Hello @marbowl, I would like to welcome you to Connect along with @ellenbracke and other members. Thank you for doing what you do. I'm sorry to hear about the pain and not being able sleep. I'm a little over a year out from my TKR and I agree with @ellerbracke that the pain is probably from over-use. 10,000 steps is a lot but I'm guessing pretty average for an RN. I'm guessing there is not much chance in your work of elevating the leg during your work day. I know that along with an ice pack helped my leg swelling in the first months. I also have lymphedema and must wear compression socks. Another thing that may help at night is to put a pillow under your mattress at the bottom of the bed to raise the legs a little. I still do this to help with my swelling.

There is another discussion that might be helpful for you.

Chronic,debilitating pain after knee replacement: https://connect.mayoclinic.org/discussion/chronicdebilitating-pain-after-knee-replacement/

Does the swelling in your leg go away overnight?