Swelling and stiffness, 3 years after total knee replacement

Posted by bengalady @bengalady, Oct 9, 2019

I had knee replacement 3 years ago. It is worse than previous knee pain, and getting worse as more time goes by. My surgeon (in another state) says everything normal based on X-ray. Ortho doc here says the same, and said I’m having pain and he referred me to pain clinic for possible nerve block. I want to know WHY am I having pain, although I didn’t call it pain. ROM is 100. They can’t see everything on X-ray. I want an MRI. Want to go for second opinion. Should I tell new doc I’m there for second opinion, I don’t think that’s necessary......I think that would cause some bias, ie they would just say same thing.
Has this happened to anyone ? Thoughts ?
TIA

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Profile picture for skshapiro @skshapiro

Wow Jim363 I would immediately change pt. I had a similar situation where I had an aggressive therapist pressing my knee to get to 0 extension other exercises to improve my bend and I developed a condition called "angry knee syndrome" or synovitis. I switched pt and my knee calmed down. My therapist told me that the technique they were using is old school and new research is showing that it is not effective for some people. But I am 2 and ahalf years out from my TKR and my ROM is around 100 and stairs without a banister is a nightmare. My knee is still swollen which effects my weak quad muscle and if I over do it, it makes it worse. So it is this delicate balance I have to maneuver. I am open to trying more than just pt . . . any suggestion???

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Have you ever had sonar shockwave therapy? It helps the tissues around the joint heal faster. I also had physical therapy that was too aggressive ended up with knee and hip bursitis plus IT band syndrome. Shockwave put it right. After that was finished the doctor told me to spend several months just taking short walks every day in order to let the leg rest and finish healing. Every day feels better and my walking speed and distance are slowly improving. Once the injury healed I found stairs easier. I still have to rest when I have pain if I overdo exercise. Don't know if this relates to your situation at all. Maybe shockwave will help you. Best wishes.

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My pre surgery therapist gave me good advice. If you don't think your PT is helping you or pushing you too hard, you have every right to fire them. I agree with her. The first PT I had was a "pain, no gain" kind of guy. I could tell on the first visit it was not a good fit, so I followed the advice my pre surgery PT gave me and fired them. I am very happy with my current PT. It's our body and if it doesn't feel right don't hesitate to find someone who is more well suited to your needs.

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Are you sure you don't have something else going on with that leg? I have had mild lymphedema in my leg for years. That's what the doctor said, but I'm not sure because that's a progressive condition and mine hasn't really changed over the years. Regardless, I have swelling, especially in my thigh, and it is the leg I had the TKR on. The swelling limits range of motion and caused stiffness in my leg pre-TKR. Some days are worse than others. If I hadn't ASKED about the swelling years ago, I don't think my doctor would have even diagnosed it. I believe it is related to a very bad sprain (swelling lasted 6 weeks!) I had in high school. Anyway, it IS possible that the pain and stiffness is caused by something else, and that's why the x-ray looks good.

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Profile picture for genie15 @genie15

Have you ever had sonar shockwave therapy? It helps the tissues around the joint heal faster. I also had physical therapy that was too aggressive ended up with knee and hip bursitis plus IT band syndrome. Shockwave put it right. After that was finished the doctor told me to spend several months just taking short walks every day in order to let the leg rest and finish healing. Every day feels better and my walking speed and distance are slowly improving. Once the injury healed I found stairs easier. I still have to rest when I have pain if I overdo exercise. Don't know if this relates to your situation at all. Maybe shockwave will help you. Best wishes.

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Yes your experiences seem very similar to mine. I really appreciate your response and I will look into sonar shockwave therapy.

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Profile picture for Lawanna Bean @lawanna85

My pre surgery therapist gave me good advice. If you don't think your PT is helping you or pushing you too hard, you have every right to fire them. I agree with her. The first PT I had was a "pain, no gain" kind of guy. I could tell on the first visit it was not a good fit, so I followed the advice my pre surgery PT gave me and fired them. I am very happy with my current PT. It's our body and if it doesn't feel right don't hesitate to find someone who is more well suited to your needs.

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But how do you know what is the rights advise? The lack of consensus on this issue is very concerning. I did not progress after my replacement. I had very aggressive PT 3x/week, "no pain no gain:" treatment for sure.
After 6 weeks it was clear that I couldn't bend nor straighten my knee to the degrees of "normal".

I ended up getting the MUA (manipulation under anesthesia) to restart the process. More aggressive therapy for weeks on end...

Just over a year out from my MUA and I give that knee a "C+" rating. I don't know if I could go through all of that again for knee #2, which is acting up big time.

I am a very healthy 65 y who stays very active. Walking and hiking are pretty good. That new knee limits what I can do with it though- wouldn't want that limitation on knee # 2 as well.

So many variables on patient and surgeon for a successful outcome; but I had heard a size of my component would be reduced second time around (!!!)- so did that contribute to issues? Surgeon always says no way.

I HATE that the only way I can get the knee going every day is by starting with an NSAID, warm up on upright bicycle, floor stretches, heel slides, weights... every day, to get her moving. When I didn't do this when on vacation, I lost 20* in flexion, making stairs very uncomfortable. It has taken me about a month to regain that. Very disconcerting that this is part of my daily routine now. My Dr. said this was normal.

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I am really sorry you are having so many problems. I know you must be very frustrated. Every body is unique and reacts differently to surgery and PT. If you have surgery on the other knee, are you going to use the same surgeon? I can't explain why, at my age, my surgery and rehab went as well as it did. There is no reason it should have. However, I realize that the new normal going forward is probably going to be regular PT exercises to keep the knee moving and maintain my flexion. Good luck to you!

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Profile picture for JK @contentandwell

@gardeningjunkie Many people have great success with stem cells. It is not 100% successful though and very few insurances cover it, although I have no idea if Medicare does. If you are in pain though it’s worth a try if you can afford it.

I had a procedure done before I was on Medicare that my regular (BC-BS) would not pay for without a pre-authorization. Then they still rejected it and I had to fight for them to pay. The funny thing was that it is covered by Medicare, maybe because it was a kyphoplasty to repair a broken vertebra and that is more common in people who have osteoporosis, which I did not, at that time so even though regular insurance does not cover it maybe if your doctor will plead your case it will get covered.
JK

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I’ve had nothing but pain since my total knee replacement & right this minute having severe pain with swelling & feels hard around the area so it’s a trip to A&E for me 😭

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TKR 9 MONYHS AGO. VERY STIFF AND INFLAMMED KNEE. SUURGEON SAYS WONDERFUL SUCCESS. X-RAY PERFECT. WAIT ANOTHER 9 MONTHS. NO SURGERGICAL SOLUTION. DOING SHOCK WAVE THERAPY, MANIPULATION AND ACCUPUNCTURE. SLOWLY GETTING LOOSER.

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I had full knee replacement on both knees and I am literally pain free and have been pain free for months. I'm not sure if your total need replacement involved them cutting your tendons or not. There are definitely some differences from different surgeons who do this procedure. I can tell you that if I were you... I would definitely be getting an MRI. It's the only way you're gonna have a complete picture. I would also get my medical files that involve that procedure, including any film.Such as x rays that way you can have that available to compare it with the new film that you get from the MRI (something's not right)

Just so you know, I had bone on bone and both knees for quite a few years and one leg was even curved and warped.... And yet today I have 2 incredibly straight legs. And I'm totally pain free and am on 0 medications.

We all know that just getting physical therapy to break up the scar tissue that forms inside our knees after these procedures involve some of the hardest work in recovery. I'm not sure what physical therapy you had and wether you got through that particular part. And how long?
your therapy happened?

The nature of your pain may also help to resolve your situation, such as... is it an aching pain or is the pain only present when you walk?

I'm pretty sure a competent Orthopedic doctor would tell you that you need some answers...

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Profile picture for jacs100 @jacs100

I’ve had nothing but pain since my total knee replacement & right this minute having severe pain with swelling & feels hard around the area so it’s a trip to A&E for me 😭

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Hi...
From my experience and recently have 2 full knee replacements over the last 9 months, I would say it sounds like because of your swelling as well as a very hard knee that you have lots of scar tissue still in your knee. I'm not sure how much and how long of physical therapy you had? But at some point, the knee should not be hard any longer, it softens and swelling seems to suggest that perhaps you're not doing enough icing and/or you're doing too much walking on it at any 1 time.

It's a tricky balance because different people can tolerate a different amount of pain as well as their knees are in different shape and condition from others. Because I exercised so much all of my life, I was easier able to take a higher amount of pain without swelling but. .. If I overdid it, I would get swelling!

> ICING CRITICAL... I would say at least 4 times a day, especially on days where you might at home. Be doing your own physical therapy. Because those particular walks or exercises such as ankle flexes and leg raises... all can irritate the knee and cause it to swell.

So you have to kind of monitor how much you can do starting with doing a minimal amount and gradually increasing it. over a few days to a few weeks, to determine that boundary.

●It's a bit of trial-and-error but it will serve youwell and when you get positive results, you will become more positive Anne.You will know the boundaries to work within a lot better as you continue to improve

● STRETCHING... 3 to 4 times daily is also very important. Because the stretching aids your range of motion and by doing the stretching, you will have less pain!

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