TKR Calf is on fire after TKA

[Doodlemama]

Hello. Has anyone experienced intense, debilitating calf pain immediately after TKA? Here's my story:

I had a TKA on 10/9, was discharged on 10/10. I'm 51, 5'3" average weight, don't carry a lot of extra. The knee that was replaced had an ACL repair back in 1989 and meniscal surgery in 2004. I've had both hips replaced due to unknown hip dysplasia, one in 2016 and one in 2017 so it's been a long haul. The night I went home from my knee replacement, my calf swelled and was very painful, more so that when I left the hospital. I called the number I was given and they said to get to the ER to check for a clot. Was given a blood thinner shot (I'm only on aspirin) and had an ultrasound the next morning - all was clear. My calf has only gotten worse. It literally feels like it's on fire when I move. It feels like both muscle pain - like a permanent charlie horse I have to work through- and also nerve pain that shoots all the way through and down. I can get it to settle down when my leg is propped up and iced, which I'm doing around the clock, but the minute I move it the pain starts shooting, especially when my foot gets to the floor, I'm assuming because of blood flow changing. It also hurts when my leg is propped up because the pressure on my calf. My skin is sensitive to touch as well.

My doc has only told me to increase my gabapentin to twice a day, and that has helped some, but I still feel some of the nerve pain (at least that's what I'm calling it) and can't get the muscle issue to settle at all. He seems to be resisting seeing me in person because he knew going in I was worried about blood clots, and I think he just thinks I'm a head case. The last phone call he got about me was from my visiting PT who was concerned about my calf. After that his nurse called me back and they offered me valium because "anxiety can run high during recovery" and it helps with muscles. I already take Effexor and with gabapentin and Dilaudid I don't think that's the solution. I was ticked to be honest, and felt like they just want to shut me up.
Has anyone experienced any pain like this??? I feel like it can't be normal. It's literally debilitating and keeping me from progressing the way I know I can with my PT. I'm still on full pain meds and using a walker, and at that I'm toe touching most of the time. I'm wondering if anyone has experienced this, how long it took to get through it and also what solutions you found. Thank you! By the way.. my knee pain itself is totally manageable. So weird.

 

[Jockette]

Hi and Welcome!

I’m sorry you’ve got this extreme pain and your doctor doesn’t seem to be listening. I’m glad that your PT listened, and saw something worth calling your doctor about

I’m going to ask @Jamie to come talk with you.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

​

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Jamie]

Since a blood clot was ruled out in the ER, my concern (like yours) is that the pain is worsening, even with the increase in Gabapentin. How much was your previous dose (amount per dose and number of times a day you take it)? And what are you taking now?

Please tag me when you respond so I'll see it quickly. To tag, you type the "at" sign (@) followed by my username with no space ..... like this @Jamie

 

[TKR_Bill]

@Jockette & @Jamie, I’m so impressed how quickly you respond to people. You’re awesome!
@Doodlemama, I’m too new at this TKR thing to give advice, but I’m confident one of these great Bonesmarties will have something encouraging for you. All the best.

 

[Jockette]

@Jockette & @Jamie, I’m so impressed how quickly you respond to people. You’re awesome!

Thank you, TKR_Bill, you just made my day!

 

[Jamie]

Thanks, @TKR_Bill.....our goal is to provide responses within 24 hours to everyone, but we actually try (and succeed) at being a lot better than that. We're proud of our great staff here on BoneSmart. We realize people need reassurance and answers....not a long waiting game.

 

[Doodlemama]

@Jamie and @Jockette, thanks for responding so quickly. Jamie, I am on 300mg of Gabapentin twice a day. Hydromorphone 2mg (Dilaudid substitute) every 4 hours as needed. Sometimes I need it every 3 but can also go 6+ hours, depending. I'm trying to reduce my usage of that because I don't know that it makes much of a difference at this point. It helps some, but I dislike it and don't want to get addicted so if I can live without it I'd prefer to. It almost feels like with the gabapentin increase to 2x/day that the muscle pain in my calf has become the primary issue, and the nerve pain secondary, although still quite painful when I stand up! It's kind of hard to describe. I'm wondering if I've lived so long with my knees aligned one way, if it's been repositioned in any way I'm feeling the pull of muscle position changes?? I will say when the left hip was replaced two years ago my left knee declined pretty rapidly. I had been discussing it with him for a couple years but trying to postpone as long as possible. It just became too much this year. But as of right now I'm regretting it. The pain also runs along the line of the nerve block I had, all along the medial/inside of my leg so I wonder if I have a compressed nerve. The swelling in my calf is almost all gone. Do have some in my ankle still. Entire lower leg is sensitive to touch. So weird. I'm thinking I pretty much demand an appointment, but I also don't want to be a drama queen. Ugh.

 

[Pumpkin]

Doodlemama,
Glad to hear the swelling is going down.

Entire lower leg is sensitive to touch.

Your PT should be able to help you with desensitization of your leg, ask them the next time you see your PT.

Don't worry about becoming addicted, as long as you are taking pain meds for pain as directed there should be no problem. You will find as you feel better you will take them less often then not at all, naturally weaning off.

 

[Jamie]

That's actually a fairly low dosage of Gabapentin, so it might be that an increase in it for a while could help get that pain under control. But you'd need to run that by either your surgeon, your GP or the doctor that prescribed the med.

I think you are right that you need a face-to-face appointment. There are tests that can be done to see if you have nerve problems. It's going to be more difficult for you to recover form your knee replacement when you have this level of pain. Being assertive and an active partner in your own health care is NOT being a Drama Queen. As long as you remain calm in the appointment, ask questions that you've written down ahead of time, and make it clear that you want to completely understand his opinion of what is going on, I'm hoping he will see your concerns and deal with them.

You mention you have had a hip replaced, please tell us the date of this surgery and any others you have so we can get that into your signature. It all is important information so we can better advise you going forward.

 

[Doodlemama]

Hi @Jamie

Thank you for the guidance and support.

My right hip was January 16, 2016, the left hip was November 21, 2017. Good times lol.

 

[Jamie]

Thanks for the other surgery information. You're a member of my club - The Three-Jointers! I have two knees and a shoulder that was done this past February.

 

[luvcats]

I'm wondering if I've lived so long with my knees aligned one way, if it's been repositioned in any way I'm feeling the pull of muscle position changes??

After my first replacement, I had constant, unending horrible cramping pain in my thigh. My pain specialist pointed out that my leg muscles had all been working a completely different way and now that they were aligned properly, every single movement was a massive workout, and they also really resented being stretched and strained. I tried using gentle heat on the biggest muscles, carefully avoiding the knee, and that helped quite a bit.

 

[kneeper]

My calves got quite crampy after my tkrs. My PT showed me some gentle stretches that helped.

I still tend toward tight muscles (with lots of sitting at work) and the stretches I learned in PT are still helpful.

 

[NewToMe]

@Doodlemama My calf was fine for 3 days then I couldn't get it on the floor to walk for 4 to 5 days. Once ER ruled out no DVT, the ER doctor said fluids go to gravity, so fluids from swelling in knee go down if not elevated. Plus generalized swelling from surgerical trauma.

I kept taking pain meds, ice and elevate and calf massages from hubby. The massages may not of medically helped, but it WAS a very nice way to get moving touch from him. I am a snuggler and it's hard to do it in a separate room!

 

[Doodlemama]

@luvcats , @kneeper and @NewToMe Thank you for sharing your experience. I think I'm turning a corner. My visiting PT gave me some good nerve slide exercises and more specific calf things to do and they're helping. I upped my gabapentin to two times a day, and my doctor also suggested valium (after several calls from me crying in pain). At first I was totally offended and told his nurse that because I assumed they just wanted to shut me up. But apparently it works well as a muscle relaxer. So I finally went and got the prescription and I think it's helping a bit. I'm not crying every day anymore- a huge bonus lol. I mean, it still hurts and I'm not able to get my heal to the ground yet due to the cramped up muscles, but I'm getting closer. I'm finally able to focus on my knee rehab, flexion and extension. Oh, my PT also told me not to elevate as high and as often anymore so I can ease the pain of the blood flow when I stand up. And my skin is far too sensitive - some of the nerve issue- so I can't have my husband massage just yet.
Who the heck knew this would be a part of it?? I was so unprepared and that was a big part of my frustration. Would have been nice to hear something like, "fyi: you might feel like you want to amputate your calf, but don't worry, even though it hurts like hell it will get better slowly, at the pace of a turtle crossing a busy highway!"

 

[Doodlemama]

@luvcats exactly what you said is what I think is going on, as well as general soft tissue trauma from surgery. I had a very similar issue when I had my first hip replaced and I was in absolute agony with leg pain. Total and utter agony for weeks and weeks, and it took 6 months of PT to heal. It was not a typical hip experience at all. I was diagnosed very late in life with hip dysplasia in both hips, so for 47 years I was aligned one way. And now that I've had both hips and this knee done my body just gets ticked at the new normal. I'm praying my remaining right knee doesn't cave! lol!!

 

[Rockgirl4]

I hate to say this, but apparently we're more normal than one would think. I had the exact same excruciating calf/ankle pain and couldn't toe-touch AT ALL for the first 2 weeks without wanting to scream. It was still very painful that entire first month post-op.

There were times I remembering telling my husband my calf/ankle hurt worse than my knee (which was already excruciating), and every time I tried to get up to go to the bathroom, it was like liquid lightning moved down my leg and into my calf/ankle, taking a good 30-40 seconds before I could try to take a step----even with the walker taking almost all of my weight.

My severe swelling and bruising (my surgeon's words, not mine!!) lasted for a full 5 weeks. Even into week 6-7, there was still small amounts of bruising on the back of my calf/ankle. My PT sad to take pictures because I was an oddball. My surgeon had already told me at my 1-month checkup (it was really closer to 5 wks) that I was actually normal. TOTALLY NORMAL!!! He doesn't do 2 week checkups because the swelling/bruising/pain is often still so bad that it's not worth having people drive in, sit in uncomfortable chairs, and swell from the long-day experience....only to be told they're perfectly normal and "it will take time." Then they get mad and wonder why they wasted their time coming in to the Dr in the first place. He said some barely swell or bruise and others (like me) lost the swelling/bruising lottery.

Sure enough, somewhere between weeks 4-5 post-op I could toe touch without having to pause before taking a step (upon getting up from having my legs propped up). I had to use the walker into week 5 because of the severe calf/ankle pain, and thankfully ditched it before week 6 after my PT worked out some of the muscle tightness/soreness in my lower and upper leg. She was a Godsend in that regard and knew the main thing keeping me from walking without it was the calf/ankle pain---NOT the knee pain.

Anyway, I know many here never experienced what we did, but I'm glad to know what COULD happen when I have my other TKR in a couple of years. I won't be nearly as worried/surprised.

--Lisa

 

[Doodlemama]

oh my gosh @Rockgirl4 your description is exactly what I am experiencing. You poor thing. Standing up has been a nightmare and would make me cry. I literally felt like if I tried to heel touch my calf muscle would rip open. I have made a lot of headway in this last week and it's very slowly getting better. I am 2.5 weeks post-op and using my crutches a lot more. I'm still not heel to toe but I'm doing so much PT on my own to work through the calf pain, I'm hoping I keep turning the corner. My bruising is improving and is now mostly in the back of my calf and ankle. It had worked its way all the way up the back of my hamstring! I found my tens machine today (the e-stim thing) and just got done from a 45 minute session with that bad boy on my calf. It felt so good! I wish I had started it earlier! I also started taking Valium in addition to the gabapentin and that has helped as a muscle relaxer. I agree with you that if I ever have to do the other knee, I won't be so surprised. That was so much of my anger in the beginning- this came out of nowhere and I was not prepared in the slightest way for that. Exhausting, lol!! Hope you are well and have a happy skip in your step!

 

[Doodlemama]

@Jamie did I read somewhere that we should keep our posts to one only? I wanted to kind of put out a PSA to people recovering from very recent surgery. I totally over did it this weekend (2.5 weeks post op at the time) and really want to discourage people from getting out too much even though you feel like you can, and need it mentally. I am set back and so mad at myself. I'd hate to see others do this!! I'll be 3 weeks tomorrow and still on most of my meds, and had to go back to regular use of pain killer because I was a dummy. Grrrr. I start outpatient PT tonight and praying he can help me with my calf, which is just an insane issue that is challenging my mental strength, which is why I really wanted to get out in public! Such a balance.... fine line between healthy outings and tipping the scale to have a set back.

 

[sistersinhim]

Yes, you are to have just one recovery thread. This keeps all your information is one place for everyone to see.

Have you called your OS about your calf pain? I think you should if you haven't.