TKR Peroneal nerve issue after TKR?

[Magsmom]

Hi all
I’ve been spending time on the BoneSmart hip recovery forum as I had both hips replaced last year - the left one in September and the right in late December. Lefty is doing great- pretty straightforward and easy recovery (though I didn’t know that at the time!). Righty has been much slower and more challenging but is coming along.

I’ve come over to the knee recovery area as I have a question. Some quick background- I had a left TKR in Oct 2019. About 18 mos before that I slipped on a wet locker room floor, landed full force on my left knee and dislocated the patella. When I stood up, it sort of popped back in - but not completely. It kind of settled on top of one side of the trochlear groove. My dr said it would need to be replaced eventually but it was up to me Re when we did it. So I stuck a brace on it and went back to CrossFit which I had (and have) been doing for many years. I love the community aspect of it. It’s a supportive environment and we cheer more for the person who is last in completing the workout of the day. I was the oldest member at my box and affectionately known as the Mom of our dysfunctional family. (Btw CrossFit gets a bad rap sometimes as people think it’s just filled with fire breathing 20 and 30 year old kids. But every single movement, barbell work, gymnastics etc can be modified and scaled to your abilities and limitations. Can I get an unassisted pull-up anymore? Nope. But I used to get 6-8 pretty easily. Now I use a giant rubber band for assistance or do ring rows.

Anyhow I white knuckled it Re my knee until 2019. My TKR was extraordinarily difficult. I have an autoimmune condition that seems to prompt my body to produce ridiculous amts of scar tissue. I could barely flex or extend it despite 3 days/week PT and working on my own the other days. I ended up having 2 MUAs and an arthroscopic clean out. I’ve finally been able to flex it to ~110 (vs 135 on my good leg) and got stuck at 11 degrees or so in extension. Doesn’t sound like much but if you’ve had TKR or ACL surgery you know that it is a lot. Repairing my hips did help it. Almost immediately after the left THR, the knee swelling reduced and I picked another 5 degrees of extension. That’s good enough for me. My only other option was a revision……

There’s a particular topic I wanted to ask this group about. Ever since the surgery, I have had ongoing, continuous pain right at the neck/head of my fibula. It feels like nerve related discomfort. So - I had to see a diff surgeon since my original Dr did not participate in my new insurance plan. The new guy specializes in complex primary and revision knee and hip work. He commented that the peroneal nerve (which is a branch of the sciatic nerve tracks right over the fibula head and neck where it splits into 2 branches. Trauma to the knee and TKR surgery are 2 things likely to cause the peroneal nerve to get trapped/compressed and/or have scar tissue build up around it. The fibula tunnel is small with not alot of room. Kind of like carpal tunnel in your wrist.

I’ve been seeing the Dr who did my carpal tunnel release. He was instrumental in helping to diagnose the horrible mess my cervical spine was in. His words… “if there’s a problem at one end there’s often one at the other end as well “. He was right and I ended up having a spinal decompression and fusion of C5-C7. I feel just great now. Complete ROM in my neck and pain free!

But this fibula pain continues. NSAIDS don’t help but gabapentin, which I took for nerve pain does help calm it down. My very unscientific takeaway from gabapentin helping is that it’s nerve related. Dr is convinced I’m headed toward what I hope is a final surgery (I’ve already had 10 in 3 yrs on various body parts) to release/decompress this nerve.

Here’s my question - has anyone else ever had this peroneal nerve issue after TKR or any other major knee procedures?? I’m a really informed consumer when it comes to surgery and hospital related stuff. But this was a surprise. I’m hoping to push the procedure to September so I can enjoy the summer on the beach where we relocated last year (from NYC).

Any feedback or comments greatly appreciated!

Thanks all

 

[Jaycey]

@Magsmom I've changed your thread title to highlight your issue with the peroneal nerve after TKR. It is very common to have nerve flares post op. As you say, this nerve runs very close to the surgery site.

I'm sure our members will be along soon to give you input.

 

[WFD]

Almost immediately after the left THR, the knee swelling reduced and I picked another 5 degrees of extension.

I know this does not address your question, but do you know why the THR reduced the swelling in your knee? Was it part of your treatment, such as prescription anti-inflammatory drugs, steroids, etc.? Asking as someone with a lot of knee issues. Thanks.

 

[Magsmom]

Here’s the longer version ….

Ever since my TKR was done my knee was always so filled with fluid. Often it was red and hot too (obviously inflammation).
I had it aspirated twice to check for infection- nothing. Even letting the cultures go for 14 days, nothing grew.

I ended up w an ortho surgeon at HSS in NY who specializes in their really complex hip/knee procedures (primary and revision). We were originally set to revise the left knee…..I just so didn’t want to go through that again. But in one of my visits w him prior to the surgery date, we reviewed this full body image/xray. Both of my hips were a disaster- no cartilage, full of spurs and complete bone on bone.

So after a lengthy discussion, we decided my hips really needed to be done before even addressing the knee. The revision surgery was switched at the last minute to a left THR. His comment was something like when we get your hips right, you may get enough relief in your knee to skip the revision. My gait and bad hips etc just provided enough trouble that my knee seemed to take the brunt of it.

I really wish I had a more specific answer or scientific reason Re why it helped my knee but it did. Maybe bc I’m walking properly now? A healthy hip has got to somehow impact the knee. They’re all connected! I was really surprised I picked up another 5 degrees of extension (but very pleased). I can work with it at 5 or 6 degrees now and would rather do that than a revision with an uncertain outcome.

So, Thumbs up for no revision surgery but I have this lingering peroneal nerve issue. It’s apparently not uncommon for it to get inflamed due to trauma, knee replacement etc. (My dr says a knee replcmt is like being in a controlled car cash). It can also get entrapped/pushed too hard onto the fibula neck and head. Apparently there’s not a lot of room in the fibulae tunnel so swelling, scar tissue etc can really contribute to it. I just haven’t found anyone else who has dealt with this……

Thanks!

 

[HipRev2]

Hi Magsmom!
I just had a TKR revision on 2/14/22 - which resulted in several issues, one being that my peroneal nerve was either compressed somehow or punctured with the anesthesia needle used during surgery. So I came home with foot drop. I also have nerve pain, but it is on the top of my foot, not at the fibula head, as you have.

The pain is very sharp and usually at night. Forgive me if you already know all this, but the peroneal nerve runs from the back of the leg, to the outside of the knee where it's closest to the skin surface, then across the front of the leg to the top of the foot, to the big toe and 2nd toe.. My pain is on top of my foot, which is weird because the top of my foot is numb; thus, the dragging foot. It is definitely nerve pain, and the only things that help with the pain are ice, tramadol, and my husband massaging it a little.

How long ago was your surgery? You probably already know that the peroneal nerve regenerates at about 1mm a month, so there's a chance your nerve will heal. And hopefully you'll have no pain when it does.

I wouldn't wish this on anyone but I'm glad to know I am not alone. Please let me know how you are doing with your peroneal nerve.

 

[newkneeforme]

I am 10 weeks post L knee TKR and have symptoms that make me wonder if I have injury to the peroneal nerve. I too had alot of discomfort at the fibular head. Especially walking. Initially I was thinking IT band and maybe its still it. However now I have very little to no pain walking or standing. But sitting with my knee bent produces a worsening aching pain in my knee that descends down my knee to the side of my ankle. It becomes unbearable which requires me to straighten my leg which then relieves the pain. This is distressing because I cant ride in a car for even 5 minutes w/o significant pain.
I am curious what your symptoms are and besides gabapentin if anything else is helping?

 

[Magsmom]

Thank you everyone for your feedback!

I have had this quite a while - my TKR was October 2019. I also had 2 MUAs and an arthroscopic clean out as well. Then the pandemic hit in 2020 and everything stopped. But that area by the fibular head still hurt. Unfortunately I had to change insurance plans since I moved and my surgeon doesn’t participate in the new one.
So I Started seeing a diff surgeon (same hospital) he referred me to for further follow up. I ended up replacing both hips w him (left in Sept 2021 and right in December 2021). Now that they’re finished I’m back refocused on this peroneal nerve issue (my hip surgeon also does knees and described how the nerve can get trapped/compressed in the fibular tunnel which is pretty small. )

I needed a nerve specialist for this and the hand/wrist dr that did my carpal tunnel release a few years ago takes on these cases as well. I’m seeing him again tomorrow to figure out the plan of attack here, but after all the imaging has been done (EMG, MRI and ultrasound) he has told me I’m headed for surgery to relieve this. They can go in and “release” the nerve - much like carpal tunnel. Hopefully a same day procedure.

I don’t have foot drop but my gait gets strange if I’m tired and my foot sort of slaps on the ground. I’ve also tripped on it a few times.

I had cervical spine surgery in late 2018 and am all too familiar with nerve pain. 2 of my discs just collapsed (my word, not theirs) and were severely trapping the nerve down my right arm. It got so I couldn’t even feel it. But when I did, it was just awful. The ONLY thing that helped and tided me over until spine surgery to repair things was gabapentin. For me, it was/is a miracle drug and life saver.

I vividly remember my spine surgeon reassuring me after surgery (I was moaning bc there was still some residual pain) that “nerves are stupid”. Sometimes they take quite a while to learn how to refire correctly. Patience is key.

My very unscientific method for also determining that my peroneal nerve was involved was to try gabapentin for it when it really got sore. And it worked. It’s about the only thing I’ve found effective for nerve pain though I hear Lyrica is sometimes used. Gabapentin is cheap. NSAIDS do nothing and I won’t go back to opioids. The only other thing that helps relieve this is to get my husband to rub it for me when watching TV at night!

It’s really frustrating that my body seems to be betraying me! I’m 62, active, fit, in amazing shape from CrossFit and just not ready to slow down yet. I retired from work early at 58 and relocated from NYC to the Jersey shore last year. But this whole year has been focused on me & my surgeries/recoveries. My poor husband is getting tired of this and the added stress it generates. In the middle of the night, when I can’t sleep, I can really go down the rabbit hole and catastrophize everything! Anyone else do that?

I’d give anything for a decent nights sleep but it’s been really hard. Happy to have the BoneSmart community - at least I know I’m not the only one with various issues related to the many ortho surgeries I’ve had.

 

[Jockette]

I ended up having 2 MUAs and an arthroscopic clean out.

Can you give us those dates, please? We’d like to add them to your signature.

I’m sorry you’ve been through so much with this nerve issue.

 

[Magsmom]

Hi yes, here they are….

Left TKR Oct 19, 2019
MUA #1 Dec 21, 2019
MUA #2 plus arthroscopic clean out Feb 15, 2020

 

[Jockette]

Thanks!

 

[MurrayB]

I had a TKR in 2018, followed by 2 Arhroscopic interventions + MUA's within 18 months. Then in 2021 I had a revision of the original TKR primarily to overcome the pain and lost ROM +++ I experienced. Now after the revision I still have same pains: over the patella, over the head of the Fibula, on the medial aspect of the knee, and down the lateral aspect of theTibia from just below the Patella to the top of the ankle area. My knee has been swollen for 4 years, is warmer than the other knee by 4-5 degrees. I've had every test, scope, probe, culture, etc. etc. to no avail. I live in Canada and I am now waiting to hear from the Mayo Clinic in Florida for either a video conference or a consult. I'm 77, male living alone now and in my own home. Does anyone know of a good investigative Orthopaedic Surgeon? I'll go anywhere (even considered Germany).

 

[Magsmom]

Well, the saga of my left TKR just won’t go away.
I had gotten some relief after my left hip was done in Sept 2021 and had pretty much decided to forego a revision. But it started acting up again about 6 wks ago - swelling, doesn’t feel all that stable, pain that while not excruciating, is back.

I received a letter that there has been a recall of one of the components in my implant. Exactec is the mfr. apparently some of the tibial inserts (what replaces the cartilage) were exposed to oxygen in the packaging process. Oxidation is really bad for these - it will cause the implant to wear and end up degrading the bone (osteolysis). Approx 150,000 people have these implants.
I’ve had X-rays and will follow up w my surgeon this week. I don’t know if they can swap out that one component or if the whole thing needs revision. AAAAARRRGH.
Just so sick of this! Ok - thx for letting me blow off some steam!!……
More later

 

[sistersinhim]

The plastic inserts can be replaced only without changing out the other parts of the implant. The surgery is much easier than a total revision. Of course, your knee will probably do fine without changing it. I hope this is the case. Let us know what your doctor says.

 

[CricketHip]

@Magsmom Hi! I was thinking of you and wondering if you're doing okay and what the update is for your knee?

Hopefully it's not anything that is needing surgery!