TKR Hematoma in the knee

hemaknee

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Hello!

Needing help and advise, please.

I had my surgery on Jan. 17, 2022. It will be 7 weeks this Monday. Eleven days after TKR, I felt a swoosh sensation into my knee joint. I had instant pain, swelling, no mobility. It looks and feels like there is a baseball in my knee. I'm confused on what to do. The doctor says compression, elevate and ice. I have very little movement. I can only stand for 5-10 minutes. Walking is very difficult. If I work hard to get any ROM, I can only get to 30-40 degrees with a lot of pain. Once I get to some movement, the knee goes right back to being straight and ROM is gone.

I am so frustrated with my knee and in tears every day. I am a music teacher and was planning to get back in March to plan spring concerts and spring music events.

I know everyone is different... but I was wondering if someone has had a similar situation and what was their success? I can't seem to find the conclusion of someone who is has had a hematoma in the knee joint.

Here are some of my questions:

1. My doctor suggests compression. I have a sleeve of ace bandage type material. My wound has not fully healed yet, which is also causing concern with PT and wanting to do more ROM. It seems with the sleeve the ROM is comprised and it feels like the hematoma pushes more on the knee joint than when it is on than off. And my ROM is quit a bit less with the sleeve on. Is leaving the sleeve off a bad thing?

2. How long will a hematoma in the knee joint last? Some of the information I have read, hematomas only lasted several days to several weeks. How long is too long to wait to do something about it? Can I get a MUA with the hematoma or do I need to wait until it is completely gone?

3. Since the hematoma has happened, I have noticed some color change, but it still feels like a rock when I touch it.

4. Currently still taking Tylenol and Ibuprofen daily. Do I take more powerful pain meds to try to get more ROM?

I would appreciate any help if someone has had a hematoma directly in the knee joint. I am starting to loose hope and can't see an end to this situation. Mean while, I am loosing muscle tone and strength. I would've much rather dealt with the pain I had prior to TKR than what I am dealing with now.

BTW: My age says I am 30. I typed the wrong year. I am 50 yrs old.
 

WFD

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I had one after my revision, and had many of the same symptoms you did.

The PA aspirated more than 240 mL of what looked like mostly blood, and I was much more comfortable afterwards.

Of course, putting a needle into the joint (8 in this case) always carries with it the chance of infection. I was willing to take the risk because I am so prone to developing scar tissue in the joint. Your trade offs may be different.
 
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hemaknee

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Thank you WRD!

Did you ever wait one one out? My doctor didn't want to aspirate it when I first got it because of infection. I was wondering how long I should wait. Or do I wait the hematoma out and get a MUA?
 

WFD

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I didn’t wait it out. I am very prone to the development of scar tissue in my knee and so I decided I cannot risk having all that blood in the joint. Your situation may be different - what sid your doctor have to say? Has he seen these resolve themselves without aspiration or ?
 

Jamie

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@hemaknee.... I'm so sorry to hear you're going through this problem with your recovery. When did you last speak with your surgeon about the hematoma? Looking at the dates you've provided, it started on January 28th so it's been a problem for you for over a month. If you haven't met with your doctor in the last week or two, it's time to get checked out since things are not improving for you and you are having a significant amount of pain. Let me also try to address your specific questions:

1. My doctor suggests compression. I have a sleeve of ace bandage type material. My wound has not fully healed yet, which is also causing concern with PT and wanting to do more ROM. It seems with the sleeve the ROM is comprised and it feels like the hematoma pushes more on the knee joint than when it is on than off. And my ROM is quit a bit less with the sleeve on. Is leaving the sleeve off a bad thing?
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Rest, ice, compression and elevation, as your doctor recommended are all helpful as you wait for your body to dissolve the hematoma. Application of heat can also help by increasing blood flow to the area. Just be sure any heat you use does not result in additional swelling. It would be fine to leave the sleeve off for short periods while you do bending and stretching if that is more comfortable.

As you probably know, the condition is caused by a release of blood into the tissues surrounding an injury or wound. The "Whoosh" and sudden pain and lack of mobility suggest that is what happened. Your surgeon was correct that normally doctors prefer not to risk infection in a new knee by aspirating the hematoma.

You say your wound has not fully healed. Is it draining still? If so, what does the fluid look like?

2. How long will a hematoma in the knee joint last? Some of the information I have read, hematomas only lasted several days to several weeks. How long is too long to wait to do something about it? Can I get a MUA with the hematoma or do I need to wait until it is completely gone?
Normally a hematoma will clear or at least begin to improve by 4 weeks. Some larger hematomas can take months to completely clear. Unless you are still leaking blood into the area, there is nothing to be "done" except to wait for resorption back into your body. It is not a fast process and there is nothing you can do to "hurry" things up other than the rest, ice/heat, compression, elevation treatments. The leaked blood clots fairly quickly to form that knot that you feel. It cannot be drained at this stage unless you had a lot of new blood in the area and I would be surprised if your surgeon would suggest an MUA while you have this problem.

3. Since the hematoma has happened, I have noticed some color change, but it still feels like a rock when I touch it.
Improvement would be indicated by changes in color to the bruise and/or a lessening in the size of the bruised area on your skin. It sounds like you may have some improvements here but my question to your doctor would be whether or not it's possible that blood is still leaking into the tissues since you're still experiencing a lot of pain and reduced mobility. The hard lump is typical and will take longer to disappear.

4. Currently still taking Tylenol and Ibuprofen daily. Do I take more powerful pain meds to try to get more ROM?
This is not the time to try and force ROM. You should be doing a lot of gentle bends and stretches throughout the day, but even your therapy shouldn't push you into any real pain. That will just increase your swelling and could slow down the hematoma from healing. Your first order of business is to get the hematoma resolved, then you can focus more seriously on your ROM and strength. There is no window of time that will cause your knee to "freeze" at that ROM and never get any better as long as you are routinely doing those bends and stretches. You don't have ROM because your knee is swollen.

But I do think it's time to get back to your surgeon for a re-evaluation and to make sure you don't have additional blood leaking into the area.

I adjusted your birth date in your profile so your age reads correctly.

Good luck and please don't hesitate to ask additional questions here if needed. We're here for you.
 
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hemaknee

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Hello Jamie,

(First of all, I'm not sure if I'm posting this correctly. Please forgive me if I'm not following the thread correctly)

Thank you for all of your excellent advise. I have communicated with the dr and am planning to visit with them beginning of next week.
You say your wound has not fully healed. Is it draining still? If so, what does the fluid look like?
The wound is improving very slowly. It isn't draining, it is just now losing the last few scabs (7weeks post surgery) and I thought it was because I have been keeping it covered with the sleeve.

It sounds like you may have some improvements here but my question to your doctor would be whether or not it's possible that blood is still leaking into the tissues since you're still experiencing a lot of pain and reduced mobility. The hard lump is typical and will take longer to disappear.

But I do think it's time to get back to your surgeon for a re-evaluation and to make sure you don't have additional blood leaking into the area.

How do they determine if blood is still leaking into the hematoma? I have had the hematoma for 5 1/2 weeks now. There has been some light color changes but nothing has shown with darker colors to indicate a bruise has set in. The hematoma felt like needles were poking into my knee and some of that pain has subsided.

My PT has been excellent about taking things slowly and not causing pain.

Thank you for all your information! It's nice to hear some additional advice. I hope my next dr's visit will shed some light on the next steps.

Thank you again,
hemaknee
 

Jamie

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I'm glad you will be able to see your surgeon for further examination. It's difficult for us to be able to tell much over the internet without a lot more information (sequential photos and descriptions of what's happening). There are many variables that are better diagnosed by someone with eyes on your knee.

The development of a hematoma is a risk with knee replacement surgery, but it should be treatable so you can continue with your recovery. Your surgeon may order some imaging if he thinks there is still some leakage. He also may advise you to stop taking the ibuprofen as it can thin your blood and might be contributing to the problem. Please let us know the outcome of your consultation. We'll be here for you if you have additional questions or concerns.
 
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hemaknee

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Hello Jamie,

I really appreciate your support through this website!

My visit with the doctor was yesterday. He felt the hematoma has subsided and now I have scar tissue. I was confused of when that might have happened. To me it felt like I was still dealing with the hematoma. He said I need to really work the knee and knee cap to release the scar tissue. Do you have suggestions of how to do that and/or where I could find good information of someone that has dealt with that?

My PT is good and only wants me to push as hard as I feel comfortable.

Thanks for any information!
hemaknee
 

Jockette

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He said I need to really work the knee and knee cap to release the scar tissue.

My PT is good and only wants me to push as hard as I feel comfortable.
This may work for some people but it doesn’t work for all, and I wouldn’t push anything, especially right after having a hematoma. Gentle movements for mobility are good, walking is good, as tolerated, but not to excess yet. There is no window of opportunity for ROM to improve, mine continued to improve well into my second year, as my whole leg continued to relax and heal.

Scar tissue is not always the big bad thing that they warn us about. Some scar tissue is par for the course, and it naturally diminishes over time.

Stiffness/Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.

You are still only 2 months into a recovery that takes a year.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.
 
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hemaknee

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Thanks Jockette! I appreciate your input. I am trying to take it more easy and be careful of the swelling. It has been difficult as I was hoping to return to work sooner than later. The doctor tells me returning to work could be done 6-8 weeks and I was being hopeful. I see now that can only be for super human people. :loll:

Anyway, I am now going to have a LOA with MUA next week. I can't get my knee past 50 without a real struggle. They tell me it's better to get the surgery sooner than later. I just hope I can maintain the knee without getting major scare tissue back.

Would the doctor be able to tell from the surgery if I would have Arthrofibrosis?
 

WFD

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Would the doctor be able to tell from the surgery if I would have Arthrofibrosis?

Yes. If you have arthrofibrosis, your knee joint will be full of scar tissue and it will be readily visible. In some cases, there is so much scar tissue that the surgeon, if he is performing an arthroscopic procedure, almost can't see anything and has to work hard to find his way through the joint.

Will your LOA be done arthroscopically? If yes, then will the surgeon be using an electrocauterization tool or a debrider? I had an open LOA done in March 2021 and then an arthroscopic LOA using an electrocauterization tool almost 3 weeks ago. The difference in recovery was night and day. Recovery from the open LOA was almost as bad as from the original TKR - lots of pain and swelling, definitely got worse before it got better. After the arthroscopic LOA using an electrocauterization tool the pain and swelling decreased immediately after the surgery, compared to before the surgery - my knee got better before it got better :) . I was able to punt on the Tramadol and have not needed anything for pain relief since then.
 
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hemaknee

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Hello Jockette,

I had my LOA and MUA on Friday, April 1st.
 
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hemaknee

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Hello! A little update!

It has been about 6 weeks since I had my LOA and MUA and 4 MONTHS since my TRK, I am finally starting to see some results. Last week, I was able to make a full rotation on a bike. The seat is very high and I'm on my tip toes, but I can do it! And it wasn't painful! I can make my way up the stairs with one foot in front of the other instead of taking one step at a time. I can actually sit at the table, eat a meal, and not feel like my leg will explore with it hanging down. I never thought I would get to this point with my recovery. It has been so frustrating. I would say I am at 90 degrees on some days and not at 90 on others. I'm just thankful I am able to walk into a store and get some groceries!

I want to thank everyone who responded to my posts. This journey has really tested who I am.
 

benne68

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I can make my way up the stairs with one foot in front of the other instead of taking one step at a time. I can actually sit at the table, eat a meal, and not feel like my leg will explore with it hanging down. I never thought I would get to this point with my recovery.

What a great report, @hemaknee ! Hoping you continue to see progress in the weeks ahead.
 

sistersinhim

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What a good outcome you are having!
 

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