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?

@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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Sadly, I've been through it all,TKR, MUA ,hours of painful PT with only 68 degree bend( 2018) Now 2019 New ortho Dr , revision, hours of painful Pt, hip replacement, MUA,more screaming ,crying PT still only 68 degrees-finally went to pain management specialist-exploring the possibility that this is all emanating from L3 and L4 nerve damage- MRI and Emg next…omg

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@damewocane

Sadly, I've been through it all,TKR, MUA ,hours of painful PT with only 68 degree bend( 2018) Now 2019 New ortho Dr , revision, hours of painful Pt, hip replacement, MUA,more screaming ,crying PT still only 68 degrees-finally went to pain management specialist-exploring the possibility that this is all emanating from L3 and L4 nerve damage- MRI and Emg next…omg

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@damewocane – Wow… what you have been through…How are you holding up? When is your MRI?

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@contentandwell

@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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@contentandwell JK, my bend went halfway between straight and 90 degrees. Last week the IT band was extremely tight. I spent the weekend massaging it and doing my exercises to loosen it up. When I went to PT on Tuesday the bend was better, but not at 90. The tendon on the inside of my knee is extremely sore, I came home on Thursday and massaged it util it was bruised to try and loosen it up. I made it to 90 on Friday, but it takes evey ounce of my concentration to get it to bend. Today (Saturday) it is too sore to touch and it has hurt all day. It will bend to maybe 80 (I am just estimating) and then it is like it just can't move anymore. I am one of those people that is bound and determined to make ot work, but the knee just stops and then won't move. My PT said he did not like the way the knee was responding to therapy. I start PT once a week begining the second week of October. Last time I was much further along. I have not been able to ride the stationary bike, I am still walking with a cane, and there are a lot of things that I am not able to do at this point. It is extremely frustrating.

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@contentandwell

@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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@contentandwell JK, I would like to know the name of the procedure if it is not to hard to look up. I have also heard that dry needling can help. I am not sure about that though. I've heard it hurts and then I've heard it does not hurt. Thank you!!

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@damewocane

Sadly, I've been through it all,TKR, MUA ,hours of painful PT with only 68 degree bend( 2018) Now 2019 New ortho Dr , revision, hours of painful Pt, hip replacement, MUA,more screaming ,crying PT still only 68 degrees-finally went to pain management specialist-exploring the possibility that this is all emanating from L3 and L4 nerve damage- MRI and Emg next…omg

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Thanks for asking Debra, I'm quite sad and so frustrated -groundhog day over and over! This tuesday MRI-a piece of cake, however the 10 of October is the EMG- apparently , if I can stand it, a 4 hr ordeal- Any one experienced this?

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@damewocane

Thanks for asking Debra, I'm quite sad and so frustrated -groundhog day over and over! This tuesday MRI-a piece of cake, however the 10 of October is the EMG- apparently , if I can stand it, a 4 hr ordeal- Any one experienced this?

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Hi @damewocane – I haven't had an EMG but I'm going to share some information that @johnbishop posted. He may be able to add some information – and maybe others who have experienced this.
https://www.mayoclinic.org/tests-procedures/emg/about/pac-20393913?_ga=2.147873911.170155776.1569448063-1531702906.1512411564
I hope it goes well for you. Will you keep me posted?

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@ssbionicknee

@contentandwell JK, I would like to know the name of the procedure if it is not to hard to look up. I have also heard that dry needling can help. I am not sure about that though. I've heard it hurts and then I've heard it does not hurt. Thank you!!

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@ssbionicknee I just went back onto the portal to check what the message had called it. It was "lysis of adhesions". You can ask your doctor if that would be an option for your problem. I don't know much about all of this so perhaps it is not always an option. I decided to just stay with the flex I have, it's good enough even if it is not where I had hoped to be.

@damewocane That's interesting that your problem may be from spinal nerve damage. How did the nerves there get damaged, from a fall? I hope you are able to get relief with the pain management specialist and that with that relief you will be able to improve your flex. Good luck with the EMG, I have never even heard of that before so I just checked out the lin that @debbraw sent. I hope you don't have to stay as still as you do for an MRI. I didn't see any mention of that. I will be looking forward to hearing how it all goes.
JK

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@damewocane

Thanks for asking Debra, I'm quite sad and so frustrated -groundhog day over and over! This tuesday MRI-a piece of cake, however the 10 of October is the EMG- apparently , if I can stand it, a 4 hr ordeal- Any one experienced this?

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@damewocane
Here is another video from @john bishop.

I think you will handle this well. Breathe deeply. Consciously relax your body. There were only a couple of the probes that rocked my cradle. Have a lovely sleep.

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@contentandwell

@ssbionicknee I just went back onto the portal to check what the message had called it. It was "lysis of adhesions". You can ask your doctor if that would be an option for your problem. I don't know much about all of this so perhaps it is not always an option. I decided to just stay with the flex I have, it's good enough even if it is not where I had hoped to be.

@damewocane That's interesting that your problem may be from spinal nerve damage. How did the nerves there get damaged, from a fall? I hope you are able to get relief with the pain management specialist and that with that relief you will be able to improve your flex. Good luck with the EMG, I have never even heard of that before so I just checked out the lin that @debbraw sent. I hope you don't have to stay as still as you do for an MRI. I didn't see any mention of that. I will be looking forward to hearing how it all goes.
JK

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This is the wildest thing ever. No idea what is next… all I've known for the past two years 2 years is PAIN- I was mugged and beaten unconcoious with broken and cracked lower spine vertebrae when in my late 20s- -I was young and strong and healed quickly. Never had any further problems… Now 25 some years …Maybe an answer and a horrible repercussion.

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