Knee warm, swollen, pink after knee replacement

Skin warmth after total knee replacement

1/21/2017

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.

79 Comments

trish erickson link

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?

Christopher Gorczynski, MD link

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.

You need to have a consultation with an orthopedic surgeon.

As I mention in the blog posting above, a standard 3 phase bone scan may still be "hot" up to 2 years from surgery. It does not necessarily mean that there is a problem. Your ongoing pain, warmth, and swelling at 15 months from surgery is not normal, however. This indicates your knee is still inflamed.

The explanations for your situation (differential diagnosis) includes: infection, stress reaction due to poor bone quality or malalignment of prosthesis, early loosening, sensitivity or allergy to the metals or other materials used in the prosthesis.

To help determine the cause in your case I would recommend several things:

1- Blood work. Complete blood count with differential to evaluate white blood cell level and type, erythrocyte sedimentation rate, C-reactive protein. If these are elevated an infection is more likely.

2- White blood cell labeled scan. If this shows uptake around the prosthesis, infection is more likely.

3- Material sensitivity testing. Common materials used in total knee replacement include: Cobalt, chrome, nickel, titanium, polyethylene, polymethylmethacrylate. A history of irritation due to costume jewelry could indicate metal sensitivity.

4- An objective appraisal of the prosthesis alignment in all planes including rotation. This would potentially require a CT version study to help determine rotational alignment of prosthetic components.

5- Your surgeon is correct in that your operation might need to be repeated. It is very important to have a diagnosis and plan going into surgery, however. I would complete the entire workup prior to surgery to remove as many variables as possible. Then during surgery it is important to send multiple samples of tissue to the pathology lab for evaluation using a technique called a frozen section. The pathologist immediately evaluates the tissues for the presence of acute inflammation/infection, guiding the surgeon's decision.

If an infection is diagnosed, the gold-standard treatment recommendation is a 2-stage revision. This entails packing the knee joint with high-dose antibiotic cement while you receive IV antibiotics. Then, usually 6-8 weeks later, a new prosthesis can be implanted.

For simple malalignment, a single stage reconstruction can be done, correcting the prosthetic position.

For material sensitivity/allergy, a prosthesis that does not include the offending material is needed. This can present a challenge in certain circumstances. The most common sensitivity is to nickel. For this, an oxidized zirconium implant could be used. Sometimes, unfortunately a custom implant, or other solution like a knee fusion (arthrodesis) needs to be considered.

This is clearly a complicated scenario, and my intention is not to frighten you. All of the possible issues I discussed can have a good outcome when handled properly.

I would not go directly to an early revision based on the scenario you describe. More information is needed to formulate a diagnosis and plan. This is very important. I would not recommend simply taking the prosthesis out and putting a new one in. Your surgeon needs to understand what is going on. That way the issue can be corrected.

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.
I went to therapy the next day lightly. The following day we worked more on it then I worked it over the weekend. I went back to therapy on Monday at 9 am and did 1/2 hour therapy, by 6:00 pm my upper thigh swelled so bad and I was in so much pain I called the Dr and he said it was bleeding inside around the surgery sight. Keep it elevated for 2-3 days. I went back to therapy with still some pain but continued to work it. Two weeks later I had 110 degree Bach and one hand under to flatten. I got gout so severe in my ankle I couldn’t walk for four days so by the time I finished my 20 days of therapy I was at 120 and close to being flat. My knee still hurts bad I limp all the time and the knee has been warm to touch since I had theTKR 3 years ago. What should I do? My hips also hurt along with the other knee.

Christopher Gorczynski, MD link

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.

Christopher Gorczynski, MD link

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

Christopher Gorczynski, MD link

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.

christopher gorczynski, MD link

8/23/2018 09:47:01 pm

@Barbara

A low grade fever is quite common for a couple days after surgery. Deep breathing, coughing, and walking will help this to resolve. While some pain and swelling is normal immediately after major surgery, the trend should be one of gradual improvement after the first couple of weeks. There is a normal inflammatory response to trauma that tends to peak around 10-14 days. Cryotherapy using regular ice or more conveniently with an ice machine can make an enormous difference and I strongly recommend it. Your surgeon should be monitoring your progress, particularly when your progress seems to be slower and less pleasant than normally expected.

Marjorie Ruth Jones link

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.
ruth jones

Christopher Gorczynski, MD link

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.

It is truly unfortunate that you reported a sensitivity and then a nickel containing implant was used. Avoiding titanium is more difficult, but not impossible. This is because most knee implant systems use a titanium modular baseplate on the tibia. It is much easier when done as a primary knee replacement, as a non-modular, all polyethylene tibial component could be used. This is not possible at this point as revision surgery requires a stem. Nearly all stems are titanium.

I encountered exactly this problem in the recent past. We tested the patient for allergy to zirconium. Once we proved this material did not present a problem, we then worked with the implant company to fabricate a custom revision tibial component. The patient already had a zirconium femoral component. Getting this implant fabricated took a long time and many steps, but this is a potential solution to your predicament.

Lynn Jovan

8/17/2018 11:10:18 pm

I'm two post knee replacement
And had a second knee replacement in the same knee. I too was allergic to the nickel. I've seen many doctors No one can help my pain and mobility, I will never walk right again.
The doctors all stick together, it's so sad for people like myself. The quality of my life is limited.

Christopher Gorczynski, MD link

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.
How was metal allergy diagnosed? Was the offending implant removed? If so, how long ago and what materials were used? Has infection been considered and investigated? Is the alignment and soft tissue balance in the knee optimized?

Erica Hamilton link

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.

Christopher Gorczynski, MD link

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!
I still have persistent swelling in the knee joint. I had significant nerve pain at 1 and 1/2 yrs out which was “cured” by several sessions of acupuncture. However, continued acupuncture and cupping have not reduced the swelling and aching.
I purchased a BEMER through my Sports Med doctor and we are trying it - I have been using it for 1 and 1/2 months. It seems that my metabolism has kicked up, more fluid intake is noticeable and my overall well being seems improved - but no improvement regarding reduced swelling.

About a year ago I sought a second opinion. The doctor ordered chemical analyses of my blood/fluid and determined that I was highly sensitive to the metals, nickel and titanium. He said he could do revision surgery and replace the nickel with another metal but the titanium is in all devices so it could not be changed out. I went back to my original surgeon and also sought 2 more opinions and all 3 doctors said that the metals analyses results are highly controversial with previous studies show differing results.

Can you direct me to studies on metal sensitivities from TKR and perhaps other professional opinions on the value of the metal sensitivitiy tests?

Christopher Gorczynski, MD link

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.

I just wrote a new blog post discussing this issue further, and have a bibliography attached beneath the article.

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.
My doctor finally got concerned and he did blood work and nuclear bone density test which shows inflammation.
I think I might be allergic to metal or glue (cement) but I don’t
know and also I don’t know where to do an allergy test and if it’s reliable.

Christopher Gorczynski, MD link

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?

Christopher Gorczynski, MD link

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?

Christopher Gorcynski, MD link

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.

As far as pain control- NSAIDS tend to work better than narcotic pain medication for post-surgical inflammatory pain. I also highly recommend using ice, or purchase an ice machine which is much more convenient.

While your physical therapist might be correct, my experience suggests that patients that do not achieve an acceptable range of motion by 6 weeks will not ultimately do so without either a manipulation then or more invasive treatment, as described above, later on.

Please look through this website as I have written a variety of articles with regard to knee rehabilitation, manipulation, viscoelasticity, and anatomy.

The best way to stretch is to hold the knee at the endpoint of motion while attempting to relax the thigh muscles. I recommend long duration stretching...this means minutes or hours as opposed to seconds. Most physical therapists do not do this. Check out my viscoelasticity article to understand why this technique works better.

Good luck to you.

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.

Christopher Gorczynski, MD link

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!

PHYLLIS MCDONOUGH link

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.

Christopher Gorczynski, MD link

6/5/2019 05:52:17 pm

@Phyllis McDonough...

The numb patch lateral to your knee incision is totally normal, almost universal, and permanent (but will become less noticeable over time.) The warmth and tightness are both due to ongoing inflammation and are both expected to gradually resolve over the next few months. Glad to hear you are pain-free!

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 ?

Christopher Gorczynski, MD link

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.

I don't have enough information with regard to this specific case to comment any further. Specific issues should be directed to her orthopedic surgeon. In general, worrisome signs include: fevers, chills, drainage, shiny red skin, extremely poor or progressive loss of range of motion, and increasing pain. Any of these should result in an immediate call to her surgeon.

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??

Christopher Gorczynski, MD link

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.

The first thing you must do is speak to your orthopedic surgeon. I would expect him/her to examine your knees and obtain X-rays. Depending on findings additional lab evaluation or advanced imaging may be required.

Some more information would be helpful to me to help narrow down the differential diagnosis (list of possible explanations).
1- Was the deterioration rapid or gradual
2- Have you begun any new activities?
3- How is your range of motion?
4- How is your hip strength?
5- Is there a place you can touch that hurts (tenderness to palpation), or is the pain diffuse?
6- Do your hips rotate normally and symmetrically?
7- Do you experience fevers/chills?
8- Do your knees feel stable (not wobbly when moving around)?
9- Does the pain radiate down your entire leg into your feet/ankles?

Basically- the differential diagnosis includes: referred pain from your back or hips; anterior knee pain due to patellar (kneecap) maltracking or hip weakness; instability of the knee; poor range of motion in the knees; stress fracture/reaction; infection. There are, of course, additional possibilities as well. This is why it is important to be seen by your orthopedic surgeon. If there is an inadequate explanation or plan offered, I would suggest a second opinion. Good luck, and please update us with your progress.

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.

Christopher Gorczynski, MD link

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.

Christopher Gorczynski, MD link

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??

Christopher Gorczynski, MD link

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.

Satyanarayana of Hyderabad India link

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

Christopher Gorczynski, MD link

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?

Christopher Gorczynski, MD link

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.

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.

Christopher Gorczynski, MD link

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

Christopher Gorczynski, MD link

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.
Thanks for reading, Cindy

Christopher Gorczynski, MD link

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

Christopher Gorczynski, MD link

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.

Christopher Gorczynski, MD link

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

Christopher Gorczynski, MD link

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.

Christopher Gorczynski, MD link

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.

Peggy Alluson link

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?

Christopher Gorczynski, MD link

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.

My surgeon wants to do a patella replacement procedure, which I'm fine with, but I want to learn more about my specific limitations post-surgery - specifically, skating, non contact hockey, and running. The surgeon says no problem, since the patella doesn't take a lot of load force and should last a long time.

Do you have any opinion in that regard?

Christopher Gorczynski, MD link

1/5/2019 11:12:30 am

Unfortunately, you are facing a difficult situation. You are very young but have symptomatic arthritis.

Non-operative treatments should be maximized prior to making the decision to proceed surgically. Make sure your hips are as strong as possible (check out the patellofemoral article on this website), consider patellofemoral stabilization bracing, and injections (cortisone, hyaluronic acid, and even platelet rich plasma.)

The patellofemoral joint (joint between the knee cap (patella) and femur (thigh bone) takes extremely high loads. The force between these bones can peak at up to 10 times body weight during high impact activities.

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. They preserve all the normal knee ligaments, and the rest of the articulating surfaces in the knee (which are presumably still normal.)

To do this procedure well is technically demanding. I have converted to the use of a robotic system to perform this procedure (and all other lower extremity joint replacements). This allows perfect alignment of the femoral component in all planes, restoring the patients unique anatomy as accurately as possible. It is my opinion that because robotic systems allow joint replacement surgeons to do a much better job during surgery, eventually this is the only way they will be done.

If you decide to undergo surgery, focus diligently on rehabilitating well. You have a limited period of time after surgery to regain a functional range of motion. Much of the focus of this website is on this early postoperative period following knee replacement. All of these articles apply to partial knee replacements as well.

While return to low impact sports is reasonable, I would recommend avoiding high impact activities, and try to minimize the chance of falling directly on the front of your knee as there would be a slightly increased chance of sustaining a fractured patella after resurfacing.

You should also be comfortable with the idea of revision knee replacement at some point in the, hopefully, distant future. (10-20 years would be a guess)

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.

Christopher Gorczynski, MD link

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.

My impression is that you may need further surgery. Prior to proceeding surgically it is crucial to verify the femoral and tibial components are NOT internally rotated. The best way to do this is by CT or MRI scan with metal artifact reduction sequencing. 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). The CT/MRI scan could also help assess the relative position of the tibial tubercle (insertion point for the patellar tendon which connects the patella to the tibia). 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).

I realize some of the above discussion gets a bit technical, but this can be a complex problem.

The bottom line is this: What you are experiencing is not normal. The rotation of the components must be proven to be appropriate. Surgery is likely to be needed and may include revision of the prosthesis (if not rotationally optimal), medial patellofemoral ligament reconstruction, and/or medialization osteotomy of the tibial tubercle.

I am sorry to hear about your difficulty and wish you well.

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.

The reason I believe my pain is inflammation is because I can be in agony for 8 weeks straight and then overnight I feel great for 2 weeks and then agony again. No change in diet, meds or anything.

Could my pain be an alergic reaction/ Thoughts?

Christopher Gorczynski, MD link

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.

I would refer you to a different blog posting I wrote. It contains abundant references.

https://www.yourorthomd.com/orthopedic-knowledge/metal-sensitivityallergy

While your symptoms could be related to allergy, there are some other possible diagnoses that are more commonly diagnosed, however.

Lateral hip pain, particularly tenderness to palpation could indicate bursitis. Hip weakness with pain in this area could indicate abductor tendon degeneration or rupture.

Groin pain could indicate irritation of the iliopsoas tendon as it crosses the hip joint.

Thigh pain could also be a result of lumbar spinal stenosis.

These are just a few common issues that need to be evaluated and ruled out.

MRI of the lumbar spine would rule out spinal stenosis. MRI of the hip would rule out bursitis/abductor/iliopsoas tendon pathology. It would also rule out a significant fluid collection around your implant that could indicate irritation/inflammation/allergic reaction. If this is found aspiration and analysis of this fluid +/- a cortisone injection could be performed.

Mark

2/6/2019 09:58:03 pm

Thanks.

MRI of spine was normal, MRI of hip did show chronic bursitis. Every MRI for the past 7 years shows the bursitis. No relief from PT or NSAIDs, Direct injection provided a few weeks of relief but not from the buttocks pain.

I already had a psoas release (7 years ago) due to calcification of the tendon by the implant, psoas looks fine now.

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. This is noted bilaterally.

Christopher Gorczynski, MD link

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.

Lymphocyte Transformation Testing (LTT) in Cases of Pain Following Total Knee Arthroplasty
Little Relationship to Histopathologic Findings and Revision Outcomes

Yang, Steven, MD1; Dipane, Matthew, BA2; Lu, Conrad H., MD3; Schmalzried, Thomas P., MD1,3; McPherson, Edward J., MD2

JBJS: February 6, 2019 - Volume 101 - Issue 3 - p 257-264
doi: 10.2106/JBJS.18.00134
Scientific Articles

Background: The utilization of lymphocyte transformation testing (LTT) has increased for diagnosing metal sensitivity associated with total knee arthroplasty (TKA), but its validity for the diagnosis of TKA failure due to an immune reaction has not been established. In this study, we sought to characterize the relationship of a positive LTT result to histopathologic findings and clinical and functional outcomes.

Methods: This was a retrospective study of 27 well-fixed, aseptic, primary TKA cases in which the patient had persistent pain and/or stiffness and underwent revision due to a suspected metal allergy to nickel, as determined on the basis of positive LTT. Revision procedures were performed by a single experienced arthroplasty surgeon. Periprosthetic tissue samples obtained at the time of revision surgery were scored using the aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) scoring system.

Results: Eight patients were categorized as mildly reactive; 8 patients, moderately reactive; and 11 patients, highly reactive to nickel by LTT. The predominant findings on routine histopathologic analysis were fibrosis and varying degrees of lymphocytic infiltration in 17 (63%) of the 27 cases. The average ALVAL score of the cohort was 3.1 ± 1.9, of a maximum score of 10. Average Knee Society Score (KSS) values improved post-revision, as did range of motion (all p < 0.01). Neither LTT stimulation index as a continuous variable nor as a categorical variable (mildly reactive, moderately reactive, highly reactive) was correlated with ALVAL score, pre-revision function (as assessed by KSS-clinical, KSS-functional, and range of motion), or change in function at the most recent follow-up (0.015 < r < 0.30, 0.13 < p < 0.95). In addition, the ALVAL score did not correlate significantly with either pre-revision or post-revision KSS or range of motion (0.061 < r < 0.365, 0.09 < p < 0.88).

Conclusions: On the basis of this analysis, including histopathologic assessment, LTT results alone were insufficient for the diagnosis of TKA failure due to an immune reaction. A positive LTT may not indicate that an immune reaction is the cause of pain and stiffness post-TKA. The role of LTT in assessing TKA failure from an immune reaction needs further investigation. Diagnostic criteria for such TKA failure need to be established.

Christopher Gorczynski, MD link

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.

The challenge is the correction requires bilateral revision surgery. I am sure you understand this entails some surgical risk, and also some risk of ongoing symptoms. Continued pain is possible, and I am sure your surgeon will discuss this unpredictability with you. The concern would be: what if your symptoms are not indeed due to the prosthesis?

So, because you describe your pain as severe at times, I think it is reasonable to consider revision surgery.

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 would consider revision to titanium total hip implants and a oxinium or ceramic on polyethylene bearing, depending on the brand of implants your surgeon uses.

Mark

2/9/2019 09:55:14 pm

Thanks for the reply.

LTT showed no sensitivity to Titanium nor Zirconium. Ceramic and Poly were not tested. 2.5 years ago the surgeon suggested replacing the stem portion with a poly ball and I raised the issue of being allergic, we did do skin testing and I was negative for everything. That's why now, when I no longer have any relief from NSAIDs did we do the LTT to see if this same plan makes sense.

I am trying a Steriod Piriformis injection this week to see if it gives any relief. Just trying to rule everything before undergoing another bi-lat surgery.

Just one more bit of info. Prior to the BHR I did have 2 arthroscopic labral repairs surgeries on the right and one on the left. The right failed after 6 months and the second repair was deemed sub-optimal because the bone surface was already deteriorating and the they couldnt get the anchors to attach properly. This surgery was performed by a different surgeron and he stated that I would be needing a THR in short order. 6 months later I was bone on bone and rather than use this surgeon and get a THR I found a different surgeon and got the BHR instead. This was about 9 years ago, the BHRs were done 8 years ago

Christopher Gorczynski, MD link

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?

A bit of background: I suffered several patellar subluxations in my late teens and early twenties -- it turns out that I had no patellar groove in my femur, so my kneecaps were especially prone to slipping out. I had surgery in my 20s that somehow tightened things up (the large scars run horizontally across both knees) but by the time I was 40 I was experiencing osteoarthritis pain under both kneecaps. I continued to be active and subconsciously developed several compensatory movements to avoid pain. Ultimately this led to atrophy of my quads and muscle imbalances, and this contributed to signficant migration of my patella during flexion. When I bent my knees my patella would slide up on the outside bump of my femur! Having the TKRs has not only given me better joints, but straightened out my legs. This hasn't been a pain-free journey -- my muscles etc have had to adjust to new positions, but overall it is a great improvement. Sometimes at night i have jolting muscle jerks (anywhere from 1 to 50x in a night) that are usually focused deep in my glutes.

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.)

I had TKR in January of 2017, 2 yrs, 3 months ago. Ever since the surgery, there has been a reddish area notice below the end of the scar on my leg. The redness is not a rash or surface but below. Recently I notice a change with this red area. It seems more splotchy and tiny red streaks (like blood vessels) spidering around the red area and one heading down the leg midway. I don't have other issues like hotness when touching, although I do sense a low level warmth and no other infection symptoms. My mobility is compromised because of neck and lower back stenosis and my other knee presents deterioration so have been working with a physical therapist recently. Things are improving and I'm able to walk longer distances and improving my mobility. The red area seems to be changing and I am concerned it might be related to issues with the surgery even after such a long time. I also have venous insufficiency and wear support socks at times. 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. I do have a call in to my surgeon and will call my internist if needed but since this has been so long standing and I have no fever etc., I'm not sure if this is of concern post surgery or not. I would appreciate any insights.
Thank you.

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Skin warmth after total knee replacement

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