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TKR Left TKR November 13, 2019

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Seatides

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"Common Peroneal Nerve Neuropathy"?

I can't believe I haven't posted here since late April! I hope everyone is progressing well. I'm doing OK at just about 8 months post-left TKR, but I've had persistent numbness, not only across the front of my knee, but down the outside of my left leg and into my foot. It's not pain -- it doesn't hurt -- it's just annoying, the constant numbness. I've been kind of ignoring it for several months (it's been like this since December -- I mentioned it to my ortho surgeon in early January) because we were in COVID-19 lockdown here for months.

I thought it might be from the tourniquet used during the surgery, or from the liposomal bupivacaine nerve block used in the knee during the surgery, or from lumbosacral radiculopathy that has caused severe pain in my left lower back in the past. My primary care doctor said to see a neurologist, so I went to one this morning.

He didn't do any formal tests, but after sticking me with a pin and brushing the skin of my leg with other things and testing me various ways (hopping, toe stands, heel stands, etc.), the neurologist said it was "common peroneal nerve neuropathy." He said it may well go away yet, but it may not. He said it's from compression of the nerve. I said, you mean, during the surgery? He said no, that badly arthritic knees are usually swollen, and that constant swelling puts pressure on the nerve.

Why does the cynical suspicious part of me think that doctors cover for each other, and that's why he wouldn't say it had anything to do with the surgery? I'm not saying that it was cut during the surgery (those are different nerves over the front of the knee, aren't they, that are cut when the incision is made?), or that something was done wrong, but things are stretched and pulled during the surgery and perhaps it was damaged that way?

Afterwards (I always think of these things later) I was wondering, if it's just because I had bad OA in that knee for a long time and the swelling compressed the peroneal nerve, then why didn't I have this problem before the surgery? And why don't I have this problem in my non-operated right leg (which has a swollen painful arthritic knee)? I have to research this some more.

I did do some reading, and I know it could be worse; I don't have pain, and I don't have drop foot. It's just this constant, unpleasant feeling of numbness/tingling, from my left knee to the outside of my calf, down into the bottom of my foot and into my toes. Honestly, I don't think it's improved at all in the past 6 months; if anything, it's becoming more pronounced and noticeable to me.

Then I was wondering if maybe this numbness had something to do with the fact that I tripped and fell again (my first trip-and-fall was in April); I tripped again a few weeks ago, walking upstairs from my home office to the kitchen. My left foot/toes (of my slipper) got caught on a step, and I fell forward onto my knees. Maybe my foot isn't lifting up entirely correctly? Can the numbness cause muscle weakness? The ortho surgeon wasn't happy with my left quad strength at a couple of post-op visits, but it was better the last time I saw him in mid-May. The left leg still doesn't feel strong to me.

So the neurologist said to give it more time and it may get better (or not).

I did a search on these forums for "peroneal nerve" and found quite a few posts about problems post-TKR and -THR with the common peroneal nerve; but most of the posts were from a few years ago. Has anyone on BoneSmart now had any experience with this? Is there anything more I should be doing? Maybe some exercises or -- I shudder to say this -- physical therapy (only because of the painful memories from earlier in this process)? Thank you.
 

sistersinhim

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I still have numbness on the lateral side of my knee, but not to the extent yours is. It sounds like you have tried almost all of the options available to find a fix for this. I will see if any more of the staff can offer you some suggestions.
 

Celle

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the neurologist said it was "common peroneal nerve neuropathy." He said it may well go away yet, but it may not. He said it's from compression of the nerve. I said, you mean, during the surgery? He said no, that badly arthritic knees are usually swollen, and that constant swelling puts pressure on the nerve.
I think you've done all the right things and it's good that you've seen a neurologist.
i agree with what he said. This may get better, given more time, but it may not. There's no way at this stage that he could predict which will happen. It really is going to be a matter of "wait and see".

There's also no way that the neurologist could be sure how your nerve came to be damaged. The nerve runs across the outside of your fibula, where you can feel a knob on the outside of your leg. It can be damaged by being compressed due to swelling, or due to the position your leg is held in.

The surgery itself should not have damaged the peroneal nerve, as the cutting and shaping of bone is done to the tibia, above that level. The fibula isn't cut. But it is possible that holding and manipulating your leg during surgery, or moving some of your soft tissues aside during surgery caused some compression of that nerve. No one would be able to tell you if that's what happened.

One thing you can do now, to prevent any further damage, is to avoid crossing your legs or putting long-term pressure on the back or side of your knee.

I'm sorry I can't tell you anything more definite than that.
 

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