TKR Knee discomfort

[wilbo58]

Another sleepiness night and it’s all down to aching from the top of the knee up the front quad.
The front quad muscle l mention has a large raised lump just above the operated scar , l presume it must be the large quad muscle which is inflamed as l’m sure the size seems to differ when rested, or overworked, or had my leg elevated with a ice pack ..
Could this be causing my sleepless nights , does this hard lump of muscle need to rest for the time being and just use ice packs and no exercise and will it disappear with rest or do l carry on with light exercise and a short walk Or will this agrevate the inflammation even more ..

 

[Layla]

Hello wilbo, I am sorry you're still struggling and finding it difficult to sleep. You are still fairly early in your healing journey at not quite two months post op.

l mention has a large raised lump just above the operated scar ,

Wondering how big is the lump in comparison to like a pea, marble, golf ball?
Does it feel either hard or soft consistently?
Is it visible, or you can only feel it underneath the skin?
Wondering when you first noticed it and if you brought it to the attention of the consultant or your OS?

I suggest ice / elevation and no exercise for a time and see if you notice a difference because I am not clear on what you mean in the quote below.

as l’m sure the size seems to differ when rested, or overworked, or had my leg elevated with a ice pack ..

Assuming this means it does seem to go down in-between activity or exercise and rest / icing.

Any pain or discomfort will likely cause restless nights in bed. However sleepless nights early into this year long recovery are common with the members here. You are not alone.
Not sure if you read through the Recovery Guidelines and noticed the article on sleep deprivation which helps explain it. If not, check it out for a better understanding.

I hope you're having a good day so far. Lots of comfort to you, wilbo.

 

[wilbo58]

Wondering how big is the lump in comparison to like a pea, marble, golf ball?
Does it feel either hard or soft consistently?
Is it visible, or you can only feel it underneath the skin?
Wondering when you first noticed it and if you brought it to the attention of the consultant or your OS?

Hi Layla ,

Thank you for replying,
The lump feels hard , it’s not visible by the eye , and l only feel it underneath the skin.
Size wise , it’s not golf ball size but maybe slightly larger than marble size.
Compared to the other leg it is inline with the quad muscle when l tension the leg if this makes sense.. l just wondering if lve overworked everything and this has just never had the time to settle down and causing sleepless nights and the aching..

 

[Layla]

Hmm...scar tissue, suture knot, inflamed bursa, hematoma? My guess is as good as yours. You may want to read up on those topics for starters.

When do you see your surgeon again, or is there a contact person you can run this by? Since you seemed uncertain about this, but concerned, contacting your surgeon's office may bring the reassurance and peace of mind you're seeking. Something to consider...
Stay in touch.
@wilbo58

 

[Dearjr]

One thing you might do if it's hard is soft massage
If it's a hematoma it will break it up and go away faster

 

[mendogal]

I agree with @Layla that it could be one of several things and best to check in with your ortho practice.
With both my quads just above the knee these were little lumps of scar tissue and needed some fingertip massage, both circular and "cross fiber" (side to side rather than lengthwise) several times daily. They were very slow to diminish!
@wilbo58

 

[Benay]

I had 4 pea sized (probably scar tissue) along the incision. I massaged nightly consistently and they've almost disappeared.

 

[wilbo58]

Been to the Doctors today about my lack of sleep due to aching keeping me awake .
He has put me on Amitriptyline 10mg for a month to be taken at night ..
I’m hoping this helps me get more rest and sleeping hours..
I don’t know much about the medication so if anyone knows if these work on the nerves of the knee and helps sleeping or have been on them please let me know..

 

[mendogal]

@wilbo58
Amitriptyline is an anti-depressant and a very common side effect is sleepiness.

It is also considered one of the first medications to try for nerve pain. So a good choice!

The dosage for nerve pain is lower than the dosage for depression, and the low dose is what he prescribed - so he's not quietly thinking that you're depressed!

 

[wilbo58]

That sounds ok to me , worth giving it a go.
No l’m not depressed at all , fed up of the lack of sleep but certainly not depressed..

 

[ouchie!]

Hi, I’m at 10 weeks post op and I had a lot of problems sleeping with my poor achy leg, like you. Sometimes it would be my foot that ached, sometimes it was the shin or the thigh, drove me nuts! Then I decided to use a softish pillow under the lower leg whilst lying on my back. Then I tried that same pillow whilst lying on the non operated leg, parallel, not between, my non operated leg, then I’d lift the operated less onto it and it was wonderful, my leg said aah that feels good! I tried a harder pillow and that made it ache more. I must say now at 10 weeks I don’t need anything, but of course I still take my pain meds an hour or so before bed.

Another thing that has helped me sleep is ditching the caffeine. I now drink decaf tea and coffee. It tastes just the same and I serve it to all visitors and none of them even notice. Ditch Coca Cola too if you can, although there are decaf versions now.

I also wonder if you are overdoing it with physio exercises, or even the walking. I was told 10 minutes a day walking at 7 weeks. I found whenever I overdo things (I’m a carer for my husband) later in the day boy does the pain kick in! I sometimes get popping or clicking every now and then but it doesn’t last long. As all these amazing members will tell you, you are still healing, so be kind to yourself, you’re not training for the London Marathon. I have felt a huge improvement in my sleep since Ive hit the 10 week marker, so I pray you will do too.

 

[Layla]

I hope the prescription helps with the nerve pain and you are able to get some sleep. Keep us posted.
Happy Two Month Anniversary!
@wilbo58

 

[wilbo58]

Thanks Layla,

Sleeping better with the tablets given but walking up now and again and it’s not the aching so much but the discomfort on the outer side of the knee where the IT band is .
This is causing me discomfort and pain during the day and at night as l find it very hard to bend and straighten the knee .
The excises and walking l can do and l now have a good range of movement but the pain and discomfort on the side of the knee is restricting me from walking and sleeping without discomfort and pain..
It’s hard to describe but the pain is at the side of the knee and goes to under the knee on the outer side . When my knee is straight l will bend and at 45 degrees it pains and as l move it past to 90 degrees it pops and hurts on the muscle and the same happens as l return to straighten the knee.
The knee feels stiff but l have a good range of movement but lm restricted by the pain, l also have the small lump on the quad muscle that’s not gone done yet next to the surgical scar.
I’m just wondering what is causing all the discomfort on the side of the leg ..

 

[Jockette]

I’m just wondering what is causing all the discomfort on the side of the leg ..

It’s only been 2 months since you had this major surgery which caused a lot of trauma throughout your whole leg. Healing takes a long time. Cut back on any exercises that increase your pain. Let your knee and leg settle down from the onslaught of the surgery and rehab.

 

[Layla]

Hi wilbo,
Wondering what the OS said last Thursday about the pain you're dealing with?
Try the stretches if you haven't already and see if they help. Good Luck!

ITB (ilio-tibial band) issues and treatments

The IT band is combination of muscle with a covering of tough fibrous bands called fascia. It starts on the outside top of the pelvis, passes over the greater trochanter of the hip, down the outside of the thigh and inserts into the side of the patella (knee cap) and the tibia, (shin bone). It...

bonesmart.org

@wilbo58

 

[wilbo58]

Hi wilbo,
Wondering what the OS said last Thursday about the pain you're dealing with?
Try the stretches if you haven't already and see if they help. Good Luck!

ITB (ilio-tibial band) issues and treatments

The IT band is combination of muscle with a covering of tough fibrous bands called fascia. It starts on the outside top of the pelvis, passes over the greater trochanter of the hip, down the outside of the thigh and inserts into the side of the patella (knee cap) and the tibia, (shin bone). It...

bonesmart.org

@wilbo58

Been to physio today explaining the discomfort from the side of the knee..
They now say it could be the

Fibularis muscle that needs strengthening so they have gave me a program of exercises to do ..​

 

[Layla]

Hopefully the exercises are easy, gentle and don't cause you more pain.
Please keep us posted on your progress, wilbo.
Best Wishes!
@wilbo58

 

[wilbo58]

Doing exercises and not overdoing it.
Since l’ve been on Amitriptyline to help me sleep and for nerve pain in the knee that kept me awake most of the night l have had better nights of sleep, but for the first time last night since taking the tablets l didn’t sleep very much.
My thigh was aching when l got into bed and so it was a more restless night .
I didn’t overwork the leg yesterday so cannot understand why it’s started aching again last night..
Is this normal, will l get these flare ups as recovery continues. Are these aches coming from muscles, nerves that are starting to work/recover again..

 

[EalingGran]

Ups and downs are very common in the early months and it can sometimes be really hard to figure out a reason. Maybe try a bit more rest and ice for a day or two- to see if it settles down?

 

[Layla]

Thankfully you're sleeping better these days!
Your soft tissues are still healing. Nerves that were disrupted are waking up / regenerating. You likely still have some inflammation. The muscles, tendons, ligaments are adjusting to the prosthetic. Strive to strike a healthy balance between rest and activity.

I didn’t overwork the leg yesterday so cannot understand why it’s started aching again last night..
Is this normal, will l get these flare ups as recovery continues. Are these aches coming from muscles, nerves that are starting to work/recover again..

Ups and downs are very common in the early months

Wishing you comfort and hope you feel better as the week progresses.
Rest up so you're feeling good for Christmas!