A 70-year-old woman presented with right knee pain and a 'grinding' sensation 6 months after a total knee replacement for osteoarthritis. At least my old knee didn't swell and never hurt daily. A bit more information would be helpful. A weakened immune system makes cellulitis more likely, as does advanced age. Though commonly implicated with metal on metal hip resurfacing [4, 5], the discolouration and effusion are rarely apparent on clinical inspection because of the considerable soft tissue that envelops the replaced hip joint. I recommend slow, prolonged stretching, multiple times per day. It takes about six months to fully recover from a joint infection following joint replacement. Considering this may go on for quite some time, is there any harm in exercising while the knee is swollen? However it can occur in any metallic implant subject to wear. Total knee replacement surgery has the potential to cause infection, fracture, and revision surgery. It is unusual for infection to occur after total joint replacement surgery, but it is serious. I think I might be allergic to metal or glue (cement) but I dont About a year ago I sought a second opinion. Wounds have a warm and red spot on them. A 74-year-old woman presented to her GP with a two-year history of increasing skin discolouration, pain, and swelling over the anterior left knee (Figure 1) with an anterior longitudinal midline surgical scar. Passive Range Of Motion I was sent to my family doctor and did blood test again same thing. If you have a knee replacement, you might consider getting it done. Thanks. This is clearly a complicated scenario, and my intention is not to frighten you. To decide whether a knee replacement is right for you, a surgeon checks your knee's range of motion, stability . Your surgeon should have corrected the malalignment (deformity) and made sure your range of motion under anesthesia was completely unrestricted at the conclusion of surgery. Most concerning is the deterioration in function you describe. Copyright 2015 Narlaka Jayasekera et al. I go to the store with my daughter and walking for 10 minutes puts me in extreme pain it feels like it gives out and feels like it gets stuck and I can't hardly bend it and I have trouble lifting it when I get in the car. RUB ON KNEE THEN STRETCH KNEE IN SHOWER RUN HOT WATER ON KNEE THEN STRETCH KNEE IT HELPSAFTER 11 MONTHS MIGHT HAVE TO GO TO DR REPLACE SKIN ON SIDES WHERE BANDS ARE PUT BOOTS WHERE SKIN IS THE BAND PUSHING ON INSIDE SKIN SKIN TO TIGHT USE HYDRO BOOST FOR FLUIDS TO GO IN KNEE OR DR INJECT FLUIDS IN KNEE FOR DRYNESS GRAFF MORE SHIN ON SIDES OF KNEE Does PT really help wiht scar tissue? 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. While some warmth may continue for a long time (months) after knee replacement surgery, it is not normal for this to last for years. 2014;2014 doi: 10.1136/bcr-2013-202801.202801 Is this infection or just normal for this amount of time after surgery? The Dr sats he is not happy with the inflammation. Getting proper rest is crucial to allow your body to recover. My bend is at about 107. The orthopaedic community is well aware of the phenomenon of metallosis, although it is most commonly thought of with hip arthroplasty. These tests will help to rule out an infection. Individuals indicated for total knee arthroplasty (TKA) are most often elderly, among whom limb arterial diseases are not uncommon 1.In fact, chronic lower extremity arterial insufficiency is estimated to exist in 2% of patients undergoing total knee arthroplasty 2.Popliteal artery occlusion after total knee arthroplasty occurs at a low incidence (0.03-0.17%) 3, 4, 5 but can be . However, Arthritis is the most common reason, leading to the requirement of the Hip Joint Replacement Surgery. 8- Do your knees feel stable (not wobbly when moving around)? I also think it is reasonable to use a dose of pain medication before bed to allow yourself to get some rest. Plast Reconstr Surg Glob Open. J Am Acad Orthop Surg. Patients that work diligently on their own rehabilitation from the beginning do best. The same medication can be found in the "PM" versions of medications, like Tylenol PM. Recently I notice a change with this red area. I barely can walk, sleeping is difficult due to stiffness and pain, especially when trying to change positions. Pictures Of Bruising After Total Knee Replacement Should I still have the feeling that s tight band is around my knee. Bruising After Knee Replacement (Location) Bruising is a purplish discoloration that indicates blood gathering under the skin. Clinical photograph of the discoloured soft tissue and large effusion secondary to metallosis, Lateral radiograph of the replaced knee demonstrates the loose patella prosthesis and surrounding, MeSH I have lost all trust in doctors and surgeons. Knee is moderately warm but no redness, Incision has healed well., Have endured consistent pain in hamstirngs, particularly medial insertions at tibia. Skin Discoloration Following Total Knee Replacement - rzteblatt I am walking about 2 km a day. Needless to say my leg got stiff and at 100 degrees back and still could put two hands under it. If so, how long ago and what materials were used? The swelling is very infrequent unless I walk on it for 8 plus hours at work and even then its minimal. So, because you describe your pain as severe at times, I think it is reasonable to consider revision surgery. Posterior Approach Most physical therapists do not do this. My concern is that operated leg the knee and bellow knee looks a little beat more swollen than my other one (measured it with a meter) is this normal. Nothing seems to work very long. Started PT immediately and while I am a bit self critical, it seems to me like it's a bit slower than I would like. I had a partial knee replacement one year ago. Use plenty of ice, and make sure your knee range of motion is maximized. P.C.A. My knee still feels warm and my knee still hurts at least a level 6 everyday. Shipping cost, delivery date, and order total (including tax) shown at checkout. See him at that time. Should I have any concerns? I still have persistent swelling in the knee joint. I had TKR 3 years ago. I have converted to the use of a robotic system to perform this procedure (and all other lower extremity joint replacements). Since both of your knees are affected, it is unlikely for this to be due to infection. Most people are feeling reasonably good by 6 months, although most will continue to experience improvement for a year or more following surgery. You may notice that the skin on your lower legs becomes discolored or appears bruised as you age. 4- How is your hip strength? If I apply ice to my knee, then after about 3-4 minutes, the pain in my foot gets even worse, to the point where I can't stand it and have to massage my foot and try to stay distracted just to get to about the 10 min. 2016 Sep 7;98(17):1419-28. doi: 10.2106/JBJS.15.01109. I showed the surgeon the xrays that were taken from the back unlike the previous ones which were taken from the front. In Jan. 2020 I had to see the nurse practitioner as a follow up visit. 329, supplement, pp. Keeping the leg straight may help dry the incision. Thank you for sharing this is very informative post, and looking forward to the latest one. Occasionally an off-topic question will prompt me to write an entire new posting, however. But since surgery I have had severe pain on the side of my hip towards my Buttox - and havng an ultra sound for gluteal tendinitis. This surgery was performed by a different surgeron and he stated that I would be needing a THR in short order. Patellofemoral 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. Do you have any opinion in that regard? I have been back to my hospital and they xrayed my knee and it has been damaged. Depending on the results, simply choosing a different prosthesis could prevent a problem. I've continued with my exercises before and after surgery. I was initailly told my TKR would change thing for the better its much worse than I could have possibly imagened. This is not normal. If you are just a few weeks out from surgery, I think you may be walking a bit too much. Stuart Hershman, MD, is a board-certified spine surgeon. Salem KH, Lindner N, Tingart M, Elmoghazy AD. Seemed to resolve, but a worse case recurred less than two weeks later, with a more pronounced swelling (about 25 18 cm) over knee, with purplish patch again appearing about 12 hours later. 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. My knee still feels a little warm, but I know I am blessed to have recovered so quickly. Difficulty sleeping in the first couple of months following total knee replacement is a common complaint. Great Article! If your allergy is to titanium, there is a prosthesis from Aesculap that is coated to create a barrier to metal ion release. While walking is encouraged to help prevent blood clots, 2 miles every day within a couple weeks of surgery is perhaps more than necessary. By the next morning I was back at about 20% more swelling than before all this started. One doctor said maybe nerve blocks might help but I'd like to be sure an starting to get worried. They seem to be on track for my care as I am seeing improvements but my recovery has been horrifically painful. A plain radiograph revealed loosening of the patellar prosthesis. I know that warmth is normal. Just got back from a 100 km walk in Ireland :-). Discoloration is not uncommon for several weeks or longer after knee replacement. You may need to be admitted to the hospital for observation. Regardless, I highly doubt bone demineralization is causing any pain. I only take extra-strength Tylenol now because I cannot take narcotics. Hazleton, PA 18202-9726. Successful Nonoperative Treatment of Persistently Painful Knees Thanks for the reply. After 2 or 3 hours asleep Im awaken by sharp and serve pain. Rarely, patients experience ongoing pain we can not explain. That way the issue can be corrected. What is your knee range of motion once warmed up? Managing Postoperative Pain, Swelling, and Bruising After - Healthline We never force patients to have surgery and will assist you in finding a solution that works for you. https://www.yourorthomd.com/orthopedic-knowledge/metal-sensitivityallergy#108747411520362981 Other conditions and medical treatments that can cause skin discoloration include: Bleeding into the skin. This device helps gently and slowly bend and straighten your knee. Smoking slows blood flow in the body, so it is best to quit cigarettes before surgery. Your knee also needs to heal and adjust to the prosthesis. I suggest you seek a second opinion from another orthopedic surgeon. Everything was great the first 5 weeks. If swelling is severe, is not improving, and/or there is calf pain/tenderness, you should contact your surgeon immediately. I feel I have been decieved, feel like my health problems resulting from the initial knee implant were ignored. It is important to see a doctor if you notice any unusual changes in the color or shape of your leg. Maybe there is scar tissue formed? Patch testing showed allergy to metals. I am in constant pain, I have told this to my surgeon with every post surgery monthly visit. The surgeon says no problem, since the patella doesn't take a lot of load force and should last a long time. I have 0 extension and 140 flexion. Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Metal Allergy I don't want to have another surgery. The first thing you must do is speak to your orthopedic surgeon. Difficulty sleeping is a common complaint early after knee replacement surgery. Discussion. I had a total knee replacement 3 months ago. Ceramic and Poly were not tested. You have had the appropriate workup. A purplish discoloration typically occurs as a sign of blood in the area (bruising may also appear blue, brown, yellow, or black). Would wearing a knee brace when I went for walks hurt it or would the support help with the inside healing? Add to Cart. 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. There may always be somewhat thicker tissue around your knee as a result of this trauma. Will it increase as the nerve recovers? Hernigou P, Poignard A, Nogier A, Manicom O. Rev Chir Orthop Reparatrice Appar Mot. 2014, Article ID 202801, 2014. I apologize, I haven't been able to get on this website as often as I would have preferred lately. doi: 10.1097/01.blo.0000229359.27491.9f. It did not, in fact it got bigger. Would you like email updates of new search results? Is the area of swelling tender? The immune system of metal and plastic joints does not function. Mechanical Sensations Your ongoing pain, warmth, and swelling at 15 months from surgery is not normal, however. I started researching MRSA and found out that it can cause a bone to die and can settle into organs, heart, joints and bones so I canceled my replacement surgery until I can be tested to make sure that I do not have MRSA in my knee joint. 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 been 9 month of total knee replacement and i still have pain , swalling and only 50 rom. I had TKR 7 weeks ago. Ultimately this led to atrophy of my quads and muscle imbalances, and this contributed to signficant migration of my patella during flexion. This is normal. Went back to see him September 27 2021 told me there was no infection and that he couldn't do anything else for me. I am 7 1/2 months since TKR of left knee. Rash After Surgery: Causes, Diagnosis, Treatment, and When to Worry Currently am at 130 flex, 2-3 extension. During this procedure, 2 tiny incisions are made in the front of the knee and the scar tissue that prevents motions is severed. This is not a normal result following knee replacement surgery. Blood-thinning medications can also contribute to a draining wound. This is outstanding range of motion for a 6 week old total knee replacement! Thankfully, it is a fairly rare problem. See this image and copyright information in PMC. I think that the website is amazing and has a wealth of information available to people. Her principle complaint was skin discolouration, associated with pain and swelling over the left knee, on the background of a previous total knee replacement with a metal backed patella resurfacing six years. This is quite common, particularly with patellofemoral problems. I think perhaps it is important to try to rule these things out at this point. While walking is good to help prevent blood clots, it does put stress on your new joint. I have pain around the meniscus area (inside and out) along with major inflammation. Because titanium allergy symptoms may be the result of other factors, it is critical to rule out any other possible causes before concluding that titanium allergy is the source. You should also be comfortable with the idea of revision knee replacement at some point in the, hopefully, distant future. Light ROM was prescribed and PT started. Tourniquet Hello Assuming your surgery was fairly recent, I think you may be walking a bit too much. Federal government websites often end in .gov or .mil. Try to regain more flexion, 107 is a bit tight for good function. I would not recommend additional surgery at that time. The patellofemoral joint (joint between the knee cap (patella) and femur (thigh bone) takes extremely high loads. I would expect improvement for many months yet to come. Now have 136 degrees of flexion and 0 extension, but the knee is so stiff and still aches. If left untreated, discolored legs can become a sign of vascular disease and cause other problems. J Arthroplasty. The inflammatory process associated with healing after surgery will often make the skin somewhat pink for a couple of months. A bone scan will not reveal a tendon or ligament issue. Generally infections cause pain, swelling, poor range of motion, drainage from the wound, fevers, chills, etc. I am concerned that it will not go away and will need other alternatives. Skin necrosis after total knee arthroplasty - PubMed Robotic Joint Replacement My concern is that my right knee is doing much better t h.c an left knee. 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. It is extremely difficult to get an outstanding result when trying to play "catch up." Do you feel any instability with side-to-side stress of your knee? 93, no. I appreciate the reply. Hi Jacquie. Use ice to reduce inflammation. If so, an off the shelf solution is available from Smith and Nephew- this uses oxinium (oxidized zirconium) and titanium. The next day it was swelled right back up. Swelling is normal at this stage, particularly as you continue to work on range of motion exercises. After returning to regular activities, it can take between 12 months and a year for you to fully recover. Reason to contact your office was the very helpful replies given and my Surgeon is away until mid December. 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. Apparent Skin Discoloration about the Knee Joint: A Rare Sequela of Metallosis after Total Knee Replacement Case Rep Orthop. Or, could my continued inflammation be because of some kind of ligament or muscle imbalance? This is particularly true for people at high risk for healing complications after knee replacement surgery. I had tkr in January 2019, and know we are in april 2020. Difficulty with range of motion can also cause pain. Minimizing Blood Loss Keep it elevated for 2-3 days. See this image and copyright information in PMC. My bending range seams to be fair, my dr. Has always been l pleased with this. Is ROM a concern at this time, or is more time and weight bearing needed? An x-ray would help to evaluate this, a hip joint injection could be done to confirm this diagnosis. This can be challenging for some patients. 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 . All of the possible issues I discussed can have a good outcome when handled properly. It can also can lower the oxygenation of those tissues. (1,2,3,4) Also known as knee arthroplasty, the surgery makes use of plastic and metal parts to cap the ends of the bones of the knee joint and the kneecap. All of the above being said, this is not the proper forum to address your problem. Could you please comment on this as to whether you think I am right to be tested further for the viruses and metal before I proceed with the knee replacement? Have other people had this happen? It will be removed the second day after surgery. The skin incision can be as small as 3-4 inches. 157164, 1977. sharing sensitive information, make sure youre on a federal The predominant findings on routine histopathologic analysis were fibrosis and varying degrees of lymphocytic infiltration in 17 (63%) of the 27 cases. If you follow your doctors advice and engage in moderate-intensity activities, you should be able to walk and move freely for the rest of your life. 2006;(452):166170. Contact dermatitis is a likely cause of some postsurgery rashes. Apparent Skin Discoloration about the Knee Joint: A Rare Sequela of 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. Wounds. 1977;11(2):157164. Ever since the surgery, there has been a reddish area notice below the end of the scar on my leg. 5- Is there a place you can touch that hurts (tenderness to palpation), or is the pain diffuse? While your symptoms could be related to allergy, there are some other possible diagnoses that are more commonly diagnosed, however. Your surgeon will need to determine if the drainage is coming from around the incision or from deeper around the knee replacement implant. I am an active person wanted to fix my knee so I could remain active. There should not be a permanent deformity after total knee replacement surgery. His answer was: No problem there, it will go away by itself when I repair the meniscus. Joint Space Narrowing Ive consulted my surgeon and my PT and they have no answer. The replacement benefits was the deformity was resolved and the knee is more stable prior was instability. I had both total knee replacements 15 months ago and I have had what I think a slower recovery. 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? I am 8 years post bi-lateral Birmingham Hip Resurfacing. 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. Manipulation Under Anesthesia The relative absence of pain is a very good sign, but I would definitely be concerned with the history you presented, and I recommend close follow-up by her surgeon. I did extensive therapy and 20 laser treatments following the repair. 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. This would potentially require additional surgery. I feel my knee is really not right. My surgeon put me on a lateral knee brace and crossed fingers that the dislocations would not happen again. 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. Lateral radiograph of the replaced knee demonstrates the loose patella prosthesis and surrounding osteolysis. This is an open access article distributed under the. Orthopedic surgeons performed about 520,000 hip replacements and about 581,000 knee replacements in 2006. Can scar tissue still cause pain if you're able to fully bend and straighten it ? This test will help to evaluate for infection. 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. It contains abundant references. If your surgeon used a tourniquet during surgery, it could have compressed/irritated the fatty mass causing it to become symptomatic. No relief from PT or NSAIDs, Direct injection provided a few weeks of relief but not from the buttocks pain. What can U do to help with the pain? Even your scar could continue to retain some heat and coloration in the weeks (or months) following surgery. Factors associated with hospital stay length, discharge destination, and 30-day readmission rate after primary hip or knee arthroplasty: Retrospective Cohort Study. I would expect him/her to examine your knees and obtain X-rays. Top Doc 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. I can't complain because I have NO pain, which I'm so thankful for. Average Knee Society Score (KSS) values improved post-revision, as did range of motion (all p < 0.01). According to WebMD, increased redness or discoloration after surgery is the most common sign of a blood clot. Came back positive. How is it now? Unfortunately, I don't have enough information from your question to give you an answer.Perhaps answering these questions can help me help you. Arthritis It sounds like the same thing happened to your artificial knees when you danced all night. This custom device was made by Smith and Nephew. This expectation applies to pain, motion, and inflammation. (10-20 years would be a guess). 9- Does the pain radiate down your entire leg into your feet/ankles?