TKR 2 years post op TKR issues

[dogwalker2]

@kreismama. I have that weird leg stretchy thing too, I believe its called restless leg syndrome. I used to get it preop as well, usually in bed or at the cinema!! Never pursued a specific treatment, but found if I rested more it reduced the frequency. When it happens at night I just get up and have a short walk and then back to bed.

 

[kreismama]

Hello,

I had my left TKR on February 28, 2019, when I was 55 years old. I did very well in surgery and post op, stayed one night in the hospital and did my first PT in the morning then was discharged in the afternoon.

My home recovery was good, did my exercises routinely and other than swelling I was fine, no pain and I was walking well with my walker. I began my PT within two weeks after surgery and I was doing quite well and after a few months I was at 113* bending and 0* straightened.

After about the 4th month into PT I was experiencing a bit of stiffness and my ROM was going backwards a bit to 112, 110, 109. The Therapist would try to bend my knee as much as possible before the pain was unbearable, at last attempt before I stopped my PT I was at 110* I believe, this was July 2019.

I stopped going to PT and went to see my doctor as the Therapist suggested I may need a manipulation. My doctor actually thought my progress and ROM were good but I explained that I was experiencing stiffness and ROM had gone backwards. She felt I may need a manipulation and we were going to schedule it when my insurance was canceled by my employer so I didn’t schedule the manipulation.

I then returned to work in February 2020, regained my insurance and then COVID hit so I wasn’t going to pursue elective surgery for the manipulation.

I started experiencing more pain and stiffness, The pain has always been along the outside of my knee from my hip to my knee cap. Even in the early days of PT I had this pain. The therapist said that was normal, that my tendons and muscles were still very tight and sore which was to be expected.

Now I’m at 2 years post op and the pain has gotten worse and the stiffness is also worse. The latest pain to develop is a sharp pain in my upper shin when I walk and when that pain hits i cannot bend my knee. This started about 2 months ago and is a more specific and sharper pain than I’d been experiencing before.

The pain before seemed to me to be coming from my IT band and scar tissue causes stiffness but it has never been confirmed by my doctor. This new pain I am experiencing in my shin also causes extreme pain when I try to sleep on my side, which previously I was able to do. Now when I try to side sleep it starts burning and almost feels like my knee hardware is hanging, pulling it down in a very painful way even with a pillow which I always use.

So I went to see my surgeon and she did an X-ray that looked fine but she wanted a bone scan and blood test to rule out infection and hardware loosening. My blood results showed all normal except my SED (I think she called it) which was 36, And she said normal is 30. She said it’s a bit elevated but not bad, which could indicate a small infection since all other tests were normal.

The bone scan showed some lit up areas around my knee and shin where I’m experiencing this pain. She said it’s hard to tell if it’s infection or not, so she has now ordered an Indium scan. I’m just waiting for my insurance to authorize it.

I unfortunately did not see the results in the scan as I was on teleconference with my doctor and she seemed so vague with the results. She did say that if it was determined to be the hardware I would need to see a different surgeon as she doesn’t do revisions.

Not sure if she’s leaning more towards hardware being the concern or not. I’m very frustrated, to say the least after 2 years, and so hoping my hardware doesn’t need to come out! I can’t even begin to think about that. Anyway any thoughts or feedback you may have would be helpful.

The pain is intermittent but often and I have yet to have a no pain day ever, even back in the early post op days. I realize many people don’t get the results they’d hoped for with TKR and pain doesn’t always completely go away I get that; but this isn’t right I know something isn’t correct.
Thank you.

 

[Celle]

Hello again, @kreismama .
I'm sorry you've had to come back to us with increased pain and stiffness.

It sounds to me as if your surgeon is being very thorough in investigating your knee problem.
You've had a knee X-ray, which appears normal, so loosening of your hardware seems unlikely.
There are no definite indications of infection, either.

Have you had blood tests, to see if you are allergic to any of the metals in your prosthesis? The blood test is most accurate and you can get the test done in the USA by ordering the test kit from https://www.orthopedicanalysis.com/testing/order-testing-panel . You want the Orthopedic Panel Test 2. Once you get the test kit, your GP (or any lab) can do the blood draw and send it in for testing.
Unfortunately, insurance doesn't usually cover the cost of this test, but it's still well worth getting it done.

I'm not at all convinced that you have adhesions causing the stiffness. To me, its more likely that the early and painful PT set up a chronic inflammation in your soft tissues.

Are you still dong PT or exercises? So long after surgery, you shouldn't need to. You should just be using your knee normally in your daily life.

Your symptoms to me sound as if they could be caused by inflammation of your tendons.

However, I think it would now be a good idea to look for a second opinion, from a surgeon who specializes in problem knees and who is not associated in any way, either professional or social, with your current surgeon. By doing that, you will get a completely independent opinion, not influenced by your current surgeon's opinion. Sometimes these surgeons, looking at your knee with new eyes, can discover a problem and a solution that has escaped your original surgeon.

 

[Celle]

By the way, you'll notice that I have merged your two threads together as it's best if members in recovery only have one thread.
This is because:

• That way, you have all your information in one place. This makes it easier for others to go back and review your history before providing advice.
• If you start new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

Please keep all your questions and updates on this thread. We won't miss your new question as, between us, the staff read all new posts each day.
If you need an urgent response to a question, tag a member of staff.
Tagging other members and answering tags

If you prefer a different thread title, just post what you want and we'll get it changed for you.

Here are the instructions on finding your thread, How can I find my threads and posts?

A helpful hint - Many members have found it useful to bookmark their thread so they don't lose it.

Best wishes,
Celle

 

[sistersinhim]

I agree with Celle. You need a brand new set of eyes looking at your knee. A revisionist knows what to look for in problem knees and might be able to spot it right off.

 

[kreismama]

@Celle thank you for your response and feedback.

Yes one of the other things I discussed with my surgeon was the chance that I may be allergic to the hardware metal. I forgot to mention that in my post. This thought has been on my mind for over a year now because I met a man in my PT that had to have his hardware removed due to allergic reaction years after his TKR. He was having pain and they discovered he was allergic. I’ve actually had a dentist tell me I might be allergic to nickel as my gums tend to swell occasionally around my crowns. He said nickel is used on the under side of a porcelain crown to adhere it to the post. So no I’ve never had an allergy test but the thought is on my mind as a reason for my issues with my knee.

So I did bring this up to my Dr and she said I should have an allergy test as well. We haven’t gotten to that yet as still waiting for the 2nd scan to be done.

But I think you’re right, I need to see a specialist that can help with these problems. My surgeon while being thorough doesn’t specialize in revisions.

You mentioned chronic inflammation in my soft tissue might be causing my stiffness and pain and my symptoms may be inflammation of my tendons. Is there anything that can treat this to reduce the pain and stiffness? I truly feel my tendons are the cause as well this is where the pain started and continues.

To answer your question, no I am not still doing PT I stopped going to PT after 5 months. I continue to do my daily routine of walking, errands, bending etc but one thing I cannot do at this time is ride my bike. It is very painful to get my knee up and around to pedal.

Previous to me stopping my PT I was riding the stationary bike and able to pedal in full circles normally but the seat was in a higher than normal position. I cannot ride my regular bike with the seat in a normal position and I can’t ride with it too high for fear I’ll fall.

I was starting to ride a stationary bike again at home that I bought but when this new pain started I stopped riding it. The new pain being the sharp pain in my shin that hinders my knee from bending.

So I think my best option now is to find a revision specialist and present them with my test results thus far and go from there. And take the metal allergy test. I’ll keep you posted. Please let me know if there is anything that can be done for the tendon issues if that turns out to be my problem or one of them.
Thank you!

 

[kreismama]

@sistersinhim I agree and had already been considering a new Doctor that specializes in post op problem knees. I will begin researching specialists and see someone next. I don’t see the point in continuing to see my surgeon if she doesn’t specialize or even handle revisions as she stated already. She’s probably hoping I will seek a different Doctor at this point. Not that she hasn’t tried but I feel it’s beyond her specialty at this point. I will update once I see a specialist.
Thank you.

 

[Celle]

It seems you will have tried everything except the allergy testing. I commend your surgeon for being so thorough.

I do think that your next step should be to look for a second opinion from someone who deals in problem knees. It does a lot of good to get other opinions and some people even get a third or fourth opinion.

 

[kreismama]

@Celle I am pleased with my surgeon’s diligence thus far as well. I agree I am now researching surgeons in my area that specialize in post op problem knees. If I feel the need I will definitely see 2 or 3 different doctors until I feel I’ve found the right one. I just want to get this knee right so I can move forward with my right TKR next and live my life again. Which brings me to another question regarding my next TKR. I’m researching robotics surgery for my next knee. What are your thoughts on this procedure vs traditional surgery for TKR? I’ve read and heard from patients that have had it and swear by it as far as their results and recovery. Any feedback on this subject would be helpful.

Thank you.

 

[Celle]

Which brings me to another question regarding my next TKR. I’m researching robotics surgery for my next knee. What are your thoughts on this procedure vs traditional surgery for TKR? I’ve read and heard from patients that have had it and swear by it as far as their results and recovery. Any feedback on this subject would be helpful.

Robotics surgery is good and it can sometimes help a good surgeon. It can't turn a mediocre surgeon into a good surgeon, though.

Your most important choice is still your surgeon. It's the skill of your surgeon that is the most important factor for a successful outcome.

 

[sistersinhim]

I've heard some good things about robotic surgery. This main thing, as Celle said, is to be sure your surgeon has lots of experience in revision surgery. If you are considering the robotic route, make sure that surgeon has lots of experience in that, too.

 

[kreismama]

Great points on the robotics surgery. Thank you.

 

[judgar]

HI. I had a knee replacement aug. 2019. My knee still swells and I feel like I can not bend it. I go streach it. I can do a bike. I can walk fine. I can not do steps. It hurts when I do steps. I have pain no other time except steps. But I know this is very upsetting. You go into this thinking everything will go ok. I do feel better than before it was done. But I feel like you on the swelling it stops you from bending you wonder why almost 2 years

 

[Goma]

My tkr was 3d camera assisted. I have 2 tiny cuts in my shin where the camera was inserted so my surgeon could see and fit the implant precisely. He is an excellent surgeon and my recovery is going very well. I don't know if my surgery was robotic, I should ask him.