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Ongoing Pain After Total Knee Replacement

On September 7/12 I received a total knee replacement of my left knee.  I suffer from severe osteoarthrits and am only 59 years of age.  I previously had shoulder replacements in 2008 and 2010 respectively.  My right knee is scheduled for replacement on March 25th of this year.  My initial recovery from the left knee replacement was excellent.  I was walking without a cane within 7 days, and no longer needed any medication stronger than ibupuprofen.  I had six weeks of in home physiotherapy that I performed religiously on my own on the days that the physiotherapist was not present.  I supplemented the physio with strength training in my exercise room downstairs.  During the first 4 weeks I found it hard to sleep for any length of time without feeling the need to get up and walk around a bit.  Apparently this is normal.  It relates to surgical trauma and also ongoing healing.  However your surgical leg seems to have an energy all its own that requires some sort of activity.
     I was able to travel comfortably on vacation at the 2 month mark.  It required more than 200 miles of driving, and about 1200 miles of flying.  I experienced no major issues, at least not any that required pain medication.  After returning home I went back to my regimen of physio and strengthening exercises.  I did physio on my vacation as well, and also walked several miles every morning.  However upon my return home I noticed that my progress seemed to be at a standstill.  On the days that I added my recumbent bike to my exercise regimen for a 20 minute cardio routine, I found my knee to be very sore for at least 24 hours after.  At the six month mark that still remains the case.
     At around the 3 month mark I found that when doing range of motion exercise with the left knee it seemed to catch when bending or straightening.  When it caught there was a fair bit of accompanying pain.  Now 3 months later that catching is still there, but does not seem to happen as frequently.  I guess the full recovery time for each TKR patient will vary.  My own surgeon states it can take up to a year.  Today however after a session on the recumbent bike I found even walking unpleasant, and climbing stairs almost impossible.  I still can't go down stairs comfortably unless I am having a very good day.  However I will need that ability when I get home from getting the right knee replaced.  For the moment I will have to give the recumbent bike a pass.  Until I address the issue of the catching when bending my knee with my surgeon I will stick to strengthening and range of motion exercises that don't cause me to be debilitated for a day or two after the fact.  The catching is likely caused by scar tissue.  The catching seems to be on the medial side of the patella.  Some of the scar tissue may have to removed via an arthroscopic procedure at a later date.  However I am not sorry that I chose to have the total knee replacement done.  I am sure that after I recover from the next one, my new parts will serve me well for many years in retirement.
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After going through the procedure of knee replacement surgery it can be devastating for the patient to find that the pain in the knee has persisted. This paper discusses the possible reasons why this might occur.

Common causes of persistent pain after a knee replacement

pain originating from within the knee joint itself, such as infection, internal scarring (arthrofibrosis), loosening of the prosthesis or wear of the polyurethane component - all worrying problems, and often associated with one another.
pain originating from outside the knee joint, but experienced in the region of the knee joint - commonly from the hip (eg hip arthritis) or lower spine (eg spinal stenosis - a narrowing of the spinal canal - or a 'popped' disc). This kind of pain is called referred pain.
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1711789 tn?1361308007
Hi there!

Well, without a detailed clinical evaluation it would be difficult to comment specifically on the situation. The symptoms are likely to be due to inflammation and scar formation. If mild, I would suggest ignoring them and continuing with the physiotherapy/ exercises to strengthen the muscles around the knee joint. However if the pain is moderate-severe, you may seek a review with your treating orthopedician for a detailed evaluation and suggestion of an appropriate management plan.
Hope this is helpful.

Take care!
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