2- Have you begun any new activities? This is outstanding range of motion for a 6 week old total knee replacement! Then was sent back to the doctor that did my knee and he said he had to take the fluid out of my knee when he did this it was all blood 40 ml. Tried ice treatment and a bit helpful for 2 hours. Discussion. I was told no joint swelling, though knee was still mildly purple, and mildly painful and swollen. Furthermore, early patellofemoral dislocation following surgery basically guarantees the arthrotomy incision (incision in the extensor mechanism used to open the knee joint) has failed to heal or has ruptured. I am walking about 2 km a day. I am new to this website. I'm still doing PT on my own 2x a week but it doesn't feel like it's improving like it should. Will this desapper with time or will still ramain. In addition, they will need to determine if the drainage shows signs of infection. Thank you. He looked sad and said it was avascular necrosis and ordered a STAT MRI. Blood work showed everything normal but CRP, which was 3x higher than the outer normal range. Help, please give me a reason for this and how I can get over it. I would encourage you to avoid high impact activities for another month or so. The relative absence of pain is a very good sign, but I would definitely be concerned with the history you presented, and I recommend close follow-up by her surgeon. If this shows uptake around the prosthesis, infection is more likely. I was doing extremely well up until a week ago. This delay allows your tissues to recover, so that when you ultimately return to all desired activities, you can do so with the lowest chance of injury. This is a potential issue, though it remains somewhat controversial. Thanks. After 2 or 3 hours asleep Im awaken by sharp and serve pain. Is the tight band normal and for how long. My physiotherapist says that as long as I keep working hard that he believes that I will be fine in terms of being able to increase my range of motion over the next month. Mechanical Sensations My injury had included a strained ligament and a very large Baker's cyst had also formed.Before the surgery I asked the surgeon to please make sure to get rid of the Baker's cyst. Ultimately this led to atrophy of my quads and muscle imbalances, and this contributed to signficant migration of my patella during flexion. In my experience, a well balanced knee that has 0-120 degrees of motion will become pain-free. I am currently achieving in the low 70s. My sense is that at 11 months from surgery, it should be safe to advance as tolerated. I can't get comfortable. Psychology Of Healing As I mention in the blog posting above, a standard 3 phase bone scan may still be "hot" up to 2 years from surgery. No relief from PT or NSAIDs, Direct injection provided a few weeks of relief but not from the buttocks pain. I was only able to do a couple sessions of P/T. Red and warm after PT. If you have normal redness, heat, or tenderness, take your recommended pain medication and elevate the pressure with icing and elevation. My surgeon was nice and said he wanted me to be settled in my mind that I will be ok before I have surgery. Feeling is coming back into the outside of my leg and it hurts some. 2019 May 10;116(19):343.doi: 10.3238/arztebl.2019.0343. I have been back to my hospital and they xrayed my knee and it has been damaged. Im going to have a blood test at my cost for additional information regarding a possible allergy as to why my knee is not healing. I was reassured this was not abnormal, and could take up to a year to resolve. I however am starting P/T all over again for 6 wks and returning to my surgeon for evaluation. My right knee replacement never acted like this. This surgery is typically recommended for people who have suffered a severe knee injury or severe arthritis. I was still having pain, a rash appeared at iv site, so I returned to the er today. Clinical photograph of the discoloured soft tissue and large effusion secondary to metallosis in the replaced knee. This is very important. It is most often used to repair joint damage caused by osteoarthritis or rheumatoid arthritis that causes severe knee pain and makes it hard to perform daily activities. Adequate nutrition may be present if the patient exhibits symptoms such as malnutrition, low protein levels, or other deficiencies. In the event there is a significant problem, the sooner it is diagnosed and treated the better. This was not an augmentation but he cleaned it up. Bruising is often a sign of inflammation following surgery. If you are just a few weeks out from surgery, I think you may be walking a bit too much. UPDATE: Well after almost 2 years out of surgery I found out that I'm allergic to the metal Molybdenum. 2015;2015:891904. doi: 10.1155/2015/891904. Sutton JC 3rd, Antoniou J, Epure LM, Huk OL, Zukor DJ, Bergeron SG. You need to have a consultation with an orthopedic surgeon. For this reason, anticoagulation will sometimes be held for a period of time in someone who has a persistently draining surgical incision. Went back a week later and told me everything looked fine so he ordered a White Blood Cell scan and a Bone Marrow Scan. I am 61 years old, and had a TKR on my left leg almost 18 months ago (Oct 2017). The skin incision can be as small as 3-4 inches. Do you recommend I reduce my activity levels to prevent any pain in the hope that I'll get some more future healing, or is it ok to push through as I've been doing? Think back to before your knees became arthritic. Have you? My knee still feels a little warm, but I know I am blessed to have recovered so quickly. Metal allergy testing unfortunately isn't perfectly reliable, and is often quite expensive. In the deeper joints, for example, the hip, metal deposits are mostly only seen intraoperatively. I went back to therapy with still some pain but continued to work it. A few of the common conditionsthat impact wound healing and strength include: For these reasons, most joint replacement programs will advise people to get these conditions under control prior to surgery. 2023 Brandon Orthopedics | All Right Reserved, Knee Replacement Surgery: Why The Pain May Continue, Knee Replacement Surgery: Procedure Benefits And Recovery, The Pain-Relieving Effects Of Ativan And Tramadol, How To Safely Return To Running Post-knee Arthroscopy Surgery, Arthroscopy: A Minimally Invasive Procedure For Joint Pain, Sciatica: The Progressive Pain That Could Lead To Paralysis, Outpatient Spinal Stenosis Surgery: What You Need To Know, Herniated Disc Fluid In Head: Causes Symptoms And Treatment, Degenerative Disc Disease And Workplace Injuries. If your surgeon has thoroughly evaluated your knee for any mechanical issues, and has ruled out infection and material sensitivity, then it appears pain management may be most appropriate. Could you please comment on this as to whether you think I am right to be tested further for the viruses and metal before I proceed with the knee replacement? You definitely need a second opinion. For that reason, ensuring the rapid healing of incisions is critical to the success of knee replacement surgery. Im 66 yo female had LTKR Oct 8 approximately 3 months ago. I have pain around the meniscus area (inside and out) along with major inflammation. The same medication can be found in the "PM" versions of medications, like Tylenol PM. If the wound is otherwise healing well, and your range of motion is improving appropriately, I agree that ice and anti-inflammatory medication is appropriate. In addition, the ALVAL score did not correlate significantly with either pre-revision or post-revision KSS or range of motion (0.061 < r < 0.365, 0.09 < p < 0.88). It's just those feelings that I mentioned that irritate the heck out of me. The next day I had a PT session and after about 10 minutes of light therapy, it swelled again. However it can occur in any metallic implant subject to wear. Little Relationship to Histopathologic Findings and Revision Outcomes Total knee replacement is generally a successful procedure with survival rates of at least 10 to 15 years. An additional test to consider under these circumstances would be white blood cell scan. These include prep solutions, skin glue, suture material. After 7-10 days, you should be able to . The pain increased with the feeling of a knife stabbing me repeatedly all over my knee. I recommend consistently using ice, working on range of motion, and being patient. Ice, anti-inflammatory medication, relaxation techniques before bed, and maybe a gentle sleep aid could be considered in the meantime. This is very important to regain as soon as possible. Does your knee swell up with activity? The challenge is the correction requires bilateral revision surgery. I'm very active in push mowing our yard and yes I've done this every since about 4 months after surgery. I still have some swelling and discomfort but I am able to function well by doing my exercises daily, going to outpatient Physical Therapy, and icing. I am experiencing pain in both knees and they feel hot to touch. This site needs JavaScript to work properly. While this took a long time, it was an excellent solution to an otherwise very challenging problem. I figured there was some nerve damage during surgery. I do believe I'm still recovering getting better but I do know people who have seemed not to have the hurt I still feel at times. Wounds have a warm and red spot on them. Bruising often appears as a purplish discoloration that indicates there is blood in the area (bruising can also appear blue, brown, yellow). Different patients experience varying degrees of pain and inflammation ranging from almost none to quit a bit. Results: Eight patients were categorized as mildly reactive; 8 patients, moderately reactive; and 11 patients, highly reactive to nickel by LTT. Though commonly implicated with metal on metal hip resurfacing [4, 5], the discolouration and effusion are rarely apparent on clinical inspection because of the considerable soft tissue that envelops the replaced hip joint. Rotator Cuff I was not doing any activity at the time. However, along with soft tissue healing, your bones may also be experiencing different forces since surgery and they will gradually remodel in response to these forcesbut this takes time. Wang Z, Anderson FA, Ward M, Bhattacharyya T. Surgical site infections and other postoperative complications following prophylactic anticoagulation in total joint arthroplasty. I tried calling my surgeon daily to report my symptoms and got a generic answer that pain and swelling is normal. I am glad to hear about your rapid early recovery. The left knee still hurts alot but aches most of the time. This will improve with time. When I got home they didnt set up therapy for 10 days. I agree with your surgeon recommending decolonization with mupirocin prior to surgery, and would also recommend adding vancomycin to the preoperative antibiotic given in the hospital. I would recommend workup to rule out low grade infection, or reaction to materials. I don't have enough information with regard to this specific case to comment any further. My concern was the warmth, the numbness and the tightness, sometime tighter than others which usually is at the end of the day. I have had a blotchy look on my upper thigh since my surgery. Aggressive and early treatment of skin healing problems are critical to preventing a more serious complication. My PT tells me I am doing "fantastic" at 4 weeks but I feel like I should be bending better but for the swelling. Many medical conditions can significantly impact the stages of healing andthe strength of the final scar. It is not normal to be experiencing more pain at 3 months than you had preoperatively. On January 25, 2018 I had a total knee replacement. Jonathan Cluett, MD, is board-certified in orthopedic surgery. In the hospital, the healthcare team may give you a blood thinner to prevent deep vein thrombosis, which may add to the bruising. My doctor recommend me to put some ice and helps a little bit and I'm also taking prescribed anti-inflammatory drug, but the medicine doesn't help at all. Any suggestions would be greatly appreciated, thanks. My surgeon isn't really saying anything that just give it a chance be patient. If concerned, have your surgeon check you out in the office. Thank you for the posting. My life has been ruined and every G.P. An MRI scan with metal artifact reduction sequencing (MARS) is necessary. Discoloration is not uncommon for several weeks or longer after knee replacement. I had a patellafemoral replacement about 6 weeks ago. The immune system of metal and plastic joints does not function. Two questions/issues. Hill AM, Ross-Adjie G, McPhail SM, Monterosso L, Bulsara M, Etherton-Beer C, Powell SJ, Hardisty G. BMJ Open. It is truly unfortunate that you reported a sensitivity and then a nickel containing implant was used. Minimizing Blood Loss You really need to follow-up with your orthopedic surgeon to discuss additional treatment options. Then at 4 months out of surgery I was still having a lot of problems still hot swelling and very painful. Nez E, et al. We are an online blog dedicated to providing comprehensive and accurate information about orthopedics and injury prevention. Maybe there is scar tissue formed? I'm so thankful that I found this site and can breathe a sigh of relief. According to the American Academy of Orthopedic Surgeons, nearly 90% of knee replacement surgeries continue to work well 15 years after the procedure. 9- Does the pain radiate down your entire leg into your feet/ankles? The body reacts by forming scar tissue and thickened joint capsule through the formation of granulation tissue, including macrophages and foreign-body giant cells [1]. Finally after the Covid restriction to stay at home lifted a little I was able to go to an osteopath who took an xray, measured me for a brace and told me to go back to the surgeon. 2016 Jul 13;6(7):e011139. I am 7 1/2 months since TKR of left knee. In my experience, once revised to non-allergic components, symptoms resolve. I am still experiencing knee pain on the outer side of my knee. It is possible you have a sensitivity to one or more materials used in the prosthesis. While some warmth may continue for a long time (months) after knee replacement surgery, it is not normal for this to last for years. Epub 2019 Apr 18. Osteoarthritis in both legs and throughout my other joints. D. J. Langton, T. J. Joyce, S. S. Jameson et al., Adverse reaction to metal debris following hip resurfacing: the influence of component type, orientation and volumetric wear, Journal of Bone and Joint Surgery B, vol. Two weeks later I had 110 degree Bach and one hand under to flatten. Lateral radiograph of the replaced knee demonstrates the loose patella prosthesis and surrounding osteolysis. Drive E. The patient had a well-healed surgical incision. Arch Orthop Trauma Surg. PLoS ONE. I think it is appropriate for you to follow-up with your surgeon for an evaluation and a fresh set of x-rays to make sure everything is OK. and transmitted securely. Conclusions: On the basis of this analysis, including histopathologic assessment, LTT results alone were insufficient for the diagnosis of TKA failure due to an immune reaction. After surgery, it's typical for the knee to technically be able to bend between 70 and 90 degrees, though it may be difficult due to pain and swelling. I have suffered extreme pain ever since the meniscus repair. Unauthorized use of these marks is strictly prohibited. If you have not undergone thorough workup for infection and material sensitivity/allergy- I strongly suggest you do this before, or concurrent with pain management treatment. I thought 3 months was adequate however my experience so far not enough time. Any sudden decline in function should be closely managed by your surgeon. If you have sensitivity to metals, then I agree that you should be evaluated for metal sensitivity prior to surgery. This Hip Surgery usually treats certain types of hip fractures. Careers. Most reports estimate the prevalence at between 1% and 11%. During the first few days, I gained 12 lbs in edema and was running a low grade fever. My knee x-rays at 4 wks showed small amount of effusion and demineralization.. Could this be causing my pain? Incidence of symptomatic venous thromboembolism in 2372 knee and hip replacement patients after discharge: data from a thromboprophylaxis registry in Montreal, Canada. Another option that can be effective is melatonin. What can I do to reduce the pain and swelling? I'm beginning to think I've made a huge mistake--I'm only 62 and an elementary school teacher and this is affecting how I can do my job. It is widely regarded as a safe procedure and has a high success rate. Before that could happen I had to have a Covid, Staph and MRSA test. If you had been feeling well and this is new onset warmth and stiffness, you need to follow-up with your orthopedic surgeon for evaluation. If you can use anti-inflammatory medication like ibuprofen (ask your surgeon), this could also improve your symptoms. The hip however has a very substantial soft tissue envelop and is considerably deeper than the knee. I would continue stretching on a daily basis, several times per day if possible. Should we be concerned or just count this as a set back and keep working. If swelling is severe, is not improving, and/or there is calf pain/tenderness, you should contact your surgeon immediately. I continued to be active and subconsciously developed several compensatory movements to avoid pain. Surgeon and PT are surprised by my continued pain, swelling and stiffness and both expected better progress at this point. A history of irritation due to costume jewelry could indicate metal sensitivity. Patch testing showed allergy to metals. GP. 1996;329(supplement):S187S205. I would expect your tissues to gradually relax for up to an entire year or more following surgery. I had a meniscus repair on 11/5/19 and now the end of the femur is dying. I went to therapy the next day lightly. HHS Vulnerability Disclosure, Help At six weeks following surgery, I would expect improvement, not deterioration. Journal of Biomedical Materials Research. Needing advice please. I hope this helps a bit. This is a significant risk factor for development of infection. I would not recommend additional surgery at that time. 3 and 1/2 years ago I had a total knee replacement. Hello I'm 52 and I had Total Knee Replacement 9 months ago. If your knee actually does not have what I would consider full range of motion as described above, it is important to continue working diligently on regaining it. For this reason, I recommend you contact your orthopedic surgeon ASAP for evaluation. Poorly controlled glucoses, as a result, suppress the immune system and increase the risk of infection by causing infection. It is worse than previous knee pain, and getting worse as more time goes by. That way the issue can be corrected. This is noted bilaterally. You do not mention your current range of motion, if you do not have at least 0-120 degrees by now, this is likely the issue. His answer was: No problem there, it will go away by itself when I repair the meniscus. It gradually did. This may mean skin or soft-tissue grafts will be needed. Most physical therapists do not do this. I also have like a spot that's puffy in just a small area like to left of my knee could that be fluid? Then, usually 6-8 weeks later, a new prosthesis can be implanted. Strengthening M. D. Ries, A. Cabalo, K. J. Bozic, and M. Anderson, Porous tantalum patellar augmentation: the importance of residual bone stock, Clinical Orthopaedics and Related Research, no. Knee replacement surgery, also known as knee arthroplasty, is one of the most common orthopedic surgeries performed today. You are very young but have symptomatic arthritis. At 7 weeks my ROM was about the same as yours, and i eventually (after a year) reached about 132. Until that barrier is healed, there is the potential risk of bacterial entry and infection. If an infection is diagnosed, the gold-standard treatment recommendation is a 2-stage revision. This takes time. Driving I started feeling better and was sent home. I have not pain at all. Roger C, Debuyzer E, Dehl M, Bulad Y, Lamrani A, Havet E, Mertl P. Orthop Traumatol Surg Res. [Osteolysis in revision total knee arthroplasty: a comparative study of osteolysis with and without metallosis]. My unaided bend is about 128 degrees and my extension is to zero. Click Has this pain been present ever since surgery, or is it new? mark of icing. Reason to contact your office was the very helpful replies given and my Surgeon is away until mid December. BMJ Case Reports. This is particularly true for people at high risk for healing complications after knee replacement surgery. My right knee not so much. I had surgery in my 20s that somehow tightened things up (the large scars run horizontally across both knees) but by the time I was 40 I was experiencing osteoarthritis pain under both kneecaps. However, it is critical that you consult with your doctor before using any specific range of motion. But since surgery I have had severe pain on the side of my hip towards my Buttox - and havng an ultra sound for gluteal tendinitis. I go to a regular check ups everything is ok except the level of my D dimers which now with therapy are close to the normal values. I noticed a little bubble on top of my knee cap a few days ago and today i touched it i was able to lift something up from the inside like a thick piece of paper im so scared its the weekend its so weird .anyway im calling on monday to go see my surgeon. I recommend slow, prolonged stretching, multiple times per day. I limp all the time. I would focus on range of motion exercises, and do frequent, but shorter walking distances (maybe cut your total distance for the day in half) for a few weeks. None of those years have been pain free. Prior to the BHR I did have 2 arthroscopic labral repairs surgeries on the right and one on the left. You need to discuss the situation with your surgeon, and I would expect they would ask you to come to the office for an in person assessment. I am sorry to hear about your experience. By Jonathan Cluett, MD Stiffness I been 9 month of total knee replacement and i still have pain , swalling and only 50 rom. Metallosis may cause pain, effusion, and systemic symptoms because of raised levels of serum-metal ions. Your doctor should be able to tell you if you have a bacterial infection in your body, which is a good sign. Cortisone How is your range of motion? If your bone scan was hot, you need a white blood cell labeled bone scan. Is the area of swelling red? The Birmingham cup must not be retained. I do appreciate it! Continued pain is possible, and I am sure your surgeon will discuss this unpredictability with you. Your surgeon should be able to help you figure this out. This time I had a low grade fever 100.6 F), mildly elevated CBC, but not elevated in other inflammation markers.. I have had 5 knee cap dislocations since surgery numerous buckling. Should I be worried about the progress and the blotchy marks on my thigh? Infection Stuart Hershman, MD, is a board-certified spine surgeon. Plast Reconstr Surg Glob Open. Is this something to be concerned about at this stage, or is this normal? I am 6 weeks out of knee surgery after the robotic process and cell replacement. If you could let me know these things it would be great. Even your scar could continue to retain some heat and coloration in the weeks (or months) following surgery. If this is all negative, and no mechanical explanation can be found, consider invasive pain management- they could do genicular nerve blocks to help reduce pain. In this case the patient underwent early revision knee surgery where the stained soft tissues of the knee were debrided and patella component was revised with an alternate bearing surface. I don't want to have another surgery. You may notice that the skin on your lower legs becomes discolored or appears bruised as you age. I am at about 11 months post- PFJR - I'm finding that I have delayed swelling and pain after sports (hockey/fast paced road cycling) that limits me in terms of activity post. I noticed that if I put my weight on that knee when I take weight off it it causes pain and now its started to hurt more and when bending it. My knees are still warm to the touch and I am often awakened at night with pain. WHAT'S HAPPENING TO ME???? Was the offending implant removed? The effusion may cause stretching of the joint capsule, which can cause some discomfort. Do you feel any instability with side-to-side stress of your knee? The https:// ensures that you are connecting to the The Bone Marrow Scan said something about Marrow Hypoplasia not sure what that means. The authors declare that there is no conflict of interests regarding the publication of this paper. Was tested for Lyme's disease. I have a cross-category allergy to NSAIDS. Other conditions and medical treatments that can cause skin discoloration include: Bleeding into the skin. If both of those issues are ruled out, it sounds like RSD (reflex sympathetic dystrophy), also known as CRPS (Chronic regional pain syndrome). Case Study. You mention lymphedema. Any ideas of how I should proceed?? Wowyou have been through a lot with these hips. I don't feel much discomfort, and would like to get back running on the trails again, and on the tennis court. Also surgeon told me I need to stretch the band, but when I look on-line I am told that you can't stretch the band but maybe it's the muscles or tissue that's needs to stretch. This is the type of case that really requires hands-on examination and management by a thoughtful orthopedic surgeon as there are a variety of possible explanations and treatments for what you describe. The best way to do this is by CT or MRI scan with metal artifact reduction sequencing. Sometimes lab work would also be required. Why do medical "experts" refuse to acknowledge that things can go wrong and admit to ignoring my metal alloy allergy should not have happened. 8 weeks ago I had total knee replacement on my right leg. Activity seems to exacerbate the swelling and makes it hot. It sounds like you are making excellent progress. Her principle complaint was skin discolouration, associated with pain and swelling over the left knee, on the background of a previous total knee replacement with a metal backed patella resurfacing six years. Bruising around your knee may last 1 to 2 weeks following surgery. The predominant findings on routine histopathologic analysis were fibrosis and varying degrees of lymphocytic infiltration in 17 (63%) of the 27 cases. Accessibility The rash usually lasts two months or two years after it has been surgically repaired. Right now I'm still in a lot of pain and the swelling is still there and the hot is still there. Nicely done. I have been diagnosed with Osteopenia which I believe has been caused by revision surgery. The concern would be: what if your symptoms are not indeed due to the prosthesis? It is not normal for your knee to hurt "a lot" at this stage of the recovery process. Knee replacement incision healing is an important concern for anyone undergoing knee replacement surgery. Thank you for getting back to me. After total knee replacement (TKR) surgery, you will probably stay in the hospital for several days, depending on how your recovery progresses.
