(even within the same patient each knee replacement can feel a bit different during rehab) It may be that you have been doing a bit too much, too soon. Clinical photograph of the discoloured soft tissue and large effusion secondary to metallosis in the replaced knee. While walking is good to help prevent blood clots, it does put stress on your new joint. The technical term for this is. Also consider workup for material sensitivities. Extension was 0 and I could bend it to 125 within the first 3 days. Difficulty sleeping is a common complaint early after knee replacement surgery. I had both total knee replacements 15 months ago and I have had what I think a slower recovery. Comments appreciated. However, along with soft tissue healing, your bones may also be experiencing different forces since surgery and they will gradually remodel in response to these forcesbut this takes time. 117 at 7 weeks is fine. Every knee reacts a bit differently to surgery. My sense is that at 11 months from surgery, it should be safe to advance as tolerated. I however am starting P/T all over again for 6 wks and returning to my surgeon for evaluation. Two days later I went back and he said yes the femur was dying and I would need a complete knee replacement. Total knee replacement and health-related quality of life: factors influencing long-term outcomes. Unfortunately, it is impossible for me to give specific advice without being able to examine you and evaluate your X-rays. Unfortunately, if you end up deciding to proceed surgically, you really need complete revision to titanium implants. The quality of my life is limited. Has this pain been present ever since surgery, or is it new? Good luck to you. In Jan. 2020 I had to see the nurse practitioner as a follow up visit. Journal of Bone and Joint Surgery B. Any total joint replacement that had been performing well and then becomes hot, swollen, and/or painful needs immediate evaluation by an orthopedic surgeon. If the incision does not fully heal, infection can get from the skin down to the knee replacement implant, causing concerns for serious complications. There are some technical issues (alignment, rotation, soft tissue balance) and some biological issues (low grade infection, allergy) that could be causing more inflammation than normal at this point. Some clicking can be normal. It is a significant surgery that can cause significant pain and swelling following the procedure. Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Are there any strategies that you can suggest that might help me improve my range of motion quickly? Second issue: only 10 days post-op we experienced a record snowfall and frigid temps, during which a tree split hitting the house taking out power mast and meter panel. Knee joint is very stiff, but PT does not think it is scar tissue. After surgery, it's typical for the knee to technically be able to bend between 70 and 90 degrees, though it may be difficult due to pain and swelling. You have had the appropriate workup. If the wound is otherwise healing well, and your range of motion is improving appropriately, I agree that ice and anti-inflammatory medication is appropriate. Small effusions (an effusion is simply a fluid collection within the knee joint) usually indicate some residual inflammation is present. Thank you for any feedback you can give me. Since then I have had recurring effusions tapped twice only to return and pain 24/7. I am 5 days post TKR andvitbis swollen and warm to the touch on sides of incision, and pain meds are not touching the pain, what can I do? Chronic-appearing medial femoral condyle osteochondral defect measuring 1.6 cm transverse by 0.4 cm deep, 2.Mild tricompartmental osteoarthrosis, 3.Small joint effusion, and a Baker's cyst noted in the popliteal fossa region measuring 6.4 x 4 x 1.8 cm. LVPG Orthopedics and Sports Medicine-Station Circle. Deep breathing, coughing, and walking will help this to resolve. Accessibility Specific issues should be directed to her orthopedic surgeon. The force between these bones can peak at up to 10 times body weight during high impact activities. I had TKR 3 years ago. See this image and copyright information in PMC. A positive LTT may not indicate that an immune reaction is the cause of pain and stiffness post-TKA. Click Difficulty with range of motion can also cause pain. Then, usually 6-8 weeks later, a new prosthesis can be implanted. In general, pain following hip or knee replacement is mild, with redness and warmth around the joint and a slight bruise or ecchymosis. Thanks for the reply. I don't believe my ortho doctor knows what to do with me. Please enable it to take advantage of the complete set of features! These include prep solutions, skin glue, suture material. It is highly unlikely that a knee with range of motion like you describe is infected. (Please use my first name as Vivian as my real name is unusual & if used, might compromise confidentiality.) If you surgeon is concerned after evaluating your knee, you may require X-rays, labs, and possible aspiration of the knee. 10117 Berlin Should I be concerned about my ROM? If the components are optimally positioned, then extensor mechanism rebalancing will be needed, and I would also consider medial patellofemoral ligament reconstruction (reinforcing the check-rein between the femur and the knee cap on the inside of the knee). This site needs JavaScript to work properly. Decision For Surgery A manipulation involves intravenous sedation and gentle progressive pressure applied to the knee to help it to bend. This surgery is typically recommended for people who have suffered a severe knee injury or severe arthritis. The top of the sock come to that area and also am concerned if there is more pressure placed on that area exposed above the sock level that might cause swelling at the knee and on the red area. The patellofemoral joint (joint between the knee cap (patella) and femur (thigh bone) takes extremely high loads. PLoS ONE. Depending on the results, simply choosing a different prosthesis could prevent a problem. Your range of motion will spontaneously improve as your nerve recovers. Just be sure to maintain long duration deep flexion stretching on a daily basis. My knee is still warm and somewhat swollen but everyone says I am doing well at 72. Eventually 2 years following the 1st surgery I had revision surgery with a nickel free implant. Thanks. LTT showed no sensitivity to Titanium nor Zirconium. There is a very small amount of fluid around the implant that seems to leak down into the bursa area based on the MRI, which noted a slight defect in the capsule related to the surgery. Before surgery, the most important factor you can reduce is your glycemic index. Before power could be restored, pipes began to freeze. In general, patellofemoral replacements tend not to last as long as total knee replacements, but should be considered in the younger patient with isolated patellofemoral arthritis. Thank you very much for your detailed and informative response- it is very much appreciated! Running, jumping, and climbing should be avoided if you have a history of knee pain. 2013. Platelet Rich Plasma This is the type of case that really requires hands-on examination and management by a thoughtful orthopedic surgeon as there are a variety of possible explanations and treatments for what you describe. A purplish discoloration typically occurs as a sign of blood in the area (bruising may also appear blue, brown, yellow, or black). For this reason, anticoagulation will sometimes be held for a period of time in someone who has a persistently draining surgical incision. 2016-2023 Christopher Gorczynski, MD, PLLC. My concern is if I possibly traumatized or caused some other soft tissue damage to hamstrings or tendons/ligaments during my activity in the snowstorm that has inhibited healing and progress. I am 61 years old, and had a TKR on my left leg almost 18 months ago (Oct 2017). My knee is really warm. Well, thank you for sharing here that after a knew replacement, its healing process could be monitored too. The knee is still painful. Most people are feeling reasonably good by 6 months, although most will continue to experience improvement for a year or more following surgery. See him at that time. At just 2 months after knee replacement surgery, you are still early in the recovery process. While walking a bit helps to prevent blood clots, it also adds stress to your healing knee. After returning to regular activities, it can take between 12 months and a year for you to fully recover. Careers. It could also be possible to improve the patellofemoral mechanics by surgically medializing the tibial tubercle (improving the quadriceps angle of pull on the kneecap). Swelling and warmth is a normal part of the healing process which will improve for months. Clunk Two questions/issues. Does your knee swell up with activity? Introduction. Recovery goes very well, i am walking without crutches since 1 month after surgery. I had a TKR on the 24th of Feb. In the hospital, your healthcare team. That is how much pain I am in and I have a high threshold for pain. It is for this reason I recommend early manipulation. Other than the usual pain for a week Im off meds, walker, and walking 1to 2 miles a day. My main continued complaint is aching pain along hamstring tendons along medial knee capsule, with stiffness upon standing that loosens after several steps. Metallosis may cause pain, effusion, and systemic symptoms because of raised levels of serum-metal ions. I have experience dealing with sensitivity to both nickel and titanium in a total knee patient. This can be challenging for some patients. Was this present immediately after surgery, or has it developed gradually? However, I have now had two separate and increasingly painful episodes where my TKR (rt knee) swelled and required icing and elevation, with a purple looking skin appearance like a giant bruise (15 cm x 15 cm) first time about 12 hours after initial swelling. I have not pain at all. Hello I'm 52 and I had Total Knee Replacement 9 months ago. Allergic reaction to orthopedic implants is a controversial topic. A 70-year-old woman presented with right knee pain and a 'grinding' sensation 6 months after a total knee replacement for osteoarthritis. A weakened immune system makes cellulitis more likely, as does advanced age. Perhaps prior to this revision you could also be tested for sensitivity to titanium, oxinium (zirconium), and polyethylene- just to make sure some alternative materials will be well tolerated. I had a TKR in October 2022. If you were to see me I would examine your knee, test the stability and range of motion. If you notice signs that your incision might not be healing correctly, contact your surgeon right away. 2014;9(4):e91755. In the knee, more melanin is produced than in the rest of the body. official website and that any information you provide is encrypted The average ALVAL score of the cohort was 3.1 1.9, of a maximum score of 10. When a knee replacement becomes loose, it can cause knee joint stability to be compromised. Im 66 yo female had LTKR Oct 8 approximately 3 months ago. Will it increase as the nerve recovers? If the drainage is from the deeper part of the wound or is potentially infectious, surgery will likely be necessary for treatment. -, Doom P. F., Mirra J. M., Campbell P. A., Amstutz H. C. Tissue reaction to metal on metal total hip prostheses. How to spot a problem and what you can do to prevent healing concerns. A diagnosis of metallosis was made; the patient underwent debridement of the stained soft tissue and primary revision of the prosthesis. It is extremely difficult to get an outstanding result when trying to play "catch up." Thank you. Nerve Injury A nerve known as the peroneal nerve is responsible for upward movement of the foot and sensation from the side of the lower leg. 2, pp. Frozen Shoulder https://www.yourorthomd.com/orthopedic-knowledge/metal-sensitivityallergy, I'm 7 months out from a TKR with a LONG history (almost 50 years) of knee surgeries and injuries, including a bout with RSD/CRPS2. By the next morning I was back at about 20% more swelling than before all this started. The case also demonstrates the importance of knowing the individual implants. MIS stands for minimally invasive surgery. I do well during the day alternating Aleve and ES Tylenol for discomfort, but at night I am in constant pain no matter what I take. Maybe there is scar tissue formed? Joint Space Narrowing This website/an online forum like this is really not the ideal way to handle a specific issue like you have. I just wrote a new blog post discussing this issue further, and have a bibliography attached beneath the article. An MRI scan with metal artifact reduction sequencing (MARS) is necessary. 1977;11(2):157164. It occurred throughout my life Im 67. How is your range of motion? My impression is that you may need further surgery. I started feeling better and was sent home. It's just those feelings that I mentioned that irritate the heck out of me. I also think it is reasonable to take a dose of pain medication before bed. Hernigou P, Poignard A, Nogier A, Manicom O. Rev Chir Orthop Reparatrice Appar Mot. My doctor does not seem concerned, but I am wondering if what I am going through is something that can be attributed to an abrupt increase of activity (I did ramp up pretty quickly) or a sign that something is wrong? Dear Dr. Gorczynski, Many medical conditions can significantly impact the stages of healing andthe strength of the final scar. However, it will require close follow-up as changes could signal more aggressive intervention is needed. I walk when weather permits, ride my stationary bike some days and other things we did in therapy. I apologize, I haven't been able to get on this website as often as I would have preferred lately. But for 1.5 years I had heat, swelling, and stiffness, which worried me a lot (and also worried my PT) because everyone else i talked to seemed to heal much faster. john tobin obituary, danny masterson verdict, scorpio career horoscope today,
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