TKR Violent night spasm

[Inkneed]

I see there are many that experience violent muscle spasms on this site. It’s 3:50AM, week 9 and I just had what can only be described as an EVIL episode. It literally feels like a demon raised my leg and tried to snap it sideways! This is the second one I’ve had and the first time I screamed from a state of sleep and terrified my poor wife and son who heard it. There were others, but not as severe. The one this morning had me holding my breath while I “rode it out”. So painful and really frightening. It felt like I might have damaged my implant due to the violent initial blow. I slowly got out of bed and walked around to try to loosen it up and then elevated and iced it.

I did have a busier day previous which included walking my dog twice for 30 minutes each time and I made a big dinner. I too had cut down my PT, some days not doing any and I seem to get better results in lessened stiffness and swelling. My ROM has been stuck at 35 to 45 degrees no matter how hard I pushed myself.

I was really worried about “the window of opportunity” and I’m scheduled to get a mechanical splint device put on me at my PT’s office to manipulate it. I’m reconsidering whether I should even do this after reading the posts on here as it appears I might be doing more harm than good? Sorry to be bouncing around a few subjects here. This for me has been the most painful, mentally challenging and exhausting experience of my 55 years.

The best advice I’ve seen on here is not to worry and let your body heal itself. There’s no race to get full ROM and it’s OK to cut back PT. I’d appreciate any comments or words of advice concerning the night spasms, they’re nasty! Best wishes to everyone!

 

[eaglemom]

That sounds oh so painful and frightening. To me it would seem your completely over doing. What is the date of the surgery? There is nothing wrong with backing way off of all your activities until the knee settles down. Possible contact the surgeon and a muscle relaxer might help? Remember no matter how far along you are in healing ice and elevation are your friends.

 

[Roy Gardiner]

to BoneSmart

It felt like I might have damaged my implant due to the violent initial blow.

IMO that's extremely unlikely. They are very strong!

I did have a busier day previous which included walking my dog twice for 30 minutes each time and I made a big dinner.

I think you have probable cause right there.

I was really worried about “the window of opportunity”

Please don't. There is no such thing. Soft tissue will always react to stretching/training.

I’m reconsidering whether I should even do this after reading the posts on here as it appears I might be doing more harm than good?

We know that Continuous Passive Motion machines are a bit out of favour now, I'm with you on reconsidering

My ROM has been stuck at 35 to 45 degrees no matter how hard I pushed myself.

Pushing won't help, sorry. Stretching exercises have to be gentle. If you are genuinely stuck, that is, your knee comes to a full stop when bending and just won't go any further, you may have adhesions (where soft tissue has stuck together around the knee). Week 9 is early in recovery to be considering this, and adhesions are rare, so proceed with caution. Chat to your surgeon.

And, if you have a static bike, I'd consider using that to try, gently, to improve ROM.

• Set the bike to zero resistance
• Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
• Gently turn the pedals, through discomfort but without pain.
• Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
• Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
• Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
• And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't

Here is a bit more chat and some pix and how 'healing' and 'training' are different

and your personal copy of the general reading:

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​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

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

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Care In Hospital​

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 a 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 history before providing advice.

 

[SkiBikeHikeDude]

Week 3 and 4 post surgery for me I had your nighttime spasm experience every night. I would wake up yelling out in pain, waking up my wife and scaring her to death. It got to where I dreaded going to bed.

My surgeon told me I was doing too much (even though I felt I was barely doing anything) and he prescribed cutting way back on activities, including ADL, standing, or even sitting with my feet down. He suggested going back to crutches or my walker, which seemed a bit extreme to me.

I took his advice and cut way back on my activities and mostly spent the past two weeks lying in a chair with my feet elevated and icing several hours a day. The good news is that it is working, and I am sleeping through the night and my pain is way down. The surgeon said the pain was from overdoing it and that my knee was telling me it was still healing and needed more rest.

I was not excited to cut back, but it helped. I am finally feeling like I can now return to walking and doing more activity, as long as I only increase by about 10% a day.

I suggest you really take it easy. No dog walks. No cooking dinner. Stay off your feet. See if it helps.

 

[Cjackso21]

I have had terrible cramps and spasms and they are clearly due to over activity or something new. I also realized that my electrolytes were off as I tried an electrolyte tablet (Nuun) and it definitely reduced the cramps. I also accidentally found a product from Melaleuca called Pain a trate that (like icy hot) that when I did have a cramp, I rubbed this on it and it went away quickly. Good luck! I have a hard time stopping activity as I have to walk a lot for work so finding these products really helped!

 

[Jockette]

Hi and Welcome!

Please tell us what surgery you had, and the date, and we’ll make a signature for you.

 

[MerlinWizard]

My wife had an amputation over a year ago. While it's not a knee, I think the general physiology is the same. Her amputation was due to an accident many years ago and several failed ankle fusions.

Anyway, she had violent cramps in her calf muscle after the amputation. While at the time, I thought it was related to the amputation it's not because I got those too!

The surgeon told us that if you don't use your muscles they will on their own spasm to keep blood flow going and to fight off atrophy. I still get them in my right thigh. This usually occurs, and you guess it - at bedtime!

Merlin

 

[BBCG]

That sudden pain sounds awful! I’ve had lighter ones like that too, but I realized that I sometimes do not drink enough water during the day, on the nights when they startle me awake.

I found a massage therapist after my first TKR in 2016 that I saw for ongoing pain, and she used a magnesium gel on my knee during a gentle massage about 2 months out. I was given a small amount of the gel that I used on my then new knee. Now, 5 years later I purchased a bottle of the gel myself and apply it to the areas of my new knee leg that are centers of the muscle/nerve spasms and it makes a big difference. An 8 oz bottle is more than one usually needs...

 

[FourCats]

Could you tell us more about the magnesium gel? I’d like to give it a try.

 

[BBCG]

The magnesium gel might be mentioned somewhere in articles; I kind of think I saw something earlier, and I mentioned it on someone’s thread last week, but will include it here.

It’s made by Ancient Minerals, and comes as a spray (my massage therapist said that form was not as potent), a lotion, and a gel. The gel is sticky, so that’s a bit of a downside, but tonight I just slathered it on my leg too, in fact. I might choose the lotion, as it might be less sticky, but I’d check to be sure it still contains the same potency.

 

[Inkneed]

Yup, I’m over a year since, (15 months), my op which I had Feb 2021, and only have 45 degree bend. I did EVERYTHING I could, physio, Ice, Exercise, rest, meds and a lot of praying. I’ve now developed chronic back, hip and ankle pain on my right side. My knee also hurts and it feels like a tight band surrounding the joint. I was very active before surgery and now I can’t even walk down stairs. I’m only 56 years old and I’m desperate to know what non surgical options might exist besides MUA? Your comments would be appreciated!

 

[Jcx]

Sorry to hear that you are struggling. I'm nearly six months in and the tight band is my main issue. An advisor will be along soon and give you some pointers into what help is out there for you. Take care Jcx

 

[WFD]

Besides an MUA, an arthroscopic lysis of adhesions combined with an MUA is an option. I had this surgery almost 10 weeks ago and am doing OK so far.

I know you asked for non-surgical options but if your problem is scar tissue then at 15 months it is mature and is going nowhere.

Have you consulted a revision specialist?

 

[sistersinhim]

I think you need to see a revision specialist, one that has nothing at all to do with your current surgeon. You will probably need to travel at least an hour or so to go to someone away from your area. I'm not saying you might need a revision. These doctors work with problem knees, which it sounds like yours is. It might be something simple like just needing a smaller spacer. I hope you find an explanation for your poor bend.

 

[Inkneed]

I want to thank all of you for your kind and helpful replies. I also need to apologize as my computer crashed and I haven't replied for a while as a result. I'm on the waiting list to see a knee specialist to look into what non surgical options are available. I just don't think that revision surgery will heal any better than the first time, but I will listen to the professionals and think of that as a last result. My GP said that likely it will be an even worse outcome, or even less than 45 degree bend if I choose that option. I'm reluctant already and that statement makes me even more so. If anyone has had a similar experience so long after TKR, I would appreciate hearing your story. Best of health to everyone and thank you for your kindness!

 

[Jockette]

@Inkneed First of all, we would really like the date of your surgery. It helps us to see this information in a signature, which shows on every post you make.

I just don't think that revision surgery will heal any better than the first time, but I will listen to the professionals and think of that as a last result. My GP said that likely it will be an even worse outcome, or even less than 45 degree bend if I choose that option. I'm reluctant already and that statement makes me even more so.

I’m sorry that your GP has told you this. Many of our members have had a revision and it corrected any problem that occurred with the first surgery, and they recovered fine, with a good ROM.

I’m very glad you are on the list to see a specialist and I hope he/she has good news for you. Please let us know how the appointment goes.

 

[Jamie]

I’m desperate to know what non surgical options might exist besides MUA? Your comments would be appreciated!

An MUA is not a "surgical option" and definitely something you should consider. There is no cutting. Instead, your knee is manipulated manually by the surgeon while you are under anesthetic. It can be helpful when adhesions (an abnormal development of scar tissue) are present.

As WFD mentioned, at times when an MUA is not successful, a lysis of the adhesions is done. This is usually an arthroscopic procedure. While it is surgery, it's not as much as a joint replacement. It is a very specialized procedure, though, and needs to be done by a VERY skilled revision orthopedic surgeon who understands adhesions in problem knees. If the specialist you see recommends this, be sure to ask how many of these procedures he's done successfully.

I'm not sure where the specialist you're seeing is located in Ireland, but if at all possible, you need to see someone in either Belfast or Dublin at a larger hospital. These are the people who are used to dealing with problem knees and who will give you a better chance for improved mobility.

I'm sorry about the comments your GP has made. It is quite possible that he or she is not up to date with current procedures to treat a knee with range of motion problems after a joint replacement. Try not to let these comments upset you, as there are options available if you can get to the right surgeon who deals routinely with knee revisions.
And, if by chance the best option is a revision, please know this can be extremely successful when done by an experienced surgeon like I've described. I think you will feel much better about all this once you have talked with such a person. Please let us know how things go and we'll support you as best as we can. Your BoneSmart family is on your side!

 

[WFD]

As WFD mentioned, at times when an MUA is not successful, a lysis of the adhesions is done.

I want to emphasize that in my case at least, the lysis of adhesions (an arthroscopic surgical procedure) is done first, and then a MUA is performed while the surgical incisions are still open. The MUA is targeted on the portions of scar tissue that the arthroscopic surgery could not reach, plus is used as a diagnostic to show the surgeon where the remaining scar tissue or adhesions are located.

What was done to me is the reverse of the comment above - the surgical LOA was done first and the MUA was performed only to address what was left, and ideally, would not be done at all unless necessary.

Because this is a surgical procedure, any bleeding caused by the MUA can be addressed before the incisions are closed up. This is in contrast to a conventional 'closed' MUA where any bleeding is hidden until it becomes significant enough to require an aspiration of the excess blood.

Another thing to note, most surgeons do not want to perform a conventional closed MUA after 12 weeks or so, whereas an arthroscopic LOA/MUA can be performed at any time, even years later. Mine was performed eight months after my most recent open surgery (a revision) because my surgeon wanted the inflammation to settle down (>six months) plus the effect of the most recent Covid surge shutting down 'elective' surgeries.

One thing that Jamie mentions that is absolutely true, is that an arthroscopic LOA/MUA is best performed by an extremely skilled surgeon. My first two surgeons told me flat out that it could not be done, and so I searched out and found a surgeon recognized as one of the best in the country, that *only* performs arthroscopic surgery, and was trained at some of the best practices in the world. If you need this kind of surgery, it really pays to search out the best.

 

[Inkneed]

Thank you for your replies! It’s obvious that having the right specialist is the key and I’ll definitely use caution as I don’t want to end up with even less mobility. Best wishes.