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Total knee replacement has become a very common elective surgery, and patients are often amazed at how quickly they can get back to "normal" life after surgery. Within hours of their surgery, my patients are often able to begin walking with the assistance of a physical therapist and a walker. While most of my total joint replacement patients can be discharged to home within 48 hours, many are stable for discharge within 24 hours of surgery.
In spite of the anticipated rapid early recovery following total knee replacement, there is still a significant healing process that must occur. This healing process progresses through an inflammatory cascade and continues for over a year from surgery. It is this inflammatory cascade that requires a dedicated stretching regimen to ensure optimal knee range of motion following surgery. Many patients are concerned that their knee feels warm, and may appear swollen and/or pink in the early post-operative period following knee replacement. In the vast majority of cases, this is normal and an anticipated part of the recovery period. Of course, if there is ever a concern, you should always discuss this with your orthopedic surgeon. Why does this happen? Basically, the body increases blood flow to the knee region to support the healing process. This increased blood flow results in the warmth, swelling and redness often experienced by the patient. As the healing process progresses, the warmth, swelling and redness dissipate. The warmth can take 6 months or longer to resolve. Swelling and redness generally resolve within a few weeks of surgery. A bone scan is a nuclear medicine radiological study that reveals bone metabolic activity. It will light up in areas that are irritated such as fractures, stress reactions, tumors and arthritic joints. If a bone scan is performed within 2 years of a total joint replacement, it will show increased bone metabolic activity adjacent to the relatively new prosthesis (even when the prosthesis is functioning properly). This is further indication that the healing process following joint replacement progresses over a very long period of time. Thankfully, the replaced joint usually feels great, long before the body has fully recovered. So, after total knee replacement you can monitor the healing process by feeling the skin overlying your knee. As your skin gradually cools off, month-by-month, you know the healing process is winding down. Please note: Severe swelling/redness, drainage from the wound, increasing pain, and/or loss of range-of-motion should not be assumed to be normal. If there is any concern, you need to be evaluated by your orthopedic surgeon immediately.
108 Comments
9/23/2017 07:51:23 pm
I had a total knee replacement 15 months ago. Since then 3 of my fellow co-workers have had the same procedure and they are pain free, no swelling and are can perform normal day to day activities. I am in constant pain, I have told this to my surgeon with every post surgery monthly visit. It is always hot to the touch and swollen. My surgeon prescribed a nuclear bone scan 15 months after surgery, he said I have a hot knees and he recommended I see another surgeon for a 2nd opinion. He said-worse case - i need another knee replacement. What does a hot knee mean and what causes it? 9/24/2017 08:15:58 am
I am sorry to hear you are having difficulty. While this kind of scenario is relatively infrequent, it does present a challenge.
Cary
2/16/2019 03:25:27 pm
I been 9 month of total knee replacement and i still have pain , swalling and only 50 rom. My last visit to my my surgeon was im going to stay like that for the rest of my life waking with a cane and limping and pain im only 52 years old i gain wait not able to walk only around my house because i have pain and is dificult to walk to do my normal life . i have never been able to drive again because of my bending of the knee please nee help can at this time ice will help me i stop ice 3 month because was not help. Thank you cary
Debbie
12/14/2018 08:02:41 pm
I had TKR 3 years ago. When I got home they didn’t set up therapy for 10 days. Needless to say my leg got stiff and at 100 degrees back and still could put two hands under it. A year later I went back and the same Dr. did an in and out surgery. This was not an augmentation but he cleaned it up. 12/14/2018 08:41:35 pm
I try my very best to have patients understand that the best total joint replacement results happen when patients take responsibility for their own rehab. Rehabilitating a total knee requires stretching the knee straight and bending it, for long periods of time, until an acceptable range of motion is gained. This needs to be done throughout the day, every day, with no days off. Formal physical therapy then serves only to help reduce inflammation and encourage patients. Patients that work diligently on their own rehabilitation from the beginning do best. It is extremely difficult to get an outstanding result when trying to play "catch up." It sounds like your surgeon performed an arthroscopic lysis of adhesions and manipulation under anesthesia. This helped you get an acceptable range of motion. Generally, a well rehabilitated total knee should become close to, if not completely, pain-free. When this does not occur we need to make sure the alignment of the prosthesis is optimal, there is no infection, there is no loosening, and there is no referred pain from another joint or nerve. This requires evaluation by an orthopedic surgeon. Rarely, patients experience ongoing pain we can not explain. There are still additional treatment options in this unusual situation. Unfortunately, I can not tell you exactly what to do. If you have hip arthritis (you mentioned hip pain) this often causes pain that radiates into the knee, and thus I am suspicious of this. An x-ray would help to evaluate this, a hip joint injection could be done to confirm this diagnosis. Whenever a patient experiences ongoing pain after total joint replacement, they need to follow-up with their orthopedic surgeon for evaluation and guidance.
Lori Hartman
2/5/2018 11:35:06 pm
I had total left knee replacement 3 months ago and was doing great. Until 2 weeks ago, now going on 3 weeks. My knee swells all day and I am pain 24 hours a day. My knee is really warm. My right knee replacement never acted like this. Pain meds do nothing; ice does nothing. I limp all the time. I don't believe my ortho doctor knows what to do with me. I will now get a second opinion because I can't live like thisl. 2/5/2018 11:52:03 pm
This is concerning. It is unusual to have a major setback as you describe at this stage of the recovery period. If the knee is swollen it should be aspirated and the fluid sent for gram stain and culture. You should also have some bloodwork done. This should include complete blood count, erythrocyte sedimentation rate, and C-reactive protein. These tests will help to rule out an infection. A stress fracture should also be considered based on the history of going great for a couple months. Difficulty with range of motion can also cause pain. How was your range of motion prior to this setback? How is it now?
Pauline
5/18/2018 09:04:49 am
I had a total knee replacement done in March of this year and I’ve had nothing but problems with cramps from my hip down to my foot night and day the knee is sore. It try’s to fall out from underneath me all of the time and it’s hot I can’t lay on left side all I stand nothing touching my knee at all on the door it goes numb The doctor doesn’t like to answer questions and when he does all he has to say is I guess my pain doctor said there’s something seriously wrong with the knee you can tell by looking at the color of it the knee doesn’t look right he use to to knee surgery s and hips shoulder s I where to go from here 5/21/2018 10:32:14 pm
While some discomfort is normal in the early postoperative period, this is expected to improve over time. Unfortunately, it is impossible to make a diagnosis based on your comment. I suggest you seek a second opinion from another orthopedic surgeon. If you were to see me I would examine your knee, test the stability and range of motion. We would obtain fresh x-rays as well. Sometimes lab work would also be required. Your experience is not typical. You definitely need a second opinion.
Barbara
8/19/2018 05:00:57 am
I have had similar issues. Unfortunately, my surgeon has had zero interest in my post op care. PT has told my that I have lymphatic dysfunction and post operative neuropathic pain. They seem to be on track for my care as I am seeing improvements but my recovery has been horrifically painful. It was almost 3 weeks before I could sleep longer than 15 minutes at a time. During the first few days, I gained 12 lbs in edema and was running a low grade fever. I tried calling my surgeon daily to report my symptoms and got a generic answer that pain and swelling is normal. Home health reported my issues and they received no answers back either. I am definitely finding a new surgeon for my other knee. 8/23/2018 09:47:01 pm
@Barbara 4/15/2018 01:08:58 pm
2013 I had TKR: prior to Surgery I informed Surgeon and Preassessment nurse and threatre nurse that I had metal alloy allergies: Unfortunatly I became very poorly. not getting any explanation from G.P.'s or Consultants I had a private metal allergy test done and the results showed strong positives to Nickel 1 and 11 as well as 8 other positives. I realised the implant was toxic to me and that I was being poisoned by the implant. Eventually 2 years following the 1st surgery I had revision surgery with a nickel free implant. My general health improved dramatically BUT I am now having problems with the new implant: I believe this implant also has a metal I'm allergic to namely Tatanium (I showed a positive to this metal). I have been diagnosed with Osteopenia which I believe has been caused by revision surgery. I now have to take medication for this condition. I am most unhappy that my declaration of metal alloy allergies was ignored and to compound this..my private allergy test results were either not read or simply ignored...I now have had revision surgery and suspect I am reacting to the new implant done 2015. The knee is constantly swollen, I have to use a wheelie to get around or I would be housebound. Its very painful. I was initailly told my TKR would change thing for the better... its much worse than I could have possibly imagened. I feel I have been decieved, feel like my health problems resulting from the initial knee implant were ignored. Whenever I tried to speak about the problems I was ignored and told its was most unlikely that the implant could effect my general health. My life has been ruined and every G.P. or consultant just don't want to know...What has happened to the duty of care "to do know harm". Why do medical "experts" refuse to acknowledge that things can go wrong and admit to ignoring my metal alloy allergy should not have happened. I have lost all trust in doctors and surgeons. I don't know what the future holds for me and the medicals don't care. 4/15/2018 05:18:44 pm
I am sorry to hear about your experience. Metal allergy is a known issue. Thankfully, it is a fairly rare problem. Metal allergy testing unfortunately isn't perfectly reliable, and is often quite expensive. In the ideal world everyone would be tested prior to implantation of a prosthesis.
Lynn Jovan
8/17/2018 11:10:18 pm
I'm two post knee replacement 8/23/2018 10:03:02 pm
Your frustration is understandable. Unfortunately your comment does not provide enough information for me to make any recommendations. 7/19/2018 01:51:34 pm
I had a partial knee replacement two weeks ago. It never occurred to me that I might be allergic to the metals, but I now realise I cannot wear anything but gold in my pierced ears and I never told them this. I have 115 degrees of flex and it appears to be doing well but the knee is very very hot, the wound itself stands up a lot and the discomfort is not yet decreasing. Should I worry? I have stents in the ileac arteries which are blocked 30% so infection was always my chief worry.
Christopher Gorczynski, MD
7/20/2018 10:01:36 pm
At just 2 weeks- heat and pain is normal and anticipated. This is expected to improve for months. I recommend consistently using ice, working on range of motion, and being patient. True allergy to prosthetic materials is rare. It sounds like you are actually off to a good start.
Judy
8/1/2018 06:44:23 am
Thank you I was questioning it was my knee replacement why it gets hot and looks sunburn
Lidia Herrera
7/28/2018 01:20:54 am
I had a knee replacement about 4 months ago I’m still with pain and my knee still little warm . Is that normal. 8/23/2018 09:56:45 pm
At 4 months from surgery it is normal for the knee to still feel a bit warm. Your range of motion should be good (0-115+) by this point. While a little pain can still occur, it would normally be relatively mild and the trend should be one of continual improvement for up to an entire year from surgery.
Michael Holdren
8/11/2018 09:48:12 pm
3 and 1/2 years ago I had a total knee replacement. I am 70 yrs old excellent health, no arthritis in other knee or other joints. Knee replacement done because of playing traveling softball and too many slides! 8/12/2018 10:15:52 pm
I have experience dealing with sensitivity to both nickel and titanium in a total knee patient. This was resolved by first ruling out other issues. Because knee revision systems use titanium on the tibial component and any stems/augments we had to obtain a custom fabricated revision tibial base and stem made out of zirconium. This custom device was made by Smith and Nephew. They use zirconium routinely in femoral heads and femoral knee components. While this took a long time, it was an excellent solution to an otherwise very challenging problem.
Boguslawa Katyk
9/7/2018 10:26:07 pm
On January 25, 2018 I had a total knee replacement. After 8 weeks I had an infection, took strong antibiotic for 20 days, plenty of narcotics to ease pain, but my knee is still swollen and hot. I barely can walk, sleeping is difficult due to stiffness and pain, especially when trying to change positions. 11/26/2018 05:45:01 pm
Your history of early infection, and ongoing pain, heat, and swelling suggests to me the possibility of ongoing low-grade infection. This would be more likely than allergy to materials. You really need to follow-up with your orthopedic surgeon to discuss additional treatment options. While material allergy is a possibility, the most important thing to consider is infection. If your bone scan was hot, you need a white blood cell labeled bone scan. This test will help to evaluate for infection. This would potentially require additional surgery.
Rose
9/15/2018 04:55:04 pm
I am 9 months post TNR and am active ; cycling 60k twice weekly,aqua aerobics twice weekly etc.I have no pain but find that my knee is very stiff still.Is this normal? 9/15/2018 09:54:24 pm
A patient will often report continued improvement for up to an entire year following total knee or hip replacement.This is because the healing process and post-operative inflammatory cascade takes a long time to resolve. To provide a more specific answer, I need a bit more information. What is your knee range of motion once warmed up? Does it get stiff only after exercise?
Donna Breault
9/28/2018 04:52:57 pm
I am a 52 year old female who had a TKR on my left knee 4.5 weeks ago. I am having a tough time increasing my range of motion despite doing my exercises 2-3 times daily and going to physiotherapy three times weekly. I am currently achieving in the low 70s. My surgeon told me yesterday that if I don't improve to 90+ within 4 weeks that I will have to have an additional surgery that will include a scope to help clean up scar tissue and to manipulate my knee while under anaesthetic. I found out the week that I had surgery that I am highly allergic to oxycodone, so I spent 5 days post operatively being unable to exercise because I was so sick. I only take extra-strength Tylenol now because I cannot take narcotics. My physiotherapist says that as long as I keep working hard that he believes that I will be fine in terms of being able to increase my range of motion over the next month. I don't want to have another surgery. How concerned should I be about this? Have other people had this happen? Are there any strategies that you can suggest that might help me improve my range of motion quickly? 9/30/2018 11:05:33 am
In my experience, most patients have up to 6 weeks post-operatively to regain an acceptable range of motion following knee replacement surgery. I would recommend a manipulation under anesthesia if adequate range of motion has not been regained by 6 weeks. I would not recommend additional surgery at that time. A manipulation involves intravenous sedation and gentle progressive pressure applied to the knee to help it to bend. This breaks up adhesions between tissue planes. It usually allows much better/easier progression with PT/range of motion stretching. I would not recommend a surgical procedure this early. In my experience, once a patient gets beyond 6-8 weeks from surgery, manipulation is unlikely to be helpful because the scar tissue has had time to strengthen too much. It is at this point that an arthroscopic lysis of adhesions would be necessary. During this procedure, 2 tiny incisions are made in the front of the knee and the scar tissue that prevents motions is severed. Then the knee is manipulated as described above. The procedure itself is not a big deal. There is a small risk of infection- which is a big deal. It is for this reason I recommend early manipulation.
Donna Breault
9/30/2018 11:54:15 am
Thank you very much for your detailed and informative response- it is very much appreciated! I think that the website is amazing and has a wealth of information available to people.
Lee
9/29/2018 04:33:05 pm
8 weeks ago I had total knee replacement on my right leg. I am 86 years young and have been blessed that I was off the walker in one week and off all meds including tylenol in two weeks. I could move and stretch my knee almost immediately, and my PT people said I was doing better than some fifty year olds.The first three weeks there was some pain, but I had no trouble sleeping nights. I had hesitated about having this done at my age, but had been getting injections in both knees for six years, for the arthritis. My friends can not believe how well I could walk almost immediately. My knee still feels a little warm, but I know I am blessed to have recovered so quickly. 9/30/2018 11:10:05 am
Lee- I am happy to hear about your successful early knee replacement rehabilitation. Your experience is thankfully the most common experience patients have. Most patients, once rehabilitated, tell us they wished they had decided to have their joint replaced earlier. Warmth after surgery will gradually resolve over months. Congratulations on your success and enjoy your new knee! 6/3/2019 10:44:47 am
I'm so thankful that I found this site and can breathe a sigh of relief. I had a TKR 3 months ago and am at 125 degrees bending. My concern was the warmth, the numbness and the tightness, sometime tighter than others which usually is at the end of the day. I can't complain because I have NO pain, which I'm so thankful for. It's just those feelings that I mentioned that irritate the heck out of me. I guess that will go away in time, hopefully faster than not. I should have done this surgery a year ago as I was bone-on-bone when i had it done. Thank you for any feedback you can give me. 6/5/2019 05:52:17 pm
@Phyllis McDonough...
James
10/2/2018 02:27:34 pm
My wife had knee implants done over month ago she still has pain knee hot to touch her skin has discoloration has sharp shooting pain for her knee to her thigh the Dr said it was from scar tissue ? 10/2/2018 10:05:00 pm
It is totally normal for a knee to remain warm and somewhat painful for the first 4-6 weeks following knee replacement surgery. Warmth is actually normal for many months after this surgery. Discoloration is often normal following knee replacement for several weeks or longer. This is because there is often some bleeding into the soft tissues- this would appear as a deep bruise or simply darker skin. The inflammatory process associated with healing after surgery will often make the skin somewhat pink for a couple of months. Knee replacement rehabilitation is really a race between regaining range of motion and developing scar tissue that restricts motion. This can be challenging for some patients. I have several articles within this blog discussing this and providing strategies to facilitate a good outcome.
Sarah Hermanauer
10/10/2018 09:59:37 pm
I had a dkr seven months ago and made astounding recovery in the first three months, walking with just a cane after just two weeks. Now after seven months I am in agony getting up from a chair, going down stairs and recently just walking. My knees are still warm to the touch and I am often awakened at night with pain. Any ideas of how I should proceed?? 10/12/2018 10:28:36 am
Most concerning is the deterioration in function you describe. This is not normal. Typically patients will experience continued improvement in pain, motion, strength, and endurance for an entire year or more.
Sarah
11/19/2018 08:50:30 am
I had PVNS for many years and eventually had a TKR in Jun 2017, the surgery went well and the knee has been good until now. It has started to get hot to the touch. It is usually hot first thing in the morning and after I have been sitting for a while. Should I go and see a Dr about this and what could the iissue be? When I had PVNS the knee would be very swollen, currently I have no swelling just a hot knee. 11/19/2018 09:49:00 pm
Any total joint replacement that has been performing well and then becomes hot and/or painful needs to be evaluated by an orthopedic surgeon immediately. I recommend you contact your surgeon for an urgent appointment ASAP...even if it only results in reassurance that all is well. In the event there is a significant problem, the sooner it is diagnosed and treated the better. 11/19/2018 10:20:13 pm
Any total joint replacement that has been performing well and then becomes hot, stiff, or swollen requires an urgent evaluation by an orthopedic surgeon. While it could just be inflamed, the differential diagnosis also includes:, infection, loosening, and stress fracture. All of these possibilities require prompt treatment. For this reason, I recommend you contact your orthopedic surgeon ASAP for evaluation. 11/19/2018 10:35:26 pm
Any total joint replacement that had been performing well and then becomes hot, swollen, and/or painful needs immediate evaluation by an orthopedic surgeon. While it could just be irritated, other possibilities include a stress fracture, infection, or mechanical loosening. While these are rare, prompt treatment is needed. Thus, please call your orthopedic surgeon ASAP for an urgent visit.
Sarah
11/20/2018 12:00:19 pm
Thank you so much for the advice.
Bill Purdy
11/19/2018 01:14:20 pm
At age 78 I had a replacement of my left knee. Other than the usual pain for a week I’m off meds, walker, and walking 1to 2 miles a day. My problem is at bed time. After 2 or 3 hours asleep I’m awaken by sharp and serve pain. Tried ice treatment and a bit helpful for 2 hours. Should I take prescription drugs before bed time? Reason to contact your office was the very helpful replies given and my Surgeon is away until mid December. See him at that time. 11/19/2018 09:56:53 pm
Difficulty sleeping is a common complaint in the first few months following knee replacement surgery. Walking 2 miles each day may be a bit too much early on after this operation. As long as your range of motion is improving and you are doing a bit of walking, your ability to cover long distances will come with time. It is simply not necessary to walk such long distances so early. While walking is good to help prevent blood clots, it does put stress on your new joint. Your knee also needs to heal and adjust to the prosthesis. This takes time. I also think it is reasonable to take a dose of pain medication before bed. Getting proper rest is crucial to allow your body to recover. This all will improve with time. 11/19/2018 10:13:52 pm
Difficulty sleeping in the first couple of months following total knee replacement is a common complaint. Assuming your surgery was fairly recent, I think you may be walking a bit too much. While walking is encouraged to help prevent blood clots, 2 miles every day within a couple weeks of surgery is perhaps more than necessary. Focus on range of motion exercises, walk smaller distances several times throughout the day, and continue to use plenty of ice. Your body is adjusting to the new knee replacement and your soft tissues also need time to heal. This will improve with time. I also think it is reasonable to use a dose of pain medication before bed to allow yourself to get some rest. 11/19/2018 10:44:08 pm
Difficulty sleeping is a common complaint early after knee replacement surgery. This does resolve with time. If you are just a few weeks out from surgery, I think you may be walking a bit too much. While walking a bit helps to prevent blood clots, it also adds stress to your healing knee. This inflammation is often experienced as pain at night when the distractions of the day are gone. I would focus on range of motion exercises, and do frequent, but shorter walking distances (maybe cut your total distance for the day in half) for a few weeks. I also think it is reasonable to use some pain medication before bed to help you get the rest you need while your body recovers. If you can use anti-inflammatory medication like ibuprofen (ask your surgeon), this could also improve your symptoms. Ice is also very helpful. This problem will gradually fade away as your body recovers from surgery over the next few months.
Hilda Reyes
11/21/2018 10:01:46 am
I'm 68 years old and I had total knee replacement on my right leg more than 2 months. Is it normal that my knee is very warm in the afternoon and I am also in extreme pain everyday around 5pm. Sometimes the pain doesn't go away and last the entire night. My doctor recommend me to put some ice and helps a little bit and I'm also taking prescribed anti-inflammatory drug, but the medicine doesn't help at all. Any ideas of how I should proceed?? 11/26/2018 05:41:39 pm
At just 2 months after knee replacement surgery, you are still early in the recovery process. Different patients experience varying degrees of pain and inflammation ranging from almost none to quit a bit. Warmth following total knee replacement is normal, sometimes this persists for several months. Pain, warmth, and stiffness should all be gradually improving over time. 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. If your range of motion is not adequate at this point, that can lead to inflammation. If the trend is not one of gradual improvement, I would recommend re-evaluation by your orthopedic surgeon. 11/22/2018 05:37:17 am
Ft tkr don at Kim's secunderbad Telangana on 26/4/2028 now it's fine Lt tar on12/09/2018 still stiff knee and warm why 11/26/2018 05:47:31 pm
Warmth after knee replacement surgery is normal and expected to persist for several months, sometimes even for nearly the entire first year. If you had been feeling well and this is new onset warmth and stiffness, you need to follow-up with your orthopedic surgeon for evaluation.
Jacquie Viegas
11/24/2018 09:05:27 pm
I had TKR 7 weeks ago. My range of motion is 117 degrees with physiotherapist pushing it, I can get it to 105 degrees myself. My recovery has been hindered by femoral nerve damage diagnosed by nerve conduction study last week and I was started on Lyrica for extreme muscle spasms at night (the Lyrica works and I call it my miracle drug!). My knee is still quite hot, swolllen ( 1 inch> right) and a bit discoloured. Should I be concerned about my ROM? Will it increase as the nerve recovers? Is there anything more I should be doing other than exercises at home, PT 3 x week, pool therapy 1x week? 11/26/2018 05:50:45 pm
117 at 7 weeks is fine. I would continue stretching on a daily basis, several times per day if possible. Swelling is normal at this stage, particularly as you continue to work on range of motion exercises. Your range of motion will spontaneously improve as your nerve recovers. This is something that only gets better if you continue to stretch. It sounds like you are doing all the appropriate exercises. Just be sure to maintain long duration deep flexion stretching on a daily basis.
Jeanne Mikita
9/29/2019 11:46:30 pm
Hi Jacquie. I've had both knees done (2 years apart, in my late 50s) and the healing process turned out to be similar for both. At 7 weeks my ROM was about the same as yours, and i eventually (after a year) reached about 132. I cycled, did deep-water exercises, and eventually walked longer distances. 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. I guess my body just needed longer to heal. As for the spasms, I'm not sure my situation is the same as yours, but after my 2nd surgery (Oct 2017) I started to get intense muscle twitches at nights -- jolts in my gluts or (less often) my quads that would literally lift me in the air. I had 50 or more some nights, but they're rare now. No idea why, and no one (PT or doctor) can explain. I figured there was some nerve damage during surgery. But, the end of the story is that my knees are better than they've been in years -- TKR was tough, but it's been a life changer. Just got back from a 100 km walk in Ireland :-)
elizabeth robinson
12/1/2018 09:57:58 am
I am 6 weeks out of knee surgery after the robotic process and cell replacement. It was amazing, I was walking with no cane after a week and back at the gym after 5 weeks. Glue used for the incision has left a very thin scar which is hardly visible. My knee is still warm and somewhat swollen but everyone says I am doing well at 72. 12/1/2018 10:05:21 am
I am glad to hear about your rapid early recovery. My experience doing MAKO robotic joint replacements is consistent with your experience thus far: quicker recovery, more normal feeling joints due to improved soft tissue balance, less pain, and overall happier patients. Swelling and warmth is a normal part of the healing process which will improve for months. Use plenty of ice, and make sure your knee range of motion is maximized. Thank you for the posting.
Robert Rhea
12/2/2018 07:04:49 am
After 5years out of titsl knee replacement. I am experiencing pain in both knees and they feel hot to touch. This happened after a night of fast dancing 12/2/2018 09:59:59 am
Although your knee joints have been replaced, they are still potentially susceptible to overuse injury. This is particularly the case when performing an activity you are not accustomed to. Think back to before your knees became arthritic. If you weren't used to running, but one day decided to run a 5K race, or if you went on a 10 mile backpacking trip in the mountains, it is very likely your normal knees would have been sore for a few days following this activity. This is because they were not adapted to that level of activity and became acutely inflamed. It sounds like the same thing happened to your artificial knees when you danced all night. Rest, ice, and anti-inflammatory medication will help them to recover. However, if they do not feel better within a week, I would recommend getting checked out by an orthopedic surgeon.
Cindy
12/2/2018 10:32:46 pm
I had a total knee replacement 12/5/17. I have pain around the meniscus area (inside and out) along with major inflammation. I've continued with my exercises before and after surgery. Now, if I sit all day ( non active) and do this a few days, the pain and inflammation goes away. Well, I'm not that type of person, I work 2 days a week (10 hrs a week) with days off in between. I go to the gym to help with my exercises.. Why would this still be happening? I'm so over this.. One thing I didn't add, I take anti inflammatory meds prescribed and natural... Nothing seems to be helping. I'm becoming very irritated regarding this. 12/3/2018 09:06:23 pm
So- when a total knee replacement is performed, both medial and lateral menisci are removed. Normally, the meniscus is located directly at the joint line. So when a total knee replacement patient indicates pain at the level of the meniscus, I interpret this to mean at the joint line. A bit more information would be helpful. Has this pain been present ever since surgery, or is it new? Do you feel any instability with side-to-side stress of your knee? Do you have any hip or groin pain? Does your knee swell up with activity? Does your knee have full range of motion? I am trying to rule out: 1- referred pain from your hip (this can radiate to the inside of the knee), 2- knee collateral ligament imbalance that can cause inflammation with increased activity, 3- synovial impingement which is essentially scar tissue that can become pinched within the prosthesis with activity.
Carol
12/5/2018 07:22:00 pm
Had left TKR 7/31/18 Went to therapy for 9 weeks and have a good range of motion. 0 and 145. Should I still have the feeling that s tight band is around my knee. I know that warmth is normal. How long should I continue with all of the exercises? I walk when weather permits, ride my stationary bike some days and other things we did in therapy. Is the tight band normal and for how long. Thanks 12/5/2018 09:03:47 pm
That range of motion is outstanding! Nicely done. In spite of your excellent range of motion, your knee is still recovering from the surgical trauma and early rehabilitation. Scar tissue tends to try to contract for many months after surgery. This may lead to feeling some tightness. There may always be somewhat thicker tissue around your knee as a result of this trauma. This is normal. I would expect your tissues to gradually relax for up to an entire year or more following surgery. It sounds like you are off to a good start, and I would expect further improvement for many months yet to come.
Pat Egeberg
12/7/2018 01:24:11 am
I am almost 6 weeks post-op from bilateral tkr. 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. I can't get comfortable. My surgery was on 10/30/18. My knee x-rays at 4 wks showed small amount of effusion and demineralization.. Could this be causing my pain? Surgeon says that effusion is common and the demineralization will improve with weight bearing, but I am pretty active as it is right now. I am at 130 degrees in both knees, so movement is good. 12/8/2018 10:21:28 am
Night pain is very common early-on following knee replacement surgery. This will improve with time. Small effusions (an effusion is simply a fluid collection within the knee joint) usually indicate some residual inflammation is present. This is expected at this point, and will gradually resolve with time. The effusion may cause stretching of the joint capsule, which can cause some discomfort. X-rays are not a good way to gauge bone density, and knee replacement surgery is very unlikely to cause any acute changes in bone density anyway. Regardless, I highly doubt bone demineralization is causing any pain. Your range of motion is awesome! Your body is simply healing, there is still residual inflammation within your knees, and this will improve with time. Ice, anti-inflammatory medication, relaxation techniques before bed, and maybe a gentle sleep aid could be considered in the meantime.
Carol
12/8/2018 12:03:08 pm
Is there a mild sleep aid that can be bought over the counter. My problem is getting to sleep after I get to sleep I do well, but getting my leg fixed and falling to sleep is the problem. Thanks 12/8/2018 02:36:29 pm
While I can not make specific recommendations to you, there are a couple of over-the-counter options that can be effective: Benadryl is a sedating anti-histamine that is commonly used to help with sleep. The same medication can be found in the "PM" versions of medications, like Tylenol PM. Another option that can be effective is melatonin. Valerian root can be found in supplement form, and also in some herbal teas. This also can assist with sleep.
Bill Stevens
12/9/2018 08:41:34 pm
I had a patellafemoral replacement about 6 weeks ago. I'm told I'm doing well, but swelling in the joint persists, particularly at the end of the day if ive been standing around a lot, or sitting in the office chair. Considering this may go on for quite some time, is there any harm in exercising while the knee is swollen? I don't feel much discomfort, and would like to get back running on the trails again, and on the tennis court. 12/9/2018 09:15:24 pm
In general, there is little harm that can happen with gentle exercise, even early in the postoperative period. 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 forces...but this takes time. Additionally, your muscles will take some time to recover from surgery. During this recovery period, the reaction time and force may be somewhat abnormal and your muscles may be less able to protect your joint. I would encourage you to avoid high impact activities for another month or so. Concentrate instead on walking, and gentle, progressive strengthening exercises. This delay allows your tissues to recover, so that when you ultimately return to all desired activities, you can do so with the lowest chance of injury. While I may be erring on the side of caution, I feel that being conservative now sets you up for decades of excellent joint performance in the future. 12/10/2018 10:20:08 pm
I had complete knee replacement 4 months ago. I have completed pt and are in range for numbers. My knee still feels warm and my knee still hurts at least a level 6 everyday. I cant seem to walk more than quarter if a mike and it hurts so bad to get up out of a chair. I ice it everyday as often as I can. I take Mobic 15. The Dr sats he is not happy with the inflammation. See you in 6 months. What can U do to help with the pain? 12/10/2018 11:24:56 pm
When you say "in range" what does that mean? I would expect that to mean full extension (completely straight) and bending to 120+ degrees. In my experience, a well balanced knee that has 0-120 degrees of motion will become pain-free. Generally this happens gradually over time, but certainly by 4 months I would expect good progress. It does not sound like you are reporting this. If your knee actually does not have what I would consider full range of motion as described above, it is important to continue working diligently on regaining it. There are some assistive devices/braces that can help you with motion at this point. Using ice and anti-inflammatory medication is good. Most people report continued progress with regard to pain, swelling, motion, strength, coordination, and endurance for an entire year. Not to worry you, but perhaps another opinion is warranted here as it seems you are doing significantly worse than we would normally expect at this stage. 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. I think perhaps it is important to try to rule these things out at this point.
George St.Pierre
1/5/2019 10:41:26 am
I am 45, and have deteriorating cartilage under the patella, have had an osteotomy to relieve some of the pressure 4 years ago, but now damage is too severe. 1/5/2019 11:12:30 am
Unfortunately, you are facing a difficult situation. You are very young but have symptomatic arthritis.
Terry guberman
1/29/2019 08:06:53 pm
I had a total knee replacement nov 7 2018. Therapy started2 weeks after surgery. I have had 5 knee cap dislocations since surgery numerous buckling. Instability still walking w wSlker. I feel my knee is really not right. There is a muscle type lump over knee. My life is inhibited and I fear another surgery is in my future. The subluxation of the knee is constantly on my mind and walking is a thought process rather than normal. My therapist had never seen this in 25 years. My surgeon put me on a lateral knee brace and crossed fingers that the dislocations would not happen again. I had a dance injury at the age of 16 when I first had a dislocation. It occurred throughout my life I’m 67. Very few times in the last 10 years which I did not consider this keg had a problem when to chose which leg to operate on. Osteoarthritis in both legs and throughout my other joints. My knee feels klunky and snaps in the back a lot when walking on it. I’m discouraged with my progress fearing I’ll never be the the same. Please tell me if you know of other people with similar difficulties. 1/29/2019 11:30:44 pm
What you are describing is not normal or expected following total knee replacement. While kneecap dislocation (patellofemoral instability) can occur, this suggests possible suboptimal rotation of the femoral component. Furthermore, early patellofemoral dislocation following surgery basically guarantees the arthrotomy incision (incision in the extensor mechanism used to open the knee joint) has failed to heal or has ruptured.
Mark
2/4/2019 08:05:31 pm
I am 8 years post bi-lateral Birmingham Hip Resurfacing. None of those years have been pain free. My implants are perfectly placed, and the images have been reviewed by several BHR experts. The pain I have is soft tissue, burning, soreness and weakness - Glutes, sides of the thighs and occasionally the groin. In the early days NSAIDs used to help, but not for the past 3 years. I underwent a LTT and it showed that I'm mildly alergic to Nickel and Cobalt. My Blood ion tests showed slightly elevated but very low for a bi-lat replacement. 2/6/2019 09:45:53 pm
Allergic reaction to orthopedic implants is a controversial topic. I have seen and treated it, but it is rare.
Mark
2/6/2019 09:58:03 pm
Thanks. 2/6/2019 09:51:45 pm
Here is an abstract from a paper in the latest issue of the Journal of Bone and Joint Surgery regarding the Lymphocyte Transformation Test you referenced. 2/9/2019 08:15:30 pm
You have had the appropriate workup. Your history, particularly fluid around the prosthesis and leaking out of the joint, ongoing buttock pain bilaterally, and now with LTT positive does suggest possible allergic reaction. As mentioned, this remains quite controversial.
Mark
2/9/2019 09:55:14 pm
Thanks for the reply. 2/9/2019 10:13:32 pm
Wow...you have been through a lot with these hips. Unfortunately, if you end up deciding to proceed surgically, you really need complete revision to titanium implants. The Birmingham cup must not be retained. This is because the Birmingham cup is cobalt chrome and you would end up with a large diameter metal on metal articulation again...defeating much of the purpose of the revision.
Carol
3/12/2019 08:12:07 pm
I am 7 1/2 months since TKR of left knee. Feeling is coming back into the outside of my leg and it hurts some. Would wearing a knee brace when I went for walks hurt it or would the support help with the inside healing? thanks
PHYLLIS MCDONOUGH
6/6/2019 11:07:22 am
Hi Carol, I was told that pain your feeling, I also have it, and my therapist calls it zingers. She says that's the nerve endings connecting back together again, which is a good sign.
Jeanne
3/27/2019 12:12:22 pm
I am 61 years old, and had a TKR on my left leg almost 18 months ago (Oct 2017). I have a full range of motion (flexion 130, extension 0), but I'm still regularly experiencing significant swelling and discomfort and feel heat most days. Sometimes i can attribute bad bouts of swelling to increased physical activity (ie a longer hike or bike ride, or standing for too long) but other times it's not clear why I am experiencing the discomfort. My surgeon assures me that the knee replacement went well, but I know that something isn't right, and my physical therapist agrees. I had a TKR on my right leg over 3 years ago in Dec 2015, and although it is doing well now, I required a small revision at 14 months to trim away part of my patella because i was experiencing pinching pain during flexion. I don't think this is the problem with my left knee, though I have large amounts of scar tissue from previous injuries and surgery -- could this be causing problems? And if so, what can be done about this? Ice and elevation does little to help, and the continued swelling is impeding my progress. Or, could my continued inflammation be because of some kind of ligament or muscle imbalance?
Voula Heffernan
4/8/2019 02:33:03 pm
(Please use my first name as Vivian as my real name is unusual & if used, might compromise confidentiality.) 9/29/2019 01:41:36 pm
Dear Dr. Gorczynski, 9/29/2019 03:13:47 pm
Unfortunately, I don't have enough information from your question to give you an answer....Perhaps answering these questions can help me help you. 11/10/2019 06:15:35 pm
Occasionally a patient may have an allergic reaction to the materials/chemicals used during surgery. These include prep solutions, skin glue, suture material. 1/13/2020 11:58:01 am
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? 1/13/2020 06:15:05 pm
It is normal to have pain, warmth, and swelling immediately after total knee replacement. There is a normal inflammatory reaction to surgery that tends to peak around 10-14 days from surgery. During this time I suggest using ice, compression, tylenol, NSAIDs, and narcotic medication.
Ellen Emmanuel
2/2/2020 01:00:19 pm
Hello, thanks for your website and information. We were road biking about 100-miles a week (age 68) prior to the TKR on left knee; I was back on the outside bike in about 7-weeks, being very careful and starting slow. That knee is great now, about 1-year out. However the second knee replacement was done about 3-months ago, and I ended up having a severe allergic reaction to the surgical glue so PT was postponed for about 1 week because of the swelling. Now have 136 degrees of flexion and 0 extension, but the knee is so stiff and still aches. Road biking for about 1-hour is OK, if I take Aleve. Maybe I am exercising too much? Maybe there is scar tissue formed? Maybe I am too impatient? It is very uncomfortable and stiff at night. Any suggestions would be greatly appreciated, thanks. 2/2/2020 09:22:10 pm
With the excellent range of motion that you report, I recommend being a little more patient with your knee. Ice it down after a ride, and maybe use a little anti-inflammatory medication if needed. I would expect improvement for many months yet to come.
Annette Hastings
2/8/2020 09:06:02 am
I'm 8 months into TKR I was doing good swelling down decrease pain and walking pretty good all the sudden my knee felt not as strong and started hurting when I walk. I noticed that if I put my weight on that knee when I take weight off it it causes pain and now its started to hurt more and when bending it. I went to a desk job can you tell me if that can make my knee less stronger? I also have like a spot that's puffy in just a small area like to left of my knee could that be fluid? Thank you 2/8/2020 06:19:28 pm
Less exercise can certainly lead to weakness. Weakness can sometimes lead to knee pain. Based on your question, however, I think it is best that you schedule a visit with your orthopedic surgeon. It is not normal for an 8 month old total knee to begin hurting when it was previously working fine.
Mercedes garcia
3/22/2020 03:23:29 am
Hi i just had tkr jan 22 2020. Its march 22 2020. I noticed a little bubble on top of my knee cap a few days ago and today i touched it i was able to lift something up from the inside like a thick piece of paper im so scared its the weekend its so weird .anyway im calling on monday to go see my surgeon 3/24/2020 04:31:00 pm
This sounds like a bit of absorbable suture material that your body is ejecting instead of absorbing. This is not infrequent, and generally is not a problem. 4/12/2020 06:02:37 am
I had tkr in January 2019, and know we are in april 2020. The pain I have in my replacement knee has got worse and the heat of my knee is terrible. 4/16/2020 03:32:54 pm
I would definitely recommend immediate evaluation by an orthopedic surgeon. I see no reason to wait for 6 months if the prosthesis has been damaged somehow and you are having pain. 4/25/2020 02:13:52 pm
I recently, March 11, 2020 underwent a revision of a failed TKR. I was doing extremely well up until a week ago. I was doing little lunges and felt like a crack in my knee. Right after I was able to walk still pretty well but when I got to my kitchen I went backward with my operative leg and was suddenly locked in place. Since then I have not been able to lift my leg up like the leg lift exercises and am very unsteady. Contacted the surgeon and they took x-rays and said no fix. and nothing out of place. The knee is just a little warm to touch but I am limping now and still unsteady. The surgeon wants me to continue therapy but I can’t do many of the exercises. I was wondering if it could be a tendon issue and if so would a bone scan show this? Thank you for any advice. I do appreciate it! 4/25/2020 08:17:15 pm
A bone scan will not reveal a tendon or ligament issue. An MRI scan with metal artifact reduction sequencing (MARS) is necessary. I would encourage this study if your knee continues to give you trouble. 4/26/2020 01:09:48 am
Thanks so much. It has been 2 weeks now since that injury and it’s not getting any better, so I will do what the surgeon said and go back to therapy, and also call the Dr. who referred me in the area where I live for an appointment. Thank you for getting back to me. Much appreciated...
Chris
5/18/2020 12:10:55 pm
I had tka 1wk prior to the Covid pandemic. I was only able to do a couple sessions of P/T. I however am starting P/T all over again for 6 wks and returning to my surgeon for evaluation. If I am not able to straighten my knee he may have to preform MUA. I have had a blotchy look on my upper thigh since my surgery. Its been 10 wks now. I asked my surgeon what the blotchy marks was, he said that he has never seen that before and was unsure. Should I be worried about the progress and the blotchy marks on my thigh? 5/18/2020 07:14:52 pm
You do not mention your current range of motion, but imply that you do not have full extension. This is very important to regain as soon as possible. This is also something that does not come back easily, even with manipulation. I really cannot provide further analysis without more information, but I agree with your surgeon- getting motion back is crucial, and if there is a strange appearance to the skin, it needs to be carefully monitored.
Gloria Dudt
6/30/2020 10:36:48 pm
I am new to this website. Can I simply submit a question in this box? 7/1/2020 07:28:32 am
Yes, please ask any orthopedic related questions you'd like. I will do my best to answer. Ideally, the questions will be related to the blog posting. Occasionally an off-topic question will prompt me to write an entire new posting, however. I am looking forward to hearing from you soon! 7/7/2020 10:28:05 pm
On 11/5/19 I had a meniscus repair to my left knee. My injury had included a strained ligament and a very large Baker's cyst had also formed.Before the surgery I asked the surgeon to please make sure to get rid of the Baker's cyst. His answer was: No problem there, it will go away by itself when I repair the meniscus. It did not, in fact it got bigger. I did extensive therapy and 20 laser treatments following the repair. In Jan. 2020 I had to see the nurse practitioner as a follow up visit. She dismissed my complaints of still having extreme pain, swelling, redness, hot to the touch and armed with reports of xrays and an ultrasound that my primary care doctor had ordered showing 1. 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. She said I was being impatient and that at 75 it would take a while for it to heal. She barely even looked at the report I showed her. The pain increased with the feeling of a knife stabbing me repeatedly all over my knee. I iced it which did no permanent good. 7/26/2020 09:11:57 am
It is absolutely appropriate to be tested for COVID and MRSA prior to knee replacement surgery. I think most hospitals have now mandated that all elective cases are shown to be negative for COVID prior to entering the hospital. This is obviously to help prevent spreading this disease within the hospital. 7/7/2020 10:41:21 pm
I had a meniscus repair on 11/5/19 and now the end of the femur is dying. I tested positive to MRSA and Staph in preparation for a complete knee replacement. The doctor said to apply Mupirocin in my nose twice a day and I would be fine. In light of the fact that the large Baker's cyst did not go away like he said it would when he did the meniscus repair, and the fact that his nurse practitioner ignored a report of a test ordered by my primary care doctor that I showed her in my Jan. 2020 follow up which indicated that there was a medial femoral condyle osteochondral defect measuring 1.6 cm transverse by 0.4 cm deep I canceled my surgery until I can be tested to make sure I do not have MRSA in my knee. In my research I saw that MRSA can cause avascular necrosis which was plainly shown in xrays and an MRI in May. And now that I have read some of the emails that people have sent to you about metal allergy, I think I should have that test too since I do have skin allergies to earrings and some metal necklaces. Do you think I am wise to pursue those tests before having the surgery? I have suffered extreme pain ever since the meniscus repair. Your comment will be posted after it is approved.
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