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THR Knee pain/swelling and limping

Hoppa

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Hi,

I'm 43 and had a THR 13 weeks ago. I'm doing very well with the hip itself - no pain and good movement. However....since day one I've had a swollen painful knee on the operated side, which doesn't seem to be improving - I am having physio and doing the exercises. A few weeks ago my knee started crunching when I was going up stairs and also when I am doing my exercises. It has also started 'jamming' when I straighten my knee for some exercises. I'm wondering if anyone else has had similar symptoms, including crunching noises in their knee, and what was your outcome? I'm concerned that something in my knee has been torn during surgery and may need further intervention to fix it given its now been 13 weeks.

Secondly, I still cannot walk without one crutch due to limping, BUT, its not the operated leg that is limping, instead I am hitching my unoperated hip up when taking a step with my unoperated side! The lower leg also moves a little strangely on the unoperated side. I didn't have any limp pre-surgery on either side and have no pain now in either hip. So I cannot fathom why I'm hitching the unoperated hip up when walking and neither can my physio.

I'm quite worried about these issues and would really welcome any ideas, or reassurances from others who may have experienced similar. Thanks.
 

Elf1

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:wave: @Hoppa and welcome to Bone Smart! Can you please tell me which hip you had replaced and the exact date so we can add it to your signature. Makes it easier for folks to know where you're at in recovery when they want to respond to your posts.

While you had surgery approximately 3 months ago I'm going to leave you our Recovery Guidelines there may be some items that are still useful to you in your recovery.

Hip 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!)
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
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for THRs
6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery

Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

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 a 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 history before providing advice.
 

Elf1

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It's not uncommon for knees to have referred pain from the THR, they manipulate us pretty good during surgery and the knee sometimes takes the brunt of it.

Have you been doing any icing and elevating? If not I would encourage you to give it a try. The how to's are in item 2 above. Basically you should ice for at least 45-60 minutes at a time, a good four times or more a day. This can be really helpful with pain and swelling.

You say the pain and swelling has been from day one and that you are doing physio and exercises. Not knowing what and how much you're doing you might want to consider stopping all exercise except normal walking and your daily activities for a couple of weeks and see if that helps. You had muscle and tissue that were pretty beat up and it sounds like they weren't given a chance to heal.

When walking try to really concentrate on heal hitting ground and rolling up through your toes. It really does take concentration but really helps to stop the limping. Just some ideas that you might find useful.
 
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Hoppa

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Hi Elf1,

Hello, and thank you for your reply.
It was my right hip that was replaced on 25 Nov 19.
In the earlier days I tried the elevation and icing that you mentioned (albeit not for longer than 20 mins a time, so will try doing it for longer as you suggest) and have decided to stop the exercises prescribed by the physio to strengthen my knee as they aren't helping - and I have been quite diligent in doing them. I've also been concentrating on heal to toe walking, which doesn't seem to present a challenge. The challenge for me is trying to get the unoperated hip and lower leg to move normally, which is just baffling me.
I'm seeing the consultant 9 March but am hoping that someone on the forum might recognise that they have/had similar issues and be able to provide some info or reassurance that it'll right itself.
 

Layla

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Hello and Happy Thursday to you!
As Elf mentioned, the knee can be manipulated rather aggressively during the dislocation process. Mine has never returned to what I consider normal since my surgery. I'm not hinting that will be the case for you. I did mention my knee issues at a couple of my follow up visits and my OS finally ordered x-rays which showed very mild arthritic changes. Wondering if you've had yours x-rayed?

Since Physio is unable to offer any advice on the issues you've described, its good you're checking back with your surgeon, or consultant, as you've planned. Hopefully he'll have answers and ideas that will bring you relief. Taking a break from Physical Therapy and icing in the interim is about all you can do for now. I hope you find out more on the 9th and receive clear direction on how to proceed. Please let us know what you hear.

Wishing you comfort and a relaxing end to the week.
@Hoppa
 
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Hoppa

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Thanks Layla. I'm going to ask for an MRI of the soft tissues and muscles around the knee when I see my consultant (surgeon).
I will absolutely keep this thread updated with the outcome of that appt as I'm not only hoping that in the end this will all be fixed, but that either way it might help others with similar issues.
@Layla
 

YoungHippy

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Secondly, I still cannot walk without one crutch due to limping, BUT, its not the operated leg that is limping, instead I am hitching my unoperated hip up when taking a step with my unoperated side! The lower leg also moves a little strangely on the unoperated side. I didn't have any limp pre-surgery on either side and have no pain now in either hip. So I cannot fathom why I'm hitching the unoperated hip up when walking and neither can my physio.
You described the way that I walk perfectly. Although I don't use any walking aids. I probably should but I'm hard headed. I am almost 4 years out and have walked like this since I was allowed to be fully weight bearing again. My surgeon's office pretty much gave up on me once my insurance lapsed. All they say is that the hip looks good. I also had the right hip replaced. The left leg feels fine mostly. My knee on that side is starting to protest the limp, but so far only occasionally. In my quest for answers I ended up seeing a podiatrist because I was told they could help diagnose LLD if there was one. I do have a slight difference, 5mm or so. Podiatrist assumed that my hitch in my non OP side could be due to nerve damage on my OP side. She observed that I wasn't lifting the front part of my foot fully when taking steps and was hitching the opposite hip to compensate. Her description of my walk was that it looked like I was trying to climb invisible stairs. She recommended a brace to help with the foot drop. I used it for awhile, but I broke the brace after about 8 months, and I couldn't tell enough difference in my gait to warrant purchasing another one. I haven't gotten any other opinions on it due to no insurance. Although my unproven theory is that maybe my cup implant is angled incorrectly. I've never had standing x-rays, only lying.

Wishing you luck and hope that you find your answers.
 
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Hoppa

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@YoungHippy
Thank you for your reply, and I'm sorry that has been your outcome from the surgery. I must admit, I fear nerve damage is my issue too, as the physio told me that both legs are similar in strength now (so I don't see how it can be the expected post operative muscle weakness).
Can I ask, if you do use a stick in your left hand, does the left hip 'hitch' reduce drastically (mine does).
 

kimbarella

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My knee pain started on the operated leg 4 weeks out after anterior replacement of the hip, to the extent I am using cane more, just a touch. Pain is only on weightbearing, about 60 to 70 percent of the time. Since I am 5 weeks out, I am just going to continue to take it easy and see if it settles, with a bit more time and tylenol. I have been very careful with small exercises and walking, not to speed things along. But the new pain made me think, oh geesh, now I need a knee replacement...jumping right to the extreme!
 
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Hoppa

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My knee pain started on the operated leg 4 weeks out after anterior replacement of the hip, to the extent I am using cane more, just a touch. Pain is only on weightbearing, about 60 to 70 percent of the time. Since I am 5 weeks out, I am just going to continue to take it easy and see if it settles, with a bit more time and tylenol. I have been very careful with small exercises and walking, not to speed things along. But the new pain made me think, oh geesh, now I need a knee replacement...jumping right to the extreme!
I think it's easy to jump to worse case scenario when we're feeling cautious during recovery.....I'm trying to bear that in mind when worrying about my knee and limping!
 

YoungHippy

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@YoungHippy
Thank you for your reply, and I'm sorry that has been your outcome from the surgery. I must admit, I fear nerve damage is my issue too, as the physio told me that both legs are similar in strength now (so I don't see how it can be the expected post operative muscle weakness).
Can I ask, if you do use a stick in your left hand, does the left hip 'hitch' reduce drastically (mine does).
I actually don't use a stick. I used a walker for the first month after my surgery when I was only 50% weight bearing, then switched over to crutches when I started driving because they were easier to get in and out of the car by myself. I eventually dropped to one crutch, and attempted to transition to a cane but it made me feel more wobbly. I just continued using the crutch until I started forgetting it. I have begun to think about trying a cane again recently, especially for distances. Hitching that hip all the time makes walking tiring. I've also noticed that the tireder I get the worse the hitch gets, so more compensation, and even more tiredness.

But you are still in early days too. Nerves take around 9 months to regenerate depending on the severity of the damage. So you may be feeling a little nerve damagey now and over time not so much. I was told that nothing was considered permanent until after a year. So there is still plenty of healing time left.
 
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Hoppa

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@YoungHippy
Thank you again. I will keep this thread updated and that way if I get any info. along the way that may help you (or others) then it'll be on here.
 
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Hoppa

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Hi everyone :wave:An update as promised......I went back to see my surgeon today. Had xrays of my pelvis and knee while I was there. My knee has fluid on it but otherwise looks OK on the xray. Surgeon said that it will settle, but I explained that symptoms are getting worse, as on top of the crunching and jamming of the knee cap, I've now started to get a trapped nerve pain from the inside of my knee down to the arch of my foot and am having pins and needles on the sole of my foot. So on my request I'm having a steroid injection in early April to try to get the inflammation to subside, by which time it will have been swollen and painful for 5 months, so if it hasn't settled by then, clearly needs the help.
With regards my limp, he has reassured me that it will be muscle related and will go away with time......I do feel much better for the reassurances he has given me, and hope being less worried about these things will help the healing along.
 

Layla

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:hi: Hi, I’m glad to hear you were comforted by the reassurance you received.
Best of luck with the injection in April. Please let us know how it goes.
Its a special day today...Happy Four Month Anniversary!
Be safe and stay well. :)
@Hoppa
 
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Hoppa

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Hi @Layla,
Thanks for checking in on me.
Unfortunately the knee injection has been cancelled for the forseeable future given the COVID-19 situation. In any case, after seeing my consultant and being told it would settle, the reassurance wore off quite quickly, so I visited my GP who has referred me for an ultrasound.
Meanwhile, I also saw a different physio who measured my legs - I now have a longer leg on the operated side, and a shoe insole raising my non-operated leg has drastically reduced my limp, but not eradicated it. The physio has asked my consultant to refer me to orthotics for a specially made insole to fit the leg length difference perfectly. @YoungHippy I wonder if you've ever had your legs measured, and if you have been left with different leg lengths whether a shoe insert might help your gait?
 
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Hoppa

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@YoungHippy
I can see in your earlier reply that you do have LLD - mine is similar around 5mm.
 

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