Pain after TKR

[wendelo]

My husband had a TKR 4 weeks ago. He is having terrible pain in the back of his knee during the return of flexing his knee. He has about 90-100 degrees of flexation, but because of this pain he is being hindered from much more. He has difficulty reaching this amount of flexation on his own while sitting but can get it squatting or in a CPM machine.  It seems that as therapy goes on, it's only getting worse. I massaged his calf muscle yesterday which seems to be all knotted up, but he said his therapy today was awful and he could hardly move it at all. He had a non-cemented replacement which means he can't put full weight on it for another two weeks. Has anyone had similar problems or have any advice?

[mommagigi198]

I am 4 weeks post op with a left Total Knee Replacement.  I am experiencing difficulty with flexion on my own as well.  I developed post op blisters over my incision site which delayed my therapy because of pain.  My physician and my therapist have been talking about manipulation as well and I am pretty nervous about this.  My pain has reached a level that is tolerable (to say the least) and I am afraid of taking a huge step backward as far as pain is concerned.  I am under the impression that the lack of flexion is  due to the atrophy of my other muscles and the edema at the knee itself.  My quad was severely atrophied and I feel like I am expected to walk like someone without any history of knee problems, when in fact I have been compensating for years because of this knee.  Is there anyone out there who can provide me with reassurance that I am not going to end up disabled forever!!!! ??????

[mikro]

Hello
I had TKR three months agon and everything was fine and doing very well intell one month ago and my thigh started killing me. Could not put all my weight on it at all and still can't. My OS thought it was tenditis,but don't know for sure.Today im going back to pt and see what he says or can do. Is any of yours like that.
Keep me informed
Mike

[JainMD]

Hi,
How is his pain now?
How is the physio going on?
I think physio can help him with ultrasound therapy to decrease the swelling and pain too.
Keep me informed.
Bye.

[wendelo]

My husband saw the doctor yesterday as well as a new PT today and both feel that the pain he is experiencing is muscle pain and that once he strengthens his quads and hamstrings, the pain will go. The PT has given him some specific strengthening exercises as well as some alternative bending ones to do that don't cause as much discomfort. Hopefully they will help and he will be better soon. Thanks for your comments and input. Shelly, I hope things will turn around for you. I would recommend finding a therapist who really knows knees and can help you work through it. Good luck!

[Shelly3582]

I underwent a left, Cemented Total Knee Replacement in May 2007 and experienced terrible pain behind the knee and also felt like my my knee was going to explode when trying to bend it.  My orthopedic surgeon was quite confident it was scar tissue causing the problem.  He performed a manipulation under anesthesia in October, this is where he forced the knee to bend repeatedly to break up the scar tissue.  He informed my family after the procedure that there was a great deal of scar tissue and that it may be necessary at a later date to remove it arthroscopically which was done on 12/6/07.  My surgeon did a great deal of tests, he ordered an ultrasound to check for a "Baker's Cyst" which forms behind the knee and can be very painful.  He also has done multiple tests to rule out infection.  I have visited many many Orthopedic Hospital websites looking for more information about my challanges following my TKA.  I am still hopeful that in the end that my outcome will be a success as I really need to have my other knee done.  Scar tissue can be a very painful, debilitating thing and some people seem to be prone to building more than others.  If you have the time I would suggest you search the internet under "Painful Scar Tissue following TKA",  "Pain behind the knee following TKA".  I hope that none of this information is needed any more  and that your husband is well on his way to leading a happy, normal life with his new knee joint.
Shelly3582

[JainMD]

Hi Wendelo,
I agree with you that some swelling would be expected after operation.
What I meant was a swelling which is significant enough to cause symptoms at flexion of knee joint.
The feeling of tightness in joint and then feeling that it might get explode appears to be due to some obstruction or due to some ligament being inflamed.
It is possible that your calf muscle massage could have caused this pain as calf is made up of two muscles:
The gastronemius which runs from behind the thigh bone (femur) to the Achilles tendon and the soleus which runs from the below the knee to a tendon which joins the gastronemius tendon.
I think you should be seeing your surgeon back if symptoms are annoying.
Keep me informed.
I would like to know what doctor have to say.
Bye.

[wendelo]

He is the same . . . I don't think there is any pronounced swelling behind the knee. A little perhaps, but isn't that to be expected at this time post op? He isn't having any grinding, locking, catching, etc. but does say that when the pain  happens, it feels as though his knee is going to "blowout." It gets really tight and feels like it is going to explode.

The PT is going to report to the doctor and in the meantime we are icing it as usual. Could my massaging the calf muscle have made it worse? My sister-in-law is a PT (she lives far away from us) but said it sounded like muscle pain to her, hence the massaging of the calf. It feels as though there is a knot there, so I massaged it several times yesterday, but didn't expect it to get worse from that.

[JainMD]

Hi Wendelo,
How is your husband now?
Is there any swelling behind the knee which is causing such symptoms?
If there is pain on flexion suggests that either there is swelling in joint or there is a scar tissue present. Does he experience any grinding, locking, catching, or giving way of the knee?
I think what he is having is Patello-femoral disorder. He needs to be evaluated with help of an x-rays and MRI study.
Did you consult the doctor who had operated? If yes, what he has to say about that?
I think you should meet him at earliest and decide regarding further plan of management.
Keep me informed.
Bye.