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Arthritis (Expert Forum)
On-going Pain after Knee replacement surgery
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
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On-going Pain after Knee replacement surgery
by Woodcroft, Aug 04, 2006 12:00AM
I am a sixty year old female. Good health. 7 years ago I underwent surgery to replace a worn knee. I had a half-knee prosthesis inserted. Although movement after surgery was easier I was never ‘pain-free’. The pain problem has become critical in that I can no longer walk or stand for any time. I have visited several orthopaedic surgeons who either want to perform new surgery for a ‘full-knee’ prosthesis or suggest I ‘grin and bear it’ which I have done up until now. The pain is now unbearable. The latest knee surgeon suggested I see a ‘Pain doctor’ to ensure that this problem was not nerve-related. Local tests on the knee showed that there was a degree of ‘nerve problem’ (nor surprising?)and a MRI scan of my back showed a certain degree of ‘moderately severe spinal canal stentosis’ and that the ‘foraminal dimensions are mildly reduced’ but there is ‘no convincing evidence of nerve root entrapment’. I then underwent, 4 weeks ago, a Spinal root block injection to see whether this would help the pain and identify it. It may have reduced the pain on an area of soft tissue which was tender but it has had no affect on the overall problem. I am awaiting a visit to the Pain Doctor. I have, incidentally, had every possible test for infections, all of which have proved negative. Further surgery may be needed but with MRSA as evident as it is I want to be sure it is necessary. I have never felt that the prosthesis is 'the problem' and every X-ray shows it to be OK (i.e. no movement etc.). An MRI scan of the knee is, obviously, impossible due to the presence of a titanium alloy prosthesis)
However, (and this is where I would like some help), it seems that I can escape the pain if the leg is raised. If the leg is ‘down’ it goes red at and below the knee and, obviously, any weight put on it leads to unacceptable pain. A warm bath or just being in the sun for a very short time turns the leg (even in the raised position) red. This characteristic does not seem to interest the specialists but I regard it as a fundamental indicator of something ‘odd’ happening. Perhaps this could be an allergic reaction to the prosthesis (it has been a problem since day #1)? Perhaps it is something too simple to be homed-in on by surgeons and specialists? There is no swelling of the leg when it goes red but it begins to hurt as soon as it goes from the horizontal.
Any ideas and suggestions are welcome.
However, (and this is where I would like some help), it seems that I can escape the pain if the leg is raised. If the leg is ‘down’ it goes red at and below the knee and, obviously, any weight put on it leads to unacceptable pain. A warm bath or just being in the sun for a very short time turns the leg (even in the raised position) red. This characteristic does not seem to interest the specialists but I regard it as a fundamental indicator of something ‘odd’ happening. Perhaps this could be an allergic reaction to the prosthesis (it has been a problem since day #1)? Perhaps it is something too simple to be homed-in on by surgeons and specialists? There is no swelling of the leg when it goes red but it begins to hurt as soon as it goes from the horizontal.
Any ideas and suggestions are welcome.
Doctor's Answer
by Kevin Pho, MD, Aug 05, 2006 12:00AM
, Aug 05, 2006 12:00AM
Difficult to say without evaluation.
I do not know what to make of the symptoms that are exacerbated when moving the leg. Obtaining another orthopedic opinion (preferably at a major academic medical center) can be considered if the treatment course is unclear.
If surgery is not an appropriate option, a referral to a physiatrist (rehabiliation physician) can be considered for a more tailored rehab schedule. A pain managment specialist - as you are doing - is also recommended.
Imaging the joint with a CT scan can be considered as well.
These options can be discussed with your personal physician, or in conjunction with another orthopedic evaluation.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
I do not know what to make of the symptoms that are exacerbated when moving the leg. Obtaining another orthopedic opinion (preferably at a major academic medical center) can be considered if the treatment course is unclear.
If surgery is not an appropriate option, a referral to a physiatrist (rehabiliation physician) can be considered for a more tailored rehab schedule. A pain managment specialist - as you are doing - is also recommended.
Imaging the joint with a CT scan can be considered as well.
These options can be discussed with your personal physician, or in conjunction with another orthopedic evaluation.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
My cousin who is a retired nurse and is in her early seventies has a lot of pain and redness in her lower legs. She too has had knee replacemennt surgery.One doctor told her that the redness was due to an allergy to the material used in the knee replacements.
She does better when resting and not walking alot and wears support knee highs to force circulation.
She has considered a type of therapy which forces oxygen into the
skin , and she uses creams prescirbed by the doctor because sometimes the skin in the red zones becomes irritated and infected or breaks open.
Hope this helps.