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TKR Sharp pain in left thigh<

kneegrrl59

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First post, but long time lurker. This forum has been very helpful to me in my recovery.

About me: 58 yo, 5’2”, 118#, fairly active, with rheumatoid arthritis for 30 years. No other health problems. Had left TKR 1/9/17. I did great during surgery, post-op, recovery, PT, etc., from January 2017 till October 2017. Had the Cconformis knee. I was released from PT in April 2017. Kept doing exercises all summer and fall.

In Sep/Oct I added addition strengthening exercises gradually as the leg with the TKR was noticeably (to me) less muscular/toned. I did some lunges and leg extensions which did not hurt at the time. A couple days later, I had a searing pain in my left thigh, felt like a butcher knife had stabbed me in my thigh, same side as the TKR. Went to see my OS, they xrayed knee and it was fine. I was diagnosed with IT band strain and sent for more PT. I did all PT but pain was still there and worsening. PTs were great but they were concerned that I want getting any better and said they had done all they could do. I was walking with a limp now.

Here’s where the knee comes in. I started having sharp pain in left TKR in December 2017. Went back to OS and he said more PT. I did this on my own. In the spring, the pain became more diffuse in my thigh plus the knee pain. I asked for an MRI of the area, from my rheumatologist as I was about to give up on my OS and it ended up that I had a small tear in the thigh area and a small labral tear in hip. My OS said it was probably from the October injury but the pain was disproportionate to the injury. My rheumatologist, who is wonderful, said the same thing.

My OS wasn’t doing anything, so I switched to a new OS in May 2018. By this time, the pain is in my hip. Groin, back, all on left side, and I am in severe pain. Still working full time, have taken no time off for it, in a moderately active job in healthcare. He examined me thoroughly and couldn’t find anything bone or muscle related, did numerous xrays. Said my knee looked great. Referred me to a pain clinic.

Pain clinic did xrays of back and said I have a small fracture in L5. I have started on injections in back. Only one injection so far and that has helped calm everything down by about 70% EXCEPT for the stabbing knee pain on outer side of knee which only presents when I have weight on it. Actually, the pain in the knee is a little less than it was, but I have some more injections to go. Pain clinic said all my pain is coming from the back and is referred pain.

I am still thinking in my gut that due to me limping for so long with my thigh injury that it did something to the left TKR, because my knee didn’t start hurting until 3 months after the injury in October. But everyone, through all the imaging tests, said my TKR looks great. I even saw the pics and it looks perfect to an unskilled eye mind you!

Any thoughts? I would hate to have a revision but I don’t know what to do at this point except continue with the injections and possibly ablation.
 

sistersinhim

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I am so sorry for all your pain these last few years. I am going to tag @Josephine
our forum director and nurse to address your concerns. She is the one to give you some guidance.
 

Josephine

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A couple days later, I had a searing pain in my left thigh, felt like a butcher knife had stabbed me in my thigh
This was the injury in October, yes?

Can you show me where this pain is using this chart?

aa hip-references-horz.jpg
 
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kneegrrl59

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The coordinate is the line where l2f and l1f is on and Y
 

Josephine

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You mean here?

kneegrr.jpg



I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
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kneegrrl59

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Update on thigh pain. I had the RFA (radiofrequency ablasion) on 12/4/18, which only helped for about 3 weeks. I had my post-treatment checkup in early January and told this to the PA. She said I could continue with the RFA in 6 months and that was probably just going to have to deal with the chronic pain indefinitely. Well, I could not accept that!

I had my quarterly visit with my rheumatologist, who is amazing, in January 2019 also. So sick of going to docs I told him everything I had been through and he asked if I had an MRI done. I said no, and he was aghast said “how did they know where to do the RFA without the MRI”.

He ordered the MRI and also said to think about a surgeon. I think he knew the problem before the MRI. In addition, during the week of the MRI, my right leg started hurting, back, butt, thigh, calf, ankle. Severe pain. As it turned out, I had two herniated discs, one on each side. I had surgery on 2/12/19.

Surgery went well but the disc on the right side had pushed the nerve up, it was almost in a “V” bad the disc had hardened. MD had to do a lot of manipulation of nerve to get all the debris out. Left disc was no problem with removal of the offending part.

Okay, now for the left leg that I had the TKR done on.
Prior to the surgery, I was off work for two weeks because the pain was so bad and walked/moved very little. The left leg started feeling a little “boggy”. I would try and walk through the pain and do some of the easy post-TKR exercises and it would go away.

About 3-4 days after surgery had a lot of post-op pain. Now two weeks later, the left TKR leg feels really boggy and tingly/tender. Had my first post-op visit and the PA said it was just the nerve healing, but I don’t have that same feeling on the right side. Throughout this whole ordeal, I’ve had some very good docs/health care providers and some not so much.

So I’m wondering if something adverse happened to my left TKR?! Both the doc from my knee replacement and the doc from the discectomy are in the same practice but I’m afraid I’ll have to schedule two different appointments if I want to see both. I wish they could consult one another but all the docs in this area practice in a vacuum. I’m going to continue to walk (haven’t done as much as I should have due to post-op pain) and see what happens in a month for my next checkup.

Anyone have any experience with “other” surgery affecting the TKR?
 

Josephine

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I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 

maryo52

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@kneegrrl59 Just checking in to make sure you saw Josephine's offer of structure advice. She just needs you to indicate you're willing to answer a few questions.
 

Josephine

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Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
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kneegrrl59

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1. Pain is about an 8, of the burning/tingling kind

2. Hydrocodone/acetaminophen 5/325 - take 1 to 2 a day, sometimes none.
Gabapentin 300 mg, 2x a day

3. Slight swelling

4. ROM is very good, I think 125

5. Ice rarely

6. Elevate most of day

7. As I am post-op with back, 3.5 weeks now, activity level is low. No bending lifting twisting. I do grocery shopping and cook dinner now, climb flight of stairs 1-2 x day

8. Walk 1 to 2 times per day, 30 minutes each. That is the only exercise the spine surgeon said to do

Do heel slides 15 reps 1x day
Leg lifts only to knee level 15reps 1x day

Hope that helps!
 

Josephine

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4. ROM is very good, I think 125
I see you've fallen into the trap hat most people do - thinking that ROM is just flexion or bend. It is not.
ROM stands for Range Of Motion which is both flexion AND extension (straightness) which I explain in the questions. So can you please tell me the number on your extension?
 
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kneegrrl59

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I have full extension, not sure of the number 95?
 
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Josephine

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Can't be that! Here is a graphic to explain how this works. Note the red and blue flags

knee ROM small.jpg
 

Josephine

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1. Pain is about an 8, of the burning/tingling kind
That's high for 10 weeks out!
2. Hydrocodone/acetaminophen 5/325 - take 1 to 2 a day, sometimes none.
Gabapentin 300 mg, 2x a day
You're not taking enough medication. You need to take the hydrocodone as prescribed which is most likely prescribed at that dose about 4 times a day at 6hrly intervals.
The Gabapentin could be bumped up too. When I was on it, I was taking 300mg 3 times a day and understood it was not a very high dose. If I were you, I'd discuss this with your surgeon or your GP. A pain score that high needs to be better medicated.
3. Slight swelling
okay
4. ROM is very good, I think 125
It's excellent
5. Ice rarely
okay
6. Elevate most of day
7. As I am post-op with back, 3½ weeks now, activity level is low. No bending lifting twisting. I do grocery shopping and cook dinner now, climb flight of stairs 1-2 x day
I don't know what "post-op with back" means.
8. Walk 1 to 2 times per day, 30 minutes each. That is the only exercise the spine surgeon said to do
Oh, you had spine surgery? You never told me that! Is much of your pain due to the spine surgery?
Do heel slides 15 reps 1x day
Leg lifts only to knee level 15reps 1x day
First you don't need to do heels slides with a flexion of 125!
And neither do you need to do leg lifts!
 

maryo52

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Obviously you are looking for answers. You have to just keep exploring and advocating for yourself. I've been down that road. You should not have this much pain. I had surgery the same day and only get pain if I do something stupid. You say you are not icing right now, and maybe you don't need to for knee swelling. But sometimes cool compresses can help with pain from other sources and wonder if you've given that a try.

Sometimes time takes care of things. I hope that's the case for you.
 
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kneegrrl59

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Josephine,
My LTKR in January 2017 went very well, no complaints, excellent recovery.
The very lengthy post from 2/27/19...had microdiscectomy L4/L5 on back, left and right side. Now the left knee where I had the LTKR 2 years ago feels boggy and hyper-sensitive and pins and needles. That is the problem I have and just wanted your input.
 

maryo52

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The pins and needles and hypersensitivity point to a nerve issue, and that can be local or stem from the back . . . which Josephine can elaborate on.
 

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