Severe Pain after 2nd TKR

Posted by ssbionicknee @ssbionicknee, Sun, Sep 8 1:58pm

I had a right TKR in May of 2018 and it was painful, but tolerable. Physical Therapy seemed to go fairly smoothly. In August of 2019, I had my left TKR and am having a horrible time controlling the pain and Physical therapy is not going near as smoothly. I went to PT last Friday and was in extreme pain afterward. I was up all night. I had sharp pains inside the wound, extreme sensitivity to touch on the inside of my knee, what felt like spasms in the back of the knee and the knee was very sensitive to anything touching it. I had to keep it still and iced all day Saturday in order to get the pain under control. I know I need to do my exercises, but am afraid of triggering the pain again. I have heard that no 2 knee replacements are the same, but this one seems to be really bad. Is this normal? I have to find a happy medium when doing physical therapy. Any thoughts or suggestions?

Pain is an indicator. You've had experience with TKR rehab. Call your doctor. I'd rest, ice (and heat depending on variables and swelling), compression, and elevate until you see PT again. Maybe try gentle massage or stretching exercises only unless pain drastically changes to keep what mobility you've gained. MMO

Liked by ssbionicknee

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I'm sorry you're experiencing so much pain!

My first response to your post is: I'm wondering if you might have an infection. I'd call your surgeon or whomever is covering for him or her, now.

My second response is that maybe the PT is too intense/damaging to such newly traumatized tissue. In my 1+ year adventure into the world of TKRs I've learned that there are basically 2 approaches to PT. One is "no pain, no gain," the other is much gentler. The high pressure PT "circuit" didn't work well for me and I had so much pain afterwards that I would miss the subsequent session. I found a gentle DPT who has helped immensely.

I hope you'll post again after you speak to a doctor.

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Hi @ssbionicknee – I'm so sorry to hear about the challenges you are having in your recovery. I had my 2nd TKR in January of this year. I'm with @babette – pain that keeps you up all night and keeps you from doing your PT does not sound normal. You probably are not much more than 6 weeks into recovery. That's early and you certainly can expect plenty of discomfort and swelling early on, but not that much pain. I would call the Orthopedic Surgeon and get him/her to check it out. Has your physical therapist commented on what could be causing the pain? Can you share when in August you had your surgery?

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@ssbionicknee As you comment, no two TKRs are alike from everything I have heard. Your story seems a bit similar to mine though. My first TKR went well. I never did get quite the flex I hoped to get but I had no serious pain.
My second TKR left me in a lot of pain, I was miserable and my ortho was seeing me often to check on it. My PT was "gentle" so it wasn't that, but It somehow miraculously lifted at about 6 weeks! I can't be exact about the number of weeks. From that point on things went excellently and now that knee is much better than the first one. My doctor was obviously concerned so I would definitely be in touch with your doctor just in case something is wrong. He will probably want to check it out and perhaps do xrays, but hopefully the pain will suddenly go away as mine did and things will be great.
JK

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Hi I have had only my left knee done and it has been a rough road for me. I had a TKR in Jan. 2019, I had home therapy as well as outpatient therapy nothing help me the knee was so stiff. I then had a MUA

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Sorry I wasn't finished. I then had a MUA on Feb.27,2019 to get the knee to bend, I went back to PT the therapist said it was still hard to bend but we were going to work on it. I went to PT 3 X week as well as did home exercise that didn't seem to work I stayed in constant pain from day one. I was then schedule to have a 2nd surgery on the same knee on May 21, 2019. I had to start the process all over again home PT as well as out PT once again I was inconstant pain everyday. My knee is still very swollen it has never gone down from the 1st surgery in Jan. Last month my PT text my surgeon and told him that something didn't seem right and that he needs to sch. an appointment for me to come in before the week is out. I went in they did an x-ray which he said looked good he also wanted me to have some blood work done. When my blood work came back he called me in telling me that my blood work was abnormal. I'm thinking now what. My surgeon said he wanted to draw some fluid out of my knee to have it tested for infection, Lupus (he did say something else he was looking for but I can't remember right now). I will get the results in two weeks (from this past Wed). I have been in so much pain when I stand it feels as though my leg is breaking, I can't move until it comes together, sometimes it feels as though it is going to give out on me. My right knee is just as bad as the left was and it gives out too, I have have almost lost my balance several times and different individuals have had to catch me. I am terrified of the thought of having to have more surgery on this knee or and especially on my right (partially good knee) I walk with a cane daily for stability. I'm sorry for babbling on, but this sometimes can be depressing. Have anyone ever experienced anything like this.

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@babette

I'm sorry you're experiencing so much pain!

My first response to your post is: I'm wondering if you might have an infection. I'd call your surgeon or whomever is covering for him or her, now.

My second response is that maybe the PT is too intense/damaging to such newly traumatized tissue. In my 1+ year adventure into the world of TKRs I've learned that there are basically 2 approaches to PT. One is "no pain, no gain," the other is much gentler. The high pressure PT "circuit" didn't work well for me and I had so much pain afterwards that I would miss the subsequent session. I found a gentle DPT who has helped immensely.

I hope you'll post again after you speak to a doctor.

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@babette I have a really good PT. He watches my face really closely to see when I have had enough. He noticed that I was having more trouble withthis knee as well. I feel like their is a lot of fluid behind my knee and am wondering if I need that drained. It seems to be keeping me from bending as far as I would like. Being checked for an infection is a good idea. Although there is no redness or major swelling. I will be making a call tomorrow. Thanks for your input!

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My left knee TKR was 2010. The ROM went to 93, due to PT and at times less. After numerous "2nd opinions" I finally was told nothing was wrong with the surgery, I finally learned about scar tissue.. Two years later was a reconstruction and 2 weeks of home PT, followed by PT by an excellent therapist. However, after many months, the ROM was a little better, but still stiff and painful. I do stairs one at a time and walking is unsteady. Surgeon said no other treatment will be effective. At the same time, my good right knee is now bone on bone. Im afraid I'll have the same outcome. I was told that 1 percent of people in surgery develop excessive scar tissue. I need advice. Are the chances of getting scar tissue going to be with any surgery? I don't know where to turn.

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I'm not sure, but I do know that I had shoulder surgery back in 2007 & then again in 2010 by another surgeon who said that he had to go back in because scar tissue had built up. Even with that I didn't have nearly as much problems as I am having with my knee. During the 2nd surgery the surgeon said I had so much scar tissue unlike anything he has ever seen within his 10 + years of being a surgeon. All I know is that I am afraid of the thought of the surgeon going back into my knee as well as the good knee, which they say is bone on bone. I'm afraid that I may experience the same issues. I have heard that all surgeries are not the same, well I don't want to take the chance.

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@lynnwade54

Sorry I wasn't finished. I then had a MUA on Feb.27,2019 to get the knee to bend, I went back to PT the therapist said it was still hard to bend but we were going to work on it. I went to PT 3 X week as well as did home exercise that didn't seem to work I stayed in constant pain from day one. I was then schedule to have a 2nd surgery on the same knee on May 21, 2019. I had to start the process all over again home PT as well as out PT once again I was inconstant pain everyday. My knee is still very swollen it has never gone down from the 1st surgery in Jan. Last month my PT text my surgeon and told him that something didn't seem right and that he needs to sch. an appointment for me to come in before the week is out. I went in they did an x-ray which he said looked good he also wanted me to have some blood work done. When my blood work came back he called me in telling me that my blood work was abnormal. I'm thinking now what. My surgeon said he wanted to draw some fluid out of my knee to have it tested for infection, Lupus (he did say something else he was looking for but I can't remember right now). I will get the results in two weeks (from this past Wed). I have been in so much pain when I stand it feels as though my leg is breaking, I can't move until it comes together, sometimes it feels as though it is going to give out on me. My right knee is just as bad as the left was and it gives out too, I have have almost lost my balance several times and different individuals have had to catch me. I am terrified of the thought of having to have more surgery on this knee or and especially on my right (partially good knee) I walk with a cane daily for stability. I'm sorry for babbling on, but this sometimes can be depressing. Have anyone ever experienced anything like this.

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@lynnwade54 – Your recovery – or lack thereof – just sounds excruciating. I cannot tell you how bad I feel for you. Having had 2 TKR's, I know its not an easy journey, but I had nothing like the agony you have been through. I'm wondering if they have done any testing for metal and cement allergies. I've read of people here in this Group who had all kinds of problems due to allergies. Here is a thread that might give you some useful information:
https://connect.mayoclinic.org/discussion/need-tkr-and-had-positive-allergy-testing-bone-cement-and-metals/?utm_campaign=search
Do you know if you were tested for allergies? Could that have been what the doctor referred to when he/she said the bloodwork was abnormal?

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@mclgracie

My left knee TKR was 2010. The ROM went to 93, due to PT and at times less. After numerous "2nd opinions" I finally was told nothing was wrong with the surgery, I finally learned about scar tissue.. Two years later was a reconstruction and 2 weeks of home PT, followed by PT by an excellent therapist. However, after many months, the ROM was a little better, but still stiff and painful. I do stairs one at a time and walking is unsteady. Surgeon said no other treatment will be effective. At the same time, my good right knee is now bone on bone. Im afraid I'll have the same outcome. I was told that 1 percent of people in surgery develop excessive scar tissue. I need advice. Are the chances of getting scar tissue going to be with any surgery? I don't know where to turn.

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Hi @mclgracie – You have been suffering with this problem for a terribly long time. Having had two TKR's I know its not easy, but again, I didn't have anything like the problems you are experiencing. I've read posts from many people who did have problems with scar tissue. Here are a couple of threads that might help you:
https://connect.mayoclinic.org/discussion/scar-tissue-after-knee-replacement/?commentsorderby=DESC#chv4-comment-stream-header
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
The last one is on myofascial release. Some people swear to getting great relief from myofascial release and/or acupuncture. Have you tried either of those methods or any other alternative therapies?

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I'm not exactly sure what he meant by abnormal blood work. No I don't think that he have done any testing for metal and cement allergies, but I am going to ask him when I go back. No I have not tried myofascial release and/or acupuncture. I don't think I can deal with the acupuncture because I can't handle the needles I hear that it really hurts. I will check out the links that you sent me thanks everyone for your advice and comments.

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@lynnwade54

I'm not sure, but I do know that I had shoulder surgery back in 2007 & then again in 2010 by another surgeon who said that he had to go back in because scar tissue had built up. Even with that I didn't have nearly as much problems as I am having with my knee. During the 2nd surgery the surgeon said I had so much scar tissue unlike anything he has ever seen within his 10 + years of being a surgeon. All I know is that I am afraid of the thought of the surgeon going back into my knee as well as the good knee, which they say is bone on bone. I'm afraid that I may experience the same issues. I have heard that all surgeries are not the same, well I don't want to take the chance.

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@lynnwade54 With all you have been through I can certainly understand your reluctance to put yourself through that again. If you do get a point where the pain from not having a TKR is really bad you may change your mind. If that happens, make absolutely sure you research your orthopedic doctor and that he is excellent. The doctor who did my second TKR has pretty much all great reviews on the rating sites and when I did have more pain that anticipated after the TKR he was seeing me frequently because he too was concerned!
So, ask people, and definitely check reviews. I do not give credence to reviews if there only a few but if the doctor has been around long enough to have many you can usually trust them. If you wait too long to have a TKR, I have heard the recovery is more difficult. I did that with my first TKR and I was limping badly and in pain all day every day so I took the first doctor I could get.

I had to delay the second TKR and during that time I exercised a lot building up the supporting muscles. That made a huge difference in my discomfort. The knee had gotten so good I had to wonder if I should go ahead or not, but I did. So please do leg exercises that will help to build those muscles up, like bike (I ride my recumbent bike), walking, either regular or on a treadmill, and using an elliptical.

Are you getting synvisc injections for the "good knee"? I found them to help a lot. There is at least one other brand also that I had one time but I found for me that the synvisc seemed to work better.
JK

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@lynnwade54

I'm not exactly sure what he meant by abnormal blood work. No I don't think that he have done any testing for metal and cement allergies, but I am going to ask him when I go back. No I have not tried myofascial release and/or acupuncture. I don't think I can deal with the acupuncture because I can't handle the needles I hear that it really hurts. I will check out the links that you sent me thanks everyone for your advice and comments.

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@lynnwade54 – No acupuncture doesn't hurt. I hate needles too, but it doesn't even feel like a pinprick. After both of my TKR's, I did acupuncture to help reduce the inflammation and swelling. It really helped, and I've read of others who had the same result. Now, I'm not saying it would help with severe scar tissue build up, but it did help me recover my ROM more quickly. Will you let us know when you learn what the doctor says?

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Sounds awful. Was it done by same doctor? Now I'm scared, I'm having my second replacement, left knee, done next week!

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