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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@becinga

Something to consider. To anyone having issues. I have done both knees, a little over two years now. All has been great until a few months ago knees became very difficult and painful to bend.
I had been having what I thought were allergies at the time, this developed into a severe nasal problem, swelling, headaches, fatigue etc. My regular Doctor gave amoxicillin with little change.
I finally saw an ENT, he immediately diagnosed as a staph infection. Ran cultures to confirm. Began a different antibiotic and within days the knee issues as well as sinus began lessening.
What I am asking is if you had been doing well, might you have a bacterial infection causing the issues?
GOOD LUCK to ALL!

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Good evening @becinga. Welcome to Connect and thank you for bringing a gift with you. That information about the staph infection will be helpful to other members for a long time. We do know that while only two people might respond to one of your posts, hundreds may read and benefit from your post even though they do not participate or respond visually.

At Connect, we are big sharers.....knowing that knowledge is power and hoping to learn as much about our condition as we can.

I also have two TKR knees. The first one has survived for 11 years and the second one was just a year ago. It is amazing to see how technology and treatments have advanced to ensure that we get the most from the surgery.

Do you have any questions or concerns at this point?

May you have happiness and the causes of happiness.
Chris

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Why would ankle and leg swell after 4 years TKR. Knee has always felt swollen from beginning

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@vjb

Why would ankle and leg swell after 4 years TKR. Knee has always felt swollen from beginning

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Hello @vjb and welcome to Mayo Clinic Connect. This sounds concerning. I wonder what your doctor said about the sensation of your knee having always felt swelling even after recovery or if you had it checked?

Members like @mscan7 @eeppeerr88 have shared that they have experienced swelling long after surgery and may be able to come in and share more with you on their journey. While we wait for members to join, I wanted to share this information in case it is helpful:

" A swollen knee may be the result of trauma, overuse injuries, or an underlying disease or condition. To determine the cause of the swelling, your …" — Swollen knee – Symptoms and causes – Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/swollen-knee/symptoms-causes/syc-20378129

Swelling of any sort seems like a reasonable time to be seen again, even after four years. After all, this could be something related or unrelated to that surgery. Is it possible to call to get an appointment soon?

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@vjb

Why would ankle and leg swell after 4 years TKR. Knee has always felt swollen from beginning

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I have had 4 TKR and that sounds like a circulatory issue and I would sure have it checked to find out!! I just had the spacer replaced for a larger one and they secured it w a peg to keep it from dislocating! But I have EDSh. So it’s always something weird! But you go and be a proactive self-advocate! You are worth it!!!

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@gardeningjunkie

Could you be allergic to the implant? If allergic I imagine there would be inflamation in the area and do not know if that would show up in an xray.
Why I can't have a knee replacement- My ortho was ready to proceed with my knee replacement this spring but I insisted upon metal allergy and bone cement allergy testing first. He told me he hadn't had issues with rejection, but I am an allergic person and would rather proceed cautiously. I have Allergic Contact Dermatitis, ACD, and Patch Testing showed about 7 allergies out of 80 sites. I have multiple adhesive allergies but was never tested for the adhesive in bone cement. In my Patch Test Panel's I never have the metal panels run. I have known I react to nickle all my life. He ordered a blood tes stating this was more accurate than the Patch Test and I was told I must pay $600 up front as Medicare doesn't pay for this test. My blood test came back showing allergies to 5 metals, the bone cement was safe. He said there would not be one metal implant I could use; although not allergic to titanium, even titanium has traces of other metals I would react to. No problem as he could put in a ceramic coated implant so no metal would contact me and was ready to proceed. I did the homework on the "Gold" implant (called this as the ceramic is gold in color). Last year a class action lawsuit was filed as many have learned the bone cement won't adhere to the implant, moisture builds up between the ceramic coating and bone cement and the implant comes loose from the bone.I figure I am better off accepting the limitations I have now rather than risk rejection. I have a file with the exact name of this implant if interested I ill look it up.
I am appealing to Medicare to reimburse me for this blood test expense based upon my doctors "letter of necessity" because of my allergic history. Yet even if not reimbursed I am grateful for this test..

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Did they discuss a "press fit" option. My guess is they don't use cement.

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I had blood and patch testing for metals and cement. I am not allergic to bone cement, yet I tested positive to 5 metals. I did not test positive to titanium, but the surgeon told me there is no such thing as pure titanium, it would include trace amounts of other metals even the ones I was allergic to.

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@bengalady I have a similar story. I had a TKR (left knee) four years ago and had pain the entire time. Dec 2018', I had the initial TKR (I had meniscus tear repaired this same knee 2017' with no issues and speedy recovery). There was much pain afterwards initially with the TKR, and a lot of swelling that never really went away. In spite of physical therapy 3x week, manipulation at six weeks, followed by physical therapy daily for 2 weeks, icing, elevating, and the use of a CPM machine, I never gained much range of motion. Additional x-rays were taken on follow up visits. I was told they look "fine". I was also told I "Probably have the propensity to develop scar tissue". Nothing more was done to find out why I continued to have pain, lots of swelling and very little ROM, other than a prescription for an ice machine & six more weeks of PT. Cut to the chase - the original surgeon left the area, I moved and ended up seeing another doctor who suggested more PT with hopes of gaining a few more degrees in my bend, and then another who suggested I had arthrofibrosis and nothing could be done. My world became much smaller over the four years. I joined an 8-week medical fitness program and eventually started an aquatics program, I walked (more like limped) on almost daily walks of 2 to 2 1/2 miles. The pain subsided somewhat - but the swelling was still there, and I always had that "tight-band feeling".
Sept. of 2022' I had the good fortune to find an ortho surgeon who was newish to our area. First visit - he came into exam room with new x-rays in hand and said, "I know what the problem is". He ordered blood tests & an aspiration to rule out infection...and a bone scan, which confirmed his initial diagnosis; the body cement never adhered to the implant. It also indicated that the implant was loose - both at the tibia and femur. I re-read my original surgeons procedure notes and found out a Depuy Attune implant was used. Seems this device had failed and while never recalled, it was redesigned (Grrrr). My new surgeon performed a Revision TKR in November 22'...with Manipulation one month later. I'm now at 70 degrees ROM - not ideal but much better than the 20-degree ROM I started out with. My knee feels better, and I'm still in PT 2x week. It's been a challenge after 4 years of poor body mechanics, and a tight & shortened quad, to learn to even walk correctly again. Sadly, my new surgeon left the area recently. Now my right hip is bothering me. I'm hoping that's just it adjusting to my new movements. Oh, and the incision above the knee is red & irritated, am now taking antibiotics...praying that "This Too Shall Pass". I'm hoping with continued PT, home exercises and getting back to my routine of aqua fitness, long walks and gym workouts I will eventually gain more "bend". With my newer doctor, I didn't indicate that I wanted a second opinion, just was having knee pain. I did arrive to the appointment with surgery notes and a detailed history of my issues with my left knee...so I was prepared to answer some of the questions my new doctor had. Get a bone scan if you can...it provided amazing detail. Hoping you find answers and relief in the near future.

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Yes, although it has not been as long as your surgery, my TKR was done 14 months ago and my thigh is still swollen as well as my knee and it feels like I’m carrying a load of cement around. I would walk 2 miles every day and now I’m lucky to walk 2 blocks. I can’t walk straight, always wobbly. The pain keeps me awake every night. I’ve told the Surgeon but he doesn’t ever seem concerned. He said the X-ray shows everything fine (1 before surgery and 1 about 5 months later). I’m at the point of telling him I want an MRI. I’m so sorry I ever had this surgery done.

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@teak

Yes, although it has not been as long as your surgery, my TKR was done 14 months ago and my thigh is still swollen as well as my knee and it feels like I’m carrying a load of cement around. I would walk 2 miles every day and now I’m lucky to walk 2 blocks. I can’t walk straight, always wobbly. The pain keeps me awake every night. I’ve told the Surgeon but he doesn’t ever seem concerned. He said the X-ray shows everything fine (1 before surgery and 1 about 5 months later). I’m at the point of telling him I want an MRI. I’m so sorry I ever had this surgery done.

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My surgeon said the same and I"m almost 6 months out. I get what you experience is normal and some will always have issues...see your PCP or someone else. I don't get pain but my kneecap will get really sore sometimes. I walk 5-7000 steps a day usually and do my exercises a few times a week because if I do them too much my leg is so sore and stiff and hurts. I was never told about the issues you can have after or things like I can't get on my knee, kneel down etc... but electronic things say I was made aware which I was not. Thigh still swollen, leg still swollen and can't take nsaids. Hope you get the MRI you want. I'm thinking a second opinion at a difference place.

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@teak

Yes, although it has not been as long as your surgery, my TKR was done 14 months ago and my thigh is still swollen as well as my knee and it feels like I’m carrying a load of cement around. I would walk 2 miles every day and now I’m lucky to walk 2 blocks. I can’t walk straight, always wobbly. The pain keeps me awake every night. I’ve told the Surgeon but he doesn’t ever seem concerned. He said the X-ray shows everything fine (1 before surgery and 1 about 5 months later). I’m at the point of telling him I want an MRI. I’m so sorry I ever had this surgery done.

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I walked better and had less pain before my TKR. I am also sorry that I ever had it done. It’s two years and I’m once again back at physical therapy. I feel doomed to pain until I die.

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