Hypertrophic scars (HS) develop due to excessive collagen formation, which may regress slowly[4], but in certain cases collagen may continue to accumulate, leading to HSs[5]. We observed that scarred joint arthroplasty occurred frequently and that the scars in these areas were devoid of hair follicles and sweat glands; excessive scarring can even cause itching and discomfort. Sometimes HSs result in keloid formations, indicating a dysregulation of the normal healing process, resulting in overproduction of collagen, elastin, proteoglycans, and extracellular matrix proteins[6]. This suggests that prevention of early HS may prevent keloid formation.

My Knee Still Hurts After Knee Replacement Surgery

In this article, we report a case where a patient prone to hypertrophic scars was treated with JUMI cream, which successfully suppressed postoperative scars.

A 68-year-old woman of African descent presented with pain in her left knee and difficulty walking due to severe osteoarthritis of the left knee. Total knee replacement (TKR) was recommended. He was very concerned that the postoperative scars would be hypertrophic and painful, like the right side.

He underwent TKR of the right knee 12 months ago and underwent HS postoperatively (Figure 1A). She complained of constant itching and pain around the scar and was sometimes depressed, so depressed. She received many treatments, including the use of silicone gel to reduce the scar, all of which failed. The patient insisted that he should delay the operation on the other knee because he was afraid of another scar with the same result.

A: Postoperative scar after 12 months of total knee replacement (TKR); B: Postoperative image after removal of surgical clips in the other knee after TKR; C: Post-operative clinical picture after six weeks of JUMI anti-scar cream (JASC); D: Postoperative clinical picture 12 weeks after using JASC.

Stiffness After Knee Replacement

As his pain increased and his mobility worsened, he decided to have a total knee arthroplasty on his left side. During the second surgery, the same procedure and closure techniques from the first surgery were again used (ie, the subcutaneous layer was closed using 2-0 vicryl sutures and Covidien Appose Single Use Skin Stapler 710 from Medtronic Parkway Minneapolis, MN 55432 USA. ). Standard post-TKR rehabilitation hospital protocol was followed after both surgeries.

Two weeks after surgery, the surgical clips were removed (Figure 1B). The patient was advised to apply JUMI anti-scar cream (JASC) twice daily for 3 months, which he did regularly.

After 6 weeks of JASC application, the patient was quite satisfied with the effect on the scar (Figure 1C). Figure 1D shows the scar 12 weeks after suture removal, when the scar is free of pain or itching.

This case report shows that JASC [a combination of silicone gel and Phyto-extracts (eg Centella asiatica extract, Curcuma Longa, lavender oil, marshmallow, Musa Paradisiaca, pineapple extract and tea tree oil)] was quite effective in suppressing scar formation. . After an extensive review, Hsu et al[6] reported that most studies evaluating the ability of silicone gel to prevent HS and keloids were of poor quality with a high risk of bias. Kong et al[7] conducted a randomized study on scars after TKR and reported that silicone gel had no beneficial effect on scar pain and pruritus. Furthermore, when silicone gel was exposed to hot air, researchers observed persistent itching (80%), skin rash and maceration, and poor patient compliance[8]. HS and keloid management has improved over the years but has not reached the pinnacle of success; therefore, more trials and more effective drugs are needed.

Revision Knee Replacement Frequently Asked Questions

Phytochemical substances from medicinal plants that can be used in the treatment of HS have been studied and found to be highly effective[9-11]. Centella asiatica extract is an important phytochemical used in JASC, which has been shown to contain bioactive components such as triterpenoid saponins, flavonoids, phenolic acids, triterpenic steroids and amino acids. These improve skin health by increasing hydration and reducing transepidermal water loss with anti-inflammatory effects[12-14]. JASC is a combination of optimal phytochemicals and silicone gel and has been proven to be effective in concealing post-surgical scars.

HSs cause great dissatisfaction and psychological and emotional problems when the scars are close to the joint. Our patient was so depressed from a previous surgical scar that he decided to live with excruciating pain rather than risk another ugly scar. Our case report shows that there are many ways to hide post-surgery scars and JASC is one of them. We believe that more studies are needed to confirm the effectiveness of JASC for all types of postoperative scars.

JASC appears to be potent and effective in suppressing excessive scar formation. We believe that this finding needs further studies in larger patient groups and different surgical fields.

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Knee Replacement Recovery Time

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