Post-Surgery Bumps: Is It Bone Growth or a Knob?

The protrusion remains after the removal of the metal screw?

Hello, doctor.
Five years ago, I underwent a repair for a torn posterior cruciate ligament, and a steel screw was placed in the anterior part of my tibia.
This July, the screw was removed, but I noticed that the area where the screw was placed still has a protrusion.
Is this a bone growth from the tibia, or is it a tibial tuberosity? Currently, there is no pain, but sometimes the wound area itches.
Is there a way to improve this, or should I undergo further detailed examination?

Harper, 30~39 year old female. Ask Date: 2017/08/28

Dr. Li Yongheng reply Orthopedics

Hello, based on the symptoms you described, you underwent a repair for a torn posterior cruciate ligament and had a screw placed in the anterior aspect of the tibia.
In July of this year, the screw was removed, and it was noted that there is still a prominence at the site where the screw was placed.
Since the screw placement for the repair of the posterior cruciate ligament is typically not at the tibial tuberosity, the protrusion may be due to either bone overgrowth or scar tissue formation at the site.
This condition is generally not serious, but if you have concerns, you may return to your original physician for an examination and an X-ray.
Wishing you a speedy recovery.

Reply Date: 2017/08/28

More Info

After undergoing surgery to remove the steel rod from your tibia, it's not uncommon to notice a bump or protrusion at the site where the rod was implanted. This bump could be due to several factors, including bone remodeling, scar tissue formation, or even the presence of hardware-related changes. Let's break down these possibilities and discuss what you might consider doing next.

Bone Remodeling vs. Scar Tissue
1. Bone Remodeling: After the removal of the steel rod, your body may undergo a process called bone remodeling. This is a natural process where the bone adapts to the absence of the implant. The bone may appear slightly raised or protruded as it heals and adjusts. This is generally a normal response and can take several months to stabilize.

2. Scar Tissue Formation: The surgery itself can lead to the formation of scar tissue, which may feel firm or bumpy under the skin. This tissue is part of the healing process and can sometimes cause sensations like itching or tightness around the surgical site.

3. Hardware-Related Changes: If there were any screws or plates used in conjunction with the rod, the area might still have some residual hardware effects, which can also contribute to the bump. However, since you mentioned that the rod has been removed, this is less likely to be the cause.

Symptoms and Concerns
- Itching: The itching you are experiencing is not uncommon after surgery. It can be attributed to healing skin, nerve regeneration, or even dry skin. Keeping the area moisturized may help alleviate some of this discomfort.

- Pain: The absence of pain is a positive sign, suggesting that there are no immediate complications such as infection or significant inflammation.

When to Seek Further Evaluation
While the bump may be a normal part of your healing process, there are certain situations where you should consider seeking further evaluation:
- Persistent or Increasing Size: If the bump continues to grow or change significantly over time, it would be wise to consult your physician.

- Pain or Discomfort: If you start to experience pain, swelling, or any other unusual symptoms, it’s important to get checked out.

- Changes in Sensation: If you notice numbness, tingling, or other changes in sensation around the area, this could indicate nerve involvement and should be evaluated.

Recommended Actions
1. Monitor the Area: Keep an eye on the bump and any associated symptoms. Document any changes, as this information can be helpful for your healthcare provider.

2. Consult Your Surgeon: If you have concerns about the bump or if it does not resolve over time, consider scheduling an appointment with your orthopedic surgeon. They may recommend imaging studies, such as an X-ray or MRI, to assess the area more thoroughly.

3. Physical Therapy: If you feel that the area is limiting your mobility or function, discussing physical therapy options with your healthcare provider could be beneficial. A physical therapist can help with exercises that promote healing and improve strength and flexibility.

4. Skin Care: To manage itching, consider using a gentle moisturizer on the skin around the surgical site. Avoid scratching, as this can lead to irritation or infection.

In summary, while the bump you are experiencing is likely a normal part of the healing process, it is essential to remain vigilant and consult your healthcare provider if you have any concerns. Regular follow-ups can ensure that your recovery continues smoothly and that any potential issues are addressed promptly.

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