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Medial Tibial Pain w/ Weightbearing at 3 Months Postop TKR

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lindaolson65

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I had a TKR on Aug 6, 2007, and am still having medial tibial pain with full weightbearing where I believe the component's post is. It usually begins in late afternoon and lasts until I go to bed at night. In the morning it's usually gone. It's only on the medial side - I have no pain on the lateral side whatsoever. Pain is severe enough to make weightbearing very painful and causes a significant limp. Because this pain doesn't exists all the time, my doctor thinks it will resolve with time, but I find it very limiting and concerning. Has anyone else had this problem at this stage of their recovery? I'm concerned something is wrong.
 
Interesting because the only other case I have heard of this is in my own sister. She had both knees done, Sept 05 and Jan 06 and she now has such pain in both knees about the place you describe. Now hers is unlikely to be the same reason as yours but it's curious non the less.

I take it you have had scans and xrays done to ensure the prosthesis is correctly aligned and not loosening? Or that there isn't any tiny longitudinal cracks in the bone? If not, I would press to have this done and soon. From what you have described, I would venture to suppose a minute stress fracture might be present. It would fit what is happening. The pain resolves when you have had a night's rest and then, after you've done some weight bearing, it starts up and then gets worse.

I would want it scrutinized, anyway. And preferably by a second opinion.
 
Thanks for your input, Josephine. Yes, x-rays showed the components to be in alignment and stable. Interesting about possible stress fractures. Since it feels like it's in the area of the medial post (of the tibial component), and I've had the sensation that the post is "jamming" against the bone, small fractures would fit. Of course, if that's the case, rest would be the approach. Might be worth running it by my doc. He said it wasn't unusual to experience what I'm experiencing at this phase of my recovery, and he'd only be concerned if it were a chronic problem.

I had been using the treadmill each day (slow walk but working on form, rhythm and leg strength/function), and always felt worse afterwards. Since I stopped the treadmill, this issue has resolved. So we'll see if the symptoms return.

Again, thanks for your input. Much appreciated.

Linda
 
You're most welcome - had a feeling you were a fellow nurse! Hola!
 
Hi, Josephine!

Just thought you'd like to know I followed up with my surgeon (he's a knee/hip replacement specialist and one of the best in the Seattle area), and he said he's seen numerous cases like mine and that it should resolve in time. He said it could take up to a year for the bone to resolve from the surgery, so he didn't see the need for scanning or other imaging studies at this juncture. Another exercise in patience, patience, patience. Always different when you're the patient!!!!

Again, thanks for your input.

Linda
 
LOL!! Ain't it just! And what's that old saying about doctors and nurses making the worst patients!

Keep in touch.
 
For the record, I'm not a nurse... I'm a medical technical writer who specialized in orthopedics (I retired several years ago). Regardless, it's still true that all the clinical knowledge in the world means nothing when you're the one on the table and under the knife! It looks so cut and dried on paper!

Nice e-chatting with you. I notice you're on this site quite often, and it appears you offer great support to those writing in. Sounds like you've helped a LOT of people. Hooray for you!

Linda
 
Oooh! I could have sworn! ....

But thank you for your kind words. That's very nice of you to say so. Actually, I'm the one and only moderator on here, which is why my name is plastered all over the site! I just can't resist being a nurse even though I stopped being a nurse over a year ago!

What was that about old soldiers .... seems it can apply to nurses as well!
 
Here's an update on my medial knee pain. Turns out what I've had is pes anserinus bursitis, which felt like bone pain but actually wasn't. I ended up getting a steroid injection into the bursa and surrounding tissues (NASTY injection), which took away the pain. The components are intact, there is no bone infection or other defect....It all was bursitis. I imagine my recovery would have been soooo much better had I not been dealing with the bursal issue all those months. Never occurred to me, and my doc had trouble getting to the bottom of it, too. So if anyone is having problems with pain below the joint itself and on the inside of the leg (halfway between the shin and the side of the leg), it very well could be pes anserinus bursitis.
 
Yes, I've seen that graphic. I'm a bit surprised my doc didn't pick this up. I had questioned whether or not it was pes anserinus bursitis, but initially he dismissed that idea. Only with my persistence did he finally agree that that was the source. Oh well...At least it's been resolved. Is it possible this is what's going on with your sister, Josephine? I remember you saying she was having the same problem I was....

Linda
 
How sweet of you to ask after my sister, Linda. But we have recently learned that her pain is probably due to an acute condition in her spine arising from a very long standing back injury. We await investigations ....

As far as the doctor not taking your word for it on the diagnosis, that does seem to be a recurring problem! About three years ago I developed a pain in my foot. At first it was just a gripe but steadily got worse and worse till I could barely walk. I was loath the ask one of the surgeons as I was already being treated by one for shoulders and another for a hand problem! I hate imposing on people you work with like that. So I made an appt to see my GP who looked at it and declared it to be arthritis. I disagreed and said it was more likely a stress fracture. She hummed and ha'd but eventually agreed to send me for an xray just to please me! And guess what? I had a sizeable chunk of bone torn off the from the underside of the hind foot where a fairly major tendon is attached. Mind, by then it was almost 6 weeks old so there wasn't much point in doing anything. I had a week at home to rest it and it was fine!

Doctors!!
 
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