TKR Poking Pain When Bending Right TKR

[jackibar]

I'm just at 8 weeks PO on my RTKR and my scar has had these whitish "scabs"(?) or dry spots(?) down it so I haven't done any oils on it yet... But a few days ago this little round hard thing popped out at the bottom of the incision and I'm wondering if y'all might know what it is?! It sort of looks like a scab, but when I took a picture and zoom in, it looks like it might be something else? I'm posting two pics to show the close up of the area and the whole thing...

 

[Pumpkin]

It is probably an internal disolvable stitch that is poking through, it should go away or fall off as you heal. I had them with my TKR and with my revision. The whitish areas look like dry skin.

 

[jackibar]

Realized I forgot to come back and say the little white thing was indeed a stitch and the OS pulled it out and said that it needed to be pulled out by him to be on the safe side...

My real problem is still the "poking pain" in that right knee which is now 12 weeks out. This pain has gotten worse and worse. An x-ray at the 6 week point did show that the knee cap is not tracking in the groove where it's supposed to but the OS didn't seem terribly concerned and said the strengthening exercises for the inner quads and stretches for the IT band should help. At this point I had actually finished my home PT so I wasn't doing anything specific for this problem except the usual exercises my PT had given me previously - really just squats (which really aggravate the pain), leg extensions, and a stretching exercise where I put my foot on a step and bend the knee and press into the wall to work on the bend.

A few weeks ago I contacted my old PT who suggested an outpatient therapist in town to work on this "patellar maltracking syndrome" as he called it. So I got that set up through my OS and have been going a few times now. The new PT checked it out and really believes it's "soft tissue" causing all the problems. He had me get a "massage stick" to roll my quads and calves and IT band out and a lacrosse ball to roll the bottom of my foot and my hip area (against the wall) since we also determined I have hip bursitis in that leg. All made sense to me. They only have me doing a few exercises while there and so far none at home except the above with the stick and the ball. They also do hands on deep massage to try to loosen things up, which I'd never had done before. This PT also does not believe in using ICE!! He provided lots of research saying that stopping the natural inflammation process actual HINDERS healing. I still don't know whether to believe this or not. When I ice it does seem to help so I've started icing again...

The pain is now radiating all over - up into the quad area is so painful it keeps me in tears even with pain meds (which I'm afraid are losing their effectiveness and I need an even higher dose which I'm already on a high dose). The pain also radiates down into the front of the knee cap and down the leg a little. The poking feeling is now happening to the inside as well as the outside. It just feels like this knee is "wrong" - can it be too BIG for me or something? Or can it be loose?? I can't seem to get anyone to listen to me that I think this is more than just weakness in the muscles. If it were that, would it hurt even when I'm just sitting still and not moving around?

I went on my anniversary trip a week ago and had hoped this year I'd be walking without pain and getting around better. But the pain in that right leg was so bad I spent most of the time in tears and in the hotel room with my leg elevated. My LEFT leg now - that's another story! It didn't hurt at ALL and is doing amazing! If this right one could just be like the left one I'd be a new woman :(

Can anyone help me? @Josephine - ? I don't know who to believe any more. My sister works at the hospital where I had my surgery and saw the PT who worked with me there and asked him about all this and he said he'd never heard of such a thing happening where the patella pokes to the outside causing all this pain. I feel I should see my OS again but I'm not sure he can do anything. If this takes a revision, I'm actually HOPING for it because I want this knee to be as good as the left. If it really does mean just more time and PT then I'll do that - but shouldn't it be getting BETTER by now instead of still getting worse if this were really the problem?

 

[Josephine]

This PT also does not believe in using ICE!! He provided lots of research saying that stopping the natural inflammation process actual HINDERS healing. I still don't know whether to believe this or not. When I ice it does seem to help so I've started icing again...

Well, he's one in the army parade out of step! Never heard of such a thing! It's one of those ideas that seems like it should make sense but actually doesn't!

The pain is now radiating all over - up into the quad area is so painful it keeps me in tears even with pain meds (which I'm afraid are losing their effectiveness and I need an even higher dose which I'm already on a high dose). can it be too BIG for me or something? Or can it be loose??

I think your problem is more likely this ....

really just squats (which really aggravate the pain) (and)
a stretching exercise where I put my foot on a step and bend the knee and press into the wall to work on the bend

I'm always warning people off squats and lunges (which is what the second one is called) as they cause lots of pain issues. It may very well be these are part - a big part - of the problems you are experiencing now.

My sister works at the hospital where I had my surgery and saw the PT who worked with me there and asked him about all this and he said he'd never heard of such a thing happening where the patella pokes to the outside causing all this pain.

Well he must lead a very sheltered life then! We've seen several cases like this on BoneSmart.

 

[jackibar]

Thanks so much for your input, @Josephine. I guess I should've made it more clear that I haven't done any of the squats or lunges for over a month now. Yet, this pain is just getting worse and worse. I went to PT this morning and the lead therapist actually worked on me himself today instead of his helpers. He did a TON more work on my soft tissue - digging deep down into my calf which was so knotted I thought I would die from the pain of him massaging it. He also found some scar tissue on the top of my thigh along the incision line and broke that up. Left me with kinesiology taping to help.

When I first left, I was walking way better again - no limp - the knee pain (and surrounding area) was gone all afternoon, though my calf pain was making me limp. But around 5:30 or so this evening, a deep, aching, radiating pain began right under the knee cap area and slightly to the right (outside) and got so bad I was bawling in pain. Took my pain meds and even risked taking Aleve (which I have to watch out for due to stomach trouble) and finally got the ice on it. It took over an hour with the ice on it for it to ease up just slightly so that I could come type this. It is still hurting. I don't know if I should go to the ER for help or just deal with it until next Wednesday - I did call my OS this morning to get an appointment. I'm just wondering what would be making this get worse and worse like this. Infection? Loosening? Or just the soft tissue deformities the PT is swearing by...

 

[Josephine]

It's soft tissue issues. Have you considered trying a TENS machine? I use one for all my aches and pains.

 

[jackibar]

I haven't yet thought of using TENs. Need to see about getting one. Does that help muscles or just nerves?

Also, just curious as to what symptom(s) are convincing you it's soft tissue? I would love to be convinced that's all it is...!

 

[jackibar]

Ok just saw my OS... He did check everything, felt it while bending and straightening, asked a ton of questions. I feel he was very thorough. He said at this point we might just need more time for the soft tissue to settle down and more healing to take place. Wants to see me in 6 weeks. He also said I may need to take a BREAK from PT! That sometimes it's too much. Since I have great ROM he said that's what he usually has people in PT for so maybe I don't need it...? Don't know what to do! Keep going and getting tortured or take a break and see if things will settle down on their own?

 

[Gigi32]

Don't know what to do! Keep going and getting tortured or take a break and see if things will settle down on their own?

Girl..I think you have your answer! Even your OS told you. You have great ROM so there is no point in continuing to beat up your knee and cause yourself more pain that is unnecessary. Be grateful you have a surgeon who is informed and not insisting you keep going to PT eventhough it is counterproductive. Take a break!

 

[KarriB]

If the OS said take a break, take a break. You'll be amazed at how grateful your knee will be.

 

[Celle]

He said at this point we might just need more time for the soft tissue to settle down and more healing to take place. Wants to see me in 6 weeks. He also said I may need to take a BREAK from PT! That sometimes it's too much. Since I have great ROM he said that's what he usually has people in PT for so maybe I don't need it...? Don't know what to do! Keep going and getting tortured or take a break and see if things will settle down on their own?

Hooray for an OS who acknowledges that sometimes a break from PT is what's needed!
Take his advice.

Why on earth would you continue going to PT when you describe it as torture? Do remember what we advised in the mantras:
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist (PT) - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again

 

[jackibar]

I realized I forgot to tell y'all about how GOOD it did all weekend after last week's appointment - miraculously better. I walked, stood, baked, etc., all weekend with NO PAIN! Could hardly believe it. This was the first time the head PT worked on me. Monday his helper worked on me and it started hurting again and has hurt worse and worse! I told him that so today he worked on me himself again. I want to see how it does over the weekend and if it gets better again, I'm going to insist on him every time. If it doesn't get better, I may go ahead and take that break... I really appreciate all the input! He's just convinced that this soft tissue manipulation is what I need. Would a TENs unit do the same thing?! @Josephine

 

[Clipless]

Since you have good ROM why not cancel PT for a while? The vast majority of TKR patients can recover quite well on their own with minimal or no PT. After my second TKR I did not even begin formal PT until six weeks post op, and I did just fine.

 

[Josephine]

I totally agree with Clipless. It's my firm belief that PT is overrated, overdone and completely unnecessary. Lots have people have done very well without it.

But no, that is not how a TENS machine works. Did you not read the article I left you a link to? It explains how it works. TENS machines for pain management

 

[kneeper]

If I have a vote I'd say skip the PT and just do gentle exercises on your own (if any) since your ROM is good and you are functioning well for your stage of recovery.

 

[jackibar]

@Josephine I did read the post about TENs but just wasn't sure why you recommended it for my soft tissues... I see that it's something to do with the nerves and pain receptors which would be helpful! But will I need to do something else to get the tight muscles to loosen up so my kneecap will quit pulling out of the groove and poking? I'm sorry if it's obvious and I'm just missing it! Just not really thinking straight lately with all this pain... Thanks so much for all your help!

 

[newlybionic]

I'm sorry to hear about your continuing pain in that one knee. I'm having a problem with my TKR and I am having a revision on the 21st. I hope you are able to find a plan so that you can enjoy your life again.

 

[Josephine]

Well the only thing I can figure is that the pain is causing your muscles to go into spasm, thereby pulling on your kneecap. The TENS might make them relax but to be honest, I've never found it that effective when used where there is little skin depth and/or superficial bones. Probably because there's not the same supply of sensory nerves. But it can't hurt to try.