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TKR TKR medial pain on/near tibia

springtigger

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Hi there,
I'm 6 weeks post op and was doing great. About 2 weeks ago, horrific sporadic, stabbing, debilitating pain started on the medial side near the tibia. At the 6 week post-op visit the surgeon said I was doing great and I was actually at about a 3 month post op pace. He said the pain was most likely due to the hamstrings that attach to the tibia having to realign themselves to dealing with a straight knee. Then I went to another session of PT where I'd been told that with a TKR, no pain, no gain. Things went downhill even more after that as far as the pain and at the next PT session, I said we had to dial in back.

I thought the problem might be tendonitis, the therapist thought perhaps a bursae sac. So I got her to do some light massage, as that was all I could tolerate, tens-like therapy and ice. It's only gotten worse. Now I can't even get out of the recliner without pain as I lower the feet and I feel more pain when walking, where there had been no pain.

I've got one tramadol and a few muscle relaxers left. Gabapentin is gone. I've tried, ice, the surgeon suggested heat, so I tried that. I've up three ibuprofen and Tylenol dosage and tried magnesium pills.

Has anybody experienced this or does anyone have any suggestions? This is the worse pain of the whole recovery and it's cry worthy.

Thx in advance.
 

Celle

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Hello @springtigger - and :welome:

I'm sorry you're having so much pain.

Can you tell us, using these graphs, where the pain is worst?
Knee pain location graph..JPG


At the 6 week post-op visit the surgeon said I was doing great and I was actually at about a 3 month post op pace. He said the pain was most likely due to the hamstrings that attach to the tibia having to realign themselves to dealing with a straight knee. Then I went to another session of PT where I'd been told that with a TKR, no pain, no gain.
Your surgeon was probably correct, that it is a soft tissue pain.
All your soft tissues, muscles and tendons, were traumatized by this surgery and they need time and gentle treatment, so they can heal.

Being told "no pain, no gain" at that stage was the completely wrong thing. We recommend thinking "no pain - more gain" works better. Why would anyone want to inflict more pain on already-wounded tissues?

I think that you will find some relief if you stop doing all formal exercises (just walk a little around your house) and spend much more time resting, icing and elevating your knee and leg, to try and reduce swelling and help all those wounded tissues to calm down and heal.
 

Celle

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I've got one tramadol and a few muscle relaxers left. Gabapentin is gone. I've tried, ice, the surgeon suggested heat, so I tried that. I've up three ibuprofen and Tylenol dosage and tried magnesium pills.
It's OK to use heat on muscles well away from your knee, but using it on your knee can produce more swelling.

Have you talked to your surgeon about more pain relief?
Its possible to use Tramadol and Tylenol in combination, to good effect.
Also, if your surgeon can't prescribe more Tramadol, you can get quite good pain relief by taking Tylenol on a regular schedule.

The most effective way to take Tylenol is 2 x 500 mg tablets (Tyltnol Extra Strength) 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.
 

Celle

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Finally, here are our recovery guidelines - you'll see we recommend not pushing to pain in PT.

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.
 
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springtigger

springtigger

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Yes, it's most severe in the E LB4 and some in E LB3
 
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springtigger

springtigger

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Thanks so much for all this information and the quick responses. A lot of fantastic material here. Much appreciated. I'll keep the progress updated.
 

Celle

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Yes, it sounds as if it's all a soft tissue problem - tendons and ligaments. Treat them gently, go easy on the exercises, rest and ice the back of your knee. Give it time and it should improve slowly.

There may be some element of a Baker's Cyst as well, which is basically one of the knee bursae that has more fluid in it than usual. Baker's cysts and other knee bursae
All of the above suggestions could help with that as well.
 

nettie

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@springtigger - This sounds very difficult and painful. I hope you will be able to increase your pain medication to get you through this period. Definitely do not push your knee though painful therapy at this time. If you manage to get you swelling down, please share how you did it, and many of us (myself included) are battling swelling. Thinking of you and sending you good wishes for healing.
 

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