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Revision TKR Tibia BONE Pain

isuretri

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Hi,
I woke up the morning of 07/04/19 with pain and swelling. It took 5 months and 3 different doctors to figure out that my partial knee replacement ( which I had done on 12/5/15) had failed. I had extreme swelling and pain. I felt like I was going crazy. All the doctors told me I had everything from shin splints to bursitis to nothing is wrong, you just need physical therapy. I had x-rays, a bone scan. Nothing was showing up. I was so frustrated, and kept telling the doctors that something was really wrong!! Finally a CT scan revealed the failure.

I had my total knee replacement / revision on my right knee on 03/03/20. Recovery was going well until about 2 weeks ago when I woke up with (Again) swelling and pain. I'm not one to make a big deal out of things , so I just go on with my days with severe swelling and pain and cry myself to sleep more nights than not.
I am still wearing my compression stocking during the day just to give me the stability. When I get up after sitting, it takes me a few minutes to make sure I am not going to fall before I can start walking.
At rehab, I can get my knee to a 1 straightening and 123 bending. Does it hurt, you bet, but I do it.
I guess I am a little paranoid since my partial failed at only 4 years old.

I had a follow up (yes, an actual appointment) with my surgeon on Monday and he seems perplexed at why I am having the swelling. The x-rays look good ( but they also did with the partial when they couldn't find anything wrong).
The other issue I am having and no one seems to have any ideas is extreme pain in the lower leg/tibia area below the knee. Has anyone else experienced this?
I apparently have an abnormally small tibia bone so the surgeon couldn't drill too far down and had to use extra cement.
I have a follow up appointment in one month to see if anything changes.
Physical therapy was 2 times a week since the surgery, but we are going to every other week due to the number of appointments I have left on my insurance.
Thank you for reading and I look forward to any advice .
 

Celle

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Hello @isuretri - and :welome:

I'm sorry you've had so much trouble with your knee replacements.

While your knee is so swollen and sore, I don't think that going to Physical Therapy (PT) is going to do much good. Spending more time resting, icing and elevating your leg might help more.

If the same surgeon did your revision as did your partial, it would be a good idea to ask for a referral to a surgeon who specializes in problem knees. These surgeons see knees with problems every working day and they can often spot a cause and a solution that has eluded the original surgeon.

Meanwhile, I will give you our recovery guidelines, which include article on how best to ice and elevate your leg.
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

5. Try to follow this

6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Jamie

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I too am sorry you are experiencing this much pain. Unfortunately, you are so early in your recovery it is unlikely that a different surgeon would see you. Most want you to give your knee at least 6 months (maybe even a year) to settle. It can actually take that long.

If you're having pain while trying to bend your knee in therapy or at home when doing bending and stretching exercises, I suggest you stop pushing so hard. We advise people to push no harder than mild discomfort. Hold the bend for a count of 5 and then release. This is a more gentle way to coax your knee into normal range of motion without irritating sensitive tissues. At just 2 months out, your knee is still healing. Please read the articles that Celle has posted for you above. They will explain how long the healing really takes. Sometimes that's not made clear when patients head off into recovery.

I know you are extra sensitive after what you've been through with your PKR. Hopefully making a few changes to your activity and exercise routine will begin to let you trust this knee more. Try more gentle exercises and not so much pushing, practicing lots of ice and elevation, and taking something for any pain you have (Extra Strength Tylenol is just fine as long as you stay within the maximum of 4000mg in any 24 hour period).
 
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isuretri

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Thank you Roy, but if I let pain stop me, I wouldn't be doing anything. I have requested a CT scan from my surgeon to see if there is anything wrong. My knee was feeling good until about 2-3 weeks ago when I woke up with the pain and swelling. There is just so much of it that it hurts to do just about anything. Yes, I am still icing with my ice machine 3-6 times a day. I am having trouble sleeping from the extreme pain. My surgeon gave me Tramadol, but it doesn't touch the pain.
I know this surgery is much different from the partial I had 4 years ago, but I am in more pain now than before the surgery with a failed partial replacement. Is that normal? No one seems to be able to answer that, even the surgeon.
I was hoping there was someone else out there with a similar situation that could ease my mind! I appreciate any and all suggestions.
 

sistersinhim

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I was in quite a lot of pain for the first 6 weeks or so. I learned that if I did some kind of exercise or work, that if I immediately afterwards sat down and iced and elevated I faired much better than if I didn't. Unfortunately, pain is normal after this surgery. IMO, it's worst than having a baby and it lasts a whole lot longer. But, just like having a baby, it is temporary. After the pain goes down then you'll know that it was worth it all!

In my early days I allowed one extra thing a day. The next day I would only do the normal daily stuff to take care of my needs. The rest of the time I rested, iced, and elevated. This worked great for me. As time went on, I could do a little more, always paying attention to how my knee reacted. Trying to do too much too soon just sets recovery time back. Slow and easy wins this healing race!
 

marieltha

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Hi, Sorry you are experiencing so much pain.
If you do not mind me asking, what exactly failed with your partial? You said a CT scan showed it, but it would be helpful to learn exactly what it showed. Thanks.
 

Celle

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My surgeon gave me Tramadol, but it doesn't touch the pain.
Have you tried combining Tramadol with Tylenol? That can work very well. Here's a suggested schedule. The first table is for 4-hourly dosing and the second one is for 6-hourly:


The most effective way to take Tylenol is 2 x 500 mg tablets 6-hourly, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular doses, so you stay within that safe 24 hour limit of 4,000 mg.
 
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isuretri

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Thank you everyone for your encouraging words. I am now 5 months post op and still having extreme pain in the tibia bone region. It is not in my knee , but about 3 inches below the bottom of the knee and to the left (medial side of the leg). The doctor has finally agreed with me that he can feel a nodule on that spot and has ordered a cortisone shot for it. I am waiting for insurance to authorize it.
Has anyone else felt pain like this? I have told my surgeon that I swear it feels like a hairline fracture, but the xrays and the MRI did not show anything.
As far as my partial replacement , it was loose. The cement did not hold it.

I really am just frustrated with the whole thing. I went for a second opinion, but he doesn't have an idea either as to what is going on. I can't be the only person in the world to have this pain.

Now that I have been limping on my left leg for over a year, it is starting to go out. I get to have x-rays on that one on my next appointment.
 

sistersinhim

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You aren't even halfway through this year-long recovery. Having pain in the tibia area is fairly normal. It's probably where the shaft is going down into the bone. Another thing it could be is a shin splint. Are you consistently walking with a heel to toe gait? Not doing so can cause a shin splint. Are you still icing? That is a huge pain reducer.
 

Mrs. Ciz

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You aren't even halfway through this year-long recovery. Having pain in the tibia area is fairly normal. It's probably where the shaft is going down into the bone. Another thing it could be is a shin splint. Are you consistently walking with a heel to toe gait? Not doing so can cause a shin splint. Are you still icing? That is a huge pain reducer.
I had bilateral TKR on 7/6/20. I’m consistently having behind the knee pain that radiates down to my calf, around to my shin and down to my foot on the right leg. Left leg/knee is fine. My therapist figured out what it was earlier this week. Turns out I have a super tight hamstring that is causing problems. He has me concentrating on heel/toe walking. I also practice walking backwards focusing on the reverse - toe/heel - to really stretch out the heel. I can feel a small difference after just a few days. Maybe try that? Pain stinks, so I hope you figure it out soon!
 
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isuretri

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Does anyone else have tibia BONE pain? Not muscle pain but actual bone pain. I've had x-rays, MRI and a 3 phase bone scan and none of them are showing anything. I am not one to complain about pain , but this is the worst pain I have ever had. I had it 8 months before my TKR. Mine was a revision because my partial knee failed. I'm just wondering if there is something inside the bone that is not being seen on any of the exams.
Just wondering if I am the only person on the planet with this symptom because I can't seem to find anyone that has had anything like this.
 

Pumpkln

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@isuretri
Sound like you have stem pain from your revision, I also had stem pain it went away eventually.
Your surgeon has done all the tests to be sure that nothing is amiss, you will have to give it time for your bone to heal.
Recovery from TKR takes a year+, unfortunately it will require patience while you knee continues to heal.
 
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marieltha

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Thanks for explaining about your pkr. So sorry you are experiencing such constant pain. Do you have a lot of barometric pressure drops and/or rainy weather where you live? I was very sensitive to both and was told to expect this weather to cause bone achiness and swelling (or a feeling that the knee wasbig and heavy) after any bone surgery. I actually read about it here on bs before asking my os about it. It lessened over time. I got quite good at monitoring any expected changes in the weather.
 

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