Severe Pain after 2nd TKR

Posted by ssbionicknee @ssbionicknee, Sep 8, 2019

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?

@harley105

Hi – I'm 9 weeks out from my second TKR this year and I'm having pretty severe nerve pain when anything rubs up against the inside of the joint – including clothing, sheets, etc. — it's like burning hot spots on the kneecap and occasional zings of pain down the inside of the calf, coupled with numbness of the inside of the calf. It's wearing me out!! Anyone experienced this? It's numb and it hurts at the same time.

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Hi @harley105 – So sorry to hear about your pain after TKR. I've had two – one a couple of years ago and one in January. You can be totally assured that 9 weeks is still pretty early in the process. I bet you'll see things improving daily or at least weekly for another few months. Meantime, here are a couple of threads that discuss the kind of pain you seem to be having:
https://connect.mayoclinic.org/discussion/burning-after-total-knee-replacement/?pg=2#comment-297081
https://connect.mayoclinic.org/discussion/unable-to-sleep-after-tkr/?utm_campaign=search
Take a look and see what you think. Are you having trouble sleeping? When you say it is wearing you out, is it causing problems with mobility?

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@harley105

Hi – I'm 9 weeks out from my second TKR this year and I'm having pretty severe nerve pain when anything rubs up against the inside of the joint – including clothing, sheets, etc. — it's like burning hot spots on the kneecap and occasional zings of pain down the inside of the calf, coupled with numbness of the inside of the calf. It's wearing me out!! Anyone experienced this? It's numb and it hurts at the same time.

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@harley105 This topic of nerve pain is currently being discussed on “severe pain after 2nd TKR. @ssbionicknee is having the same problem and is being helped by lyrica.
You may want to check out that discussion.
https://connect.mayoclinic.org/discussion/severe-pain-after-2nd-tkr/?pg=2#comment-329679
JK

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Hi – I'm 9 weeks out from my second TKR this year and I'm having pretty severe nerve pain when anything rubs up against the inside of the joint – including clothing, sheets, etc. — it's like burning hot spots on the kneecap and occasional zings of pain down the inside of the calf, coupled with numbness of the inside of the calf. It's wearing me out!! Anyone experienced this? It's numb and it hurts at the same time.

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Hi @harley105 you may have noticed I moved your post to this existing discussion referenced by @contentandwell that discussion severe pain after a second TKR so that you can discuss this with others who have similar experience. Simply click VIEW & REPLY in your email notification to get to your post.

I'd like to thank @contentandwell and @debbraw for responding to your post and sharing resources. I'd also like to tag @ssbionicknee as they may be able to offer you support.

Back to you @harley105 have you been giving any guidance by your doctor? Has anything helped decrease the pain?

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Hi! @harley105. I have just had my second TKR and what you are describing is very similar to what I felt with the first TKR. I had my right TKR in May of 2018 and it took about a year for the pain and zinging to ease up. In October or 2018 I had to have major shoulder surgery as well, which meant I had to rely more on my knees to get in and out of bed. That was a bit uncomfortable. At 9 weeks you are still early in the process of healing. Have you tried loose fitting athletic pants. At home I tend to wear shorts because they are more comfortable. The pain you are describing will subside eventually. I have a small area on my right knee that is still numb and that may be permanent. It no longer bothers me. Kneeling, I am not sure will ever be the same. I got a small yoga pad, which is shaped like a small square. it cushions my right knee when I have to kneel down to get something out of the cabinet or get down on the floor. I hope the zinging pains ease up soon. I am now recovering from my second TKR on my left knee and have been in a lot of pain from the nerves. The doctor prescribed Lyrica for me, which has helped me to get through my therapy and to make the pain tolerable. You may want to ask your doctor if that is an option until the nerve pain eases up a bit. I hope that you feel better soon. One thing I can honestly say is that even though a TKR is painful, the stability that I have in my knee now has been worth it. The reason I had to have shoulder surgery was because of a fall when my knee gave out. I wish you well! Keep us updated.

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@contentandwell

@ssbionicknee Things are sounding more positive, that’s great. I’m glad that the lyrica is helping. Hopefully as the nerves heal you will be able to discontinue it.

Your physical therapist sounds great, I’m sure the water will help a lot. I tried that once but the therapist was terrible! She would tell me what to do, which wasn’t much, and that would be the last I would see of her! I never went there again. I hope to hear how you are progressing with it.
JK

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@contentandwell My goal is to get to the point where I no longer need the Lyrica or pain meds. I wasn't thrilled about taking the Lyrica, but for now it is the only way I can get the range of motion back in m knee. It has also allowed me to cut way back on pain meds. I have to admit my therapist is awesome!! In the past few years, I have fallen apart and have needed therapy. I have been seeing the same PT for about 2 and a half years now. I trust him when he is working on my knee. I know that if I get to the point of agony he will stop and try something new. At one point he did tell me that therapy did not have to be agonizing, that there were many other options to try. The water therapist has been great, as well. There are 2 patients with the therapist and her assistant. I get one on one attention the entire time I am there. I am sorry you had a bad experience.

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@ssbionicknee

@contentandwell My goal is to get to the point where I no longer need the Lyrica or pain meds. I wasn't thrilled about taking the Lyrica, but for now it is the only way I can get the range of motion back in m knee. It has also allowed me to cut way back on pain meds. I have to admit my therapist is awesome!! In the past few years, I have fallen apart and have needed therapy. I have been seeing the same PT for about 2 and a half years now. I trust him when he is working on my knee. I know that if I get to the point of agony he will stop and try something new. At one point he did tell me that therapy did not have to be agonizing, that there were many other options to try. The water therapist has been great, as well. There are 2 patients with the therapist and her assistant. I get one on one attention the entire time I am there. I am sorry you had a bad experience.

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@ssbionicknee I don’t think that the physical therapist had another patient, I think she was flirting with one of the male PTs!

The therapist I have used more recently had been very good until the last time I used him. My orthopedic surgeon wants “gentle PT”. The in-house PT knew how to deal with that and he respected it because he had worked with other patients of that doctor and knew he has a phenomenal success rate. The outpatient PT was at a loss as to what to do though.

Good PTs are hard to find I think, I have used a number of them. You are very fortunate to have found such good ones.
JK

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@ssbionicknee

@contentandwell My goal is to get to the point where I no longer need the Lyrica or pain meds. I wasn't thrilled about taking the Lyrica, but for now it is the only way I can get the range of motion back in m knee. It has also allowed me to cut way back on pain meds. I have to admit my therapist is awesome!! In the past few years, I have fallen apart and have needed therapy. I have been seeing the same PT for about 2 and a half years now. I trust him when he is working on my knee. I know that if I get to the point of agony he will stop and try something new. At one point he did tell me that therapy did not have to be agonizing, that there were many other options to try. The water therapist has been great, as well. There are 2 patients with the therapist and her assistant. I get one on one attention the entire time I am there. I am sorry you had a bad experience.

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Can you tell me when you say lack of motion how restricted are you? I have no bend what so ever. I am awaiting a second opinion as to what is causing 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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You are right about avoiding overly aggressive PT. My first one had me crying so hard. Another PP told me that should not happen. I switched therapy company, and found a very effective PT who worked me just hard enough to be effective. I gained 10 degrees every week! Too much Pain is not good therapy technique!

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@donheads

Can you tell me when you say lack of motion how restricted are you? I have no bend what so ever. I am awaiting a second opinion as to what is causing this.

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@donheads Because I had to stop bending my knee and let the pain ease up, I lost any range of motion I had gained. My PT is working on bending the knee again. I barely have any bend in the knee at all. While the Lyrica helps, it takes all my energy to focus on breathing so I can get through my PT working on my bend. This knee surgery has been a roller coaster ride. It seems like every step I take forward, I end up taking 2 steps back. The PT has been working on my T band and I have been massaging it at home, but today he said that it wasn't looking good. I am hoping that it is not scar tissue. I do not want MUA.

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@ssbionicknee

@donheads Because I had to stop bending my knee and let the pain ease up, I lost any range of motion I had gained. My PT is working on bending the knee again. I barely have any bend in the knee at all. While the Lyrica helps, it takes all my energy to focus on breathing so I can get through my PT working on my bend. This knee surgery has been a roller coaster ride. It seems like every step I take forward, I end up taking 2 steps back. The PT has been working on my T band and I have been massaging it at home, but today he said that it wasn't looking good. I am hoping that it is not scar tissue. I do not want MUA.

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@ssbionicknee oh no, I’m sorry to hear that you’ve lost range of motion. I actually did too. When I had the in-house PT my flex was just over 120 and he was confident that I would reach at least 125. Then I went to the outpatient PT and it went down to about 117. I know, that’s not bad but I really set my goal at 120.

Hopefully your flex has not decreased to the point of needing MUA. There is another procedure that is easier that can improve flex a bit. Has your surgeon mentioned that? I would to need to go back to my old notes to find what the name of it is but if you want to know I will be glad to. I think it’s something like lysis.
JK

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@ssbionicknee

@donheads Because I had to stop bending my knee and let the pain ease up, I lost any range of motion I had gained. My PT is working on bending the knee again. I barely have any bend in the knee at all. While the Lyrica helps, it takes all my energy to focus on breathing so I can get through my PT working on my bend. This knee surgery has been a roller coaster ride. It seems like every step I take forward, I end up taking 2 steps back. The PT has been working on my T band and I have been massaging it at home, but today he said that it wasn't looking good. I am hoping that it is not scar tissue. I do not want MUA.

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Don't fear the MUA too much. It can really help, and it's not as bad as you are expecting.

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