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

@sfcob

Almost 5 years after my TKR I was having pain and was put on crutches and told may be a bone scan needed to be done. Couldn't take the pain any longer made an appointment and told VA I want the bone scan first-floor thin I did that as the lowe part of my replacement failed, now 4 month out from a revision and have a rod down my leg to stabilize it, I am doing much better.

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Glad your pain is better. Do they know why you are reacting to your implant?

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@cobweb

going on 5 years with pain and swelling. Now drs said it has come lose. Fun and games. This is why i did not do my other knee and did stem cells and PRP. So far it has worked. Downside is the cost is out of pocket. Your decision. I elected no surgery and the ability to knell down when i garden etc. We are seeing more insurance coverage in our area. The local hospital now covers all its employees. Ortho surgeons are doubters.

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Good for you, I’m 1 year out from stem cell/PRP by Regenexx and had no positive results. Who did your stem cell/PRP?

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For those searching for a reason for pain long after the replacement, here’s the short version of my story.

Two years, ten surgeons, 2 bone scans, 2 MRIs, an allergy test, a nerve conduction test, a muscle conduction test and more Xrays than I can count later — my pain in my knee and inability to stand or walk was caused by a broken bone in my foot that shredded the tendon.

The foot surgeon who found the bone fragment in my foot said the bone was probably broken the day of the knee surgery.

There is a reason you hurt. Don’t stop looking for it. Someone will help you

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@melcpa86

For those searching for a reason for pain long after the replacement, here’s the short version of my story.

Two years, ten surgeons, 2 bone scans, 2 MRIs, an allergy test, a nerve conduction test, a muscle conduction test and more Xrays than I can count later — my pain in my knee and inability to stand or walk was caused by a broken bone in my foot that shredded the tendon.

The foot surgeon who found the bone fragment in my foot said the bone was probably broken the day of the knee surgery.

There is a reason you hurt. Don’t stop looking for it. Someone will help you

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@melcpa86 That's amazing, it was your foot causing your knee pain! You are so right, when you have a problem you need to keep looking for that one doctor who will figure it out and find a solution. I'm glad you found that doctor who could help you.
JK

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Isn’t that amazing! I had double knee replacement 3 years ago at Mayo Clinic and had same outcome. I just sent X-rays to the surgeon for follow up and they said the knees look fine even though in the report I filled out I had expressed issues with pain and stiffness. As long as X-rays look fine they don’t care about any other issues you may have. I have lost a great deal of respect for the Doctors that I have dealt with at the Mayo Clinic. Not helpful in trying to resolve issues.

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@bengalady

Wow, how frustrating to have to wait that long ! I haven't made appointment yet. I see Pain doctor in a few days….(Which, I don't really agree with, but we'll see.) I'm not going to say anything about second opinion, small community. This last MD, said to me, "Well, I'm going to tell you like the other docs told you, ….ie nothing can be done." That was the jest of it. It's like they think its all in my head.

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Hello @bengady, your initial post caught my attention because the symptoms I've been having for over 5 years now are similar. Each night my knee is very sore and swollen/stiff, especially when its been an active day. I do steps like you do (maybe we'll start a new trend!). My diagnosis is that the lower component of my TKN has become loose and has shifted out of line. Apparently the 'glue' material that was used back when mine was done in 2012 doesn't work well with everyone. Normally a subsequent surgery would replace it but my knee also has substantial scar tissue build-up from a previous staph infection and surgery isn't a good option for me. Anyway, your symptoms sound so similar to mine it made me wonder if one of your components may have shifted too. Hang in there! I keep thinking how amazing good my elbows work!

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My case is not that bad, but am still thinking I could have a "more perfect" outcome. In 2015 I had TKR at a Town hospital in Connecticut. Great success! I did a lot of leg exercises in advance and am also physically active. Had very little pain or discomfort throughout. Am in my 70's. In 2019 I had the second TKR at Hospital for Special Surgery, very well known for successful orthopedics. The only reason I switched surgeons is because the surgeon from 2015 did not take full Medicare assignment. This bothered me – why should I pay anything if I do not have to. It probably came out to a few hundred more for Dr. visits etc. – hardly anything. Well, to my disappointment the second knee, while also good and never much pain, is less perfect. OK – I can play a racquet sport (Pickleball) fine and that is what I wanted. And I am thrilled to be back on the court. But with this second TKR I have always had a little swelling – not much and it does not hurt. But the leg has had numb areas since the surgery (mainly in calf and shin). I also had a VERY tight band over knee with this one – so affected ROM. But I think I have 112-115. After 6 months and lots of exercise it improved. And now 16 months later it is a bit better – but the stiff band is still there. I have done lots of PT and still do treadmill, elliptical, and bike several times a week. The surgeon, who is very personable, says these surgeries are "NOT ALWAYS PERFECT". BUT I EXPECT MORE since outcome was excellent with first one, and this is HSS afterall.
So, not only numbness which affects a little me when I run a few steps (but not at all when I play Pickleball!). Another thing is I think this leg may not be the exact same length as the other now. It is very slight, but something is off. I am not as stable – my balance is not as good (although I can play sports). I told surgeon I do not pivot as well. He was not surprised he said (I think because of he device he used). When I bend over (playing golf) I am a bit unsteady for a few seconds. So, my question is, who should I see? Should I ask the first surgeon for 2nd opinion? Measure my legs for length, check the nerves for the numbness, and a little swelling (no pain)? Or find a totally neutral one for 2nd opinion? What could be done anyway? Could they suggest an orthopedic for my shoe? What about the numbness? (this cannot be a GOOD thing). I almost think I should have leg vigorously massaged daily for the rest of my life (!).
TO SUMMARIZE, Q. are: 1. length of leg; 2. tight knee band (which has improved since beginning); 3 – numbness and circulation, 4 -pivoting, 5 – unsteadiness (I do not fall) but my gait is not as smooth. Also, he said I have no MCL; that I either never had one or it was injured and "absorbed". Should I have MRI ? (he did Xrays). Thank you.

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@bengalady

Well, went to the pain doctor today. He said something about "Complex Regional Pain Syndrome" I think that's the term they use, when they can't figure it out ? Gave me Tylenol #3, and Gabapentin for now. He mentioned the Norco, but I said no. He ordered a bone scan. He also asked me what my Ortho doc said, or did he order an MRI. I said no, ect. He said I need another Orthopedic Doctor, he will give me a referral. I just want to get to the bottom of this. This is especially why I don't want the other knee done, I'm too scared of being incapacitated. I haven't been able to kneel for many years now. My cat knows that, so he goes under the bed when I want him, or am mad about something. If I ever got down on the ground somehow, no, I wouldn't be able to get up. I live alone, worry about that sometimes. It would be so nice to take a nice hot bath !!!

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@bengalady : Just happened to see your post this morning while browsing. Your comment about no being able to get up from the ground made me concerned, and curious. I’ve had a pretty successful right knee TKR 18 months ago, and I can’t kneel on that leg either. I’m lucky that I have no problems getting up or down on the floor, but – I tried to find an easy way to get off the ground, and perhaps you can try that. Get into a sitting position while on the floor, put both hands on the floor, next to your shoulders on the same side of the body, twist slightly so it looks like you want to do a push-up, rotate so you are balanced on your hands and feet (all the weight can be on your “good” leg/foot, the other one doesn’t really need to do much), and then either walk your feet toward your hands, or if that is not possible, “walk” your hands back toward your feet, and straighten up. Neither of your knees ever needs to be in contact with the ground. There you go!

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@tennisgolf

My case is not that bad, but am still thinking I could have a "more perfect" outcome. In 2015 I had TKR at a Town hospital in Connecticut. Great success! I did a lot of leg exercises in advance and am also physically active. Had very little pain or discomfort throughout. Am in my 70's. In 2019 I had the second TKR at Hospital for Special Surgery, very well known for successful orthopedics. The only reason I switched surgeons is because the surgeon from 2015 did not take full Medicare assignment. This bothered me – why should I pay anything if I do not have to. It probably came out to a few hundred more for Dr. visits etc. – hardly anything. Well, to my disappointment the second knee, while also good and never much pain, is less perfect. OK – I can play a racquet sport (Pickleball) fine and that is what I wanted. And I am thrilled to be back on the court. But with this second TKR I have always had a little swelling – not much and it does not hurt. But the leg has had numb areas since the surgery (mainly in calf and shin). I also had a VERY tight band over knee with this one – so affected ROM. But I think I have 112-115. After 6 months and lots of exercise it improved. And now 16 months later it is a bit better – but the stiff band is still there. I have done lots of PT and still do treadmill, elliptical, and bike several times a week. The surgeon, who is very personable, says these surgeries are "NOT ALWAYS PERFECT". BUT I EXPECT MORE since outcome was excellent with first one, and this is HSS afterall.
So, not only numbness which affects a little me when I run a few steps (but not at all when I play Pickleball!). Another thing is I think this leg may not be the exact same length as the other now. It is very slight, but something is off. I am not as stable – my balance is not as good (although I can play sports). I told surgeon I do not pivot as well. He was not surprised he said (I think because of he device he used). When I bend over (playing golf) I am a bit unsteady for a few seconds. So, my question is, who should I see? Should I ask the first surgeon for 2nd opinion? Measure my legs for length, check the nerves for the numbness, and a little swelling (no pain)? Or find a totally neutral one for 2nd opinion? What could be done anyway? Could they suggest an orthopedic for my shoe? What about the numbness? (this cannot be a GOOD thing). I almost think I should have leg vigorously massaged daily for the rest of my life (!).
TO SUMMARIZE, Q. are: 1. length of leg; 2. tight knee band (which has improved since beginning); 3 – numbness and circulation, 4 -pivoting, 5 – unsteadiness (I do not fall) but my gait is not as smooth. Also, he said I have no MCL; that I either never had one or it was injured and "absorbed". Should I have MRI ? (he did Xrays). Thank you.

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@tennisgolf : I can only comment regarding leg length. About 6 months after TKR, once I got back up to brisk walking speed, I developed problems with hip pain. PT, followed by a cortisone injection, did not help. Therapist compared leg lengths and found a small, 1/3” difference. I got custom orthotics made, and within 2 to 3 weeks the hip pain disappeared. I keep the orthotics in my running shoes, so I only wear them for exercise, or extended shopping trips. Still, even wearing them only for those few hours have solved the problem.

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@ellerbracke

@tennisgolf : I can only comment regarding leg length. About 6 months after TKR, once I got back up to brisk walking speed, I developed problems with hip pain. PT, followed by a cortisone injection, did not help. Therapist compared leg lengths and found a small, 1/3” difference. I got custom orthotics made, and within 2 to 3 weeks the hip pain disappeared. I keep the orthotics in my running shoes, so I only wear them for exercise, or extended shopping trips. Still, even wearing them only for those few hours have solved the problem.

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@ellerbracke I find your post interesting because I have hip pain also. I have attributed it to bursitis or the fall I had in July which caused a minimal fracture of my trochanteric femur. Now I am wondering if it could be a discrepancy in leg length. I was due to have PT just as everything closed down so now it is put off until whenever. I have always, when having pants shortened, had a difference in my leg lengths though, I was told that is pretty typical. I am not sure if it's from one hip being higher than the other or actual leg length.
This is something I definitely plan to look into when I can start PT again. Thanks for mentioning it again.
JK

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@contentandwell

@ellerbracke I find your post interesting because I have hip pain also. I have attributed it to bursitis or the fall I had in July which caused a minimal fracture of my trochanteric femur. Now I am wondering if it could be a discrepancy in leg length. I was due to have PT just as everything closed down so now it is put off until whenever. I have always, when having pants shortened, had a difference in my leg lengths though, I was told that is pretty typical. I am not sure if it's from one hip being higher than the other or actual leg length.
This is something I definitely plan to look into when I can start PT again. Thanks for mentioning it again.
JK

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@contentandwell : Worth trying. When I said the therapist measured my legs, he actually measured where my heels lined up after a series of push-pull-tug exercises. So it may have been the leg length – most likely, or some pre-existing issue with hips or knees that got magnified after the TKR. I admit that I may well have had legs of different lengths before, but never aware of the fact, and never causing any problems until after TKR.

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@ellerbracke

@tennisgolf : I can only comment regarding leg length. About 6 months after TKR, once I got back up to brisk walking speed, I developed problems with hip pain. PT, followed by a cortisone injection, did not help. Therapist compared leg lengths and found a small, 1/3” difference. I got custom orthotics made, and within 2 to 3 weeks the hip pain disappeared. I keep the orthotics in my running shoes, so I only wear them for exercise, or extended shopping trips. Still, even wearing them only for those few hours have solved the problem.

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Good to know. Thank you! I am bothered that the surgeon does not seem interested or even that it is a possibility. I can place racquet sports fine. But my walking is a tad "off balance". No one probably notices. But I think my legs are uneven.

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@contentandwell

@ellerbracke I find your post interesting because I have hip pain also. I have attributed it to bursitis or the fall I had in July which caused a minimal fracture of my trochanteric femur. Now I am wondering if it could be a discrepancy in leg length. I was due to have PT just as everything closed down so now it is put off until whenever. I have always, when having pants shortened, had a difference in my leg lengths though, I was told that is pretty typical. I am not sure if it's from one hip being higher than the other or actual leg length.
This is something I definitely plan to look into when I can start PT again. Thanks for mentioning it again.
JK

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It is so interesting you both are questioning leg length. Mine stride is just a tad off, but my balance, which has always been GREAT, is also a tad off. I never had hip pain either. But now I have a little feeling in hip (not painful – just an ache).

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@tennisgolf

It is so interesting you both are questioning leg length. Mine stride is just a tad off, but my balance, which has always been GREAT, is also a tad off. I never had hip pain either. But now I have a little feeling in hip (not painful – just an ache).

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@tennisgolf At this point I am thinking that my hip pain is probably from my fracture in July. One of the doctors, either the ER one or the orthopedic one I saw afterward, when asked when I would be 100%, said maybe never. I think whoever said that was right.
JK

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I had TKR (R) July 2018 and I still have swelling and stiffness after nearly 2 years post-op. X-Rays, Ultra sound, Blood tests, nerve blocks etc etc. and the pain (only during certain movements) is always present. Developed a rash at my knee but Dr.'s say it's not a reaction to the knee (materials). I disagree. I have swelling from the knee joint line right down to the ankle. And the more I stand, walk, do stairs, etc. the more I pay for that in tiredness, stiffness, pain(lateral side) to the point that I feel that exercise worsens my condition. And that's what happened after the TKR too. My TKR knee is 1" larger in circum. than the L side. Likewise the R leg is larger due to Edema down to the ankle. I know I have a lot of 'Scar Tissue' and that probably is the main reason I have stiffness, etc. I've had Arthroscopy surgery to remove scar tissue, & do a manual manip. of the knee but 3 weeks after it was back to where it was before. I need a 'Sherlock Holmes' to figure out what to do. My life sucks now due to reduced activity. When I try & pick up an object off the floor, I look like a Giraffe. I can't kneel down. I'm protective all the time of my knee. And now my L knee needs attention. But that won't happen or I'd be in a wheelchair.

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