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What Causes Persistent Knee Pain After Total Knee Replacement?

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Posted on Mon, 2 Jun 2014
Question: hello-- I am a 53 year old woman who had a total knee replacement approx 6 months ago-- my xrays look structurally fine, but I have (seriously) about 50 times more pain now than I did prior to the surgery--I had the surgery because I had bone on bone pain from having 4 arthroscopies for torn cartiledge---my dr told me to get a partial replacement, but he didnt do them anymore and the referred dr said I had a big cyst and that I had arthritis throughout my knee--I had NO pain from the arthritis--- I have a lot of allergies-- to metals, foods and medicines--I am allergic to NSAIDS- as is my mother, sister, and aunt--I cannot take tramadol, or neurontin--we had all sorts of allergy testing, but it wasnt until after the surgery that I found out that I was NOT tested for titanium or oxsinium=== and the surgeon is so arrogant=== my knee locks up and I scream and fall--it gets "stuck"-like its caught on something--and the pain then is unbearable---I have not had one day painfree since last november!! I have been taking hydrocodone ---after PT it usually takes 15 mg to be "bearable" so I can function--now the surgeon says that he doesn't have any patients that need narcotic medicine after 6 mos--but he did admit that he gets calls alot from pts up to a year after the surgery--and he gives them celebrex or naproxin--which I am allergic to--- the physical therapist has to tape my kneecap UP in such a way that it doesnt feel like a serated knife is twisting in thearea where the hamstring and a tendon attach? I cannot spend my life icing it---now my dr wants me to just abruptly stop taking the pain medication---I seriously do not know what to do---this is the worst pain I have ever experienced--and I wish to God that I could go back and tell them to just leave my knee as it was-- this pain makes my pre surgical pain see like nothing!!!! I need help with this-- this has been and continues to be the most traumatic and painful thing I have ever had to go through--- my knee feels hot--even through my pant legs-and it feels like it weighs about 200 lbs with a monster gnawing on it---constantly!! even with the hydrocodone, It still hurts--but its bearable--just,,, also, I cannot even walk up a low gradient hill with out pain---my muscle tone is great-- I have good motion---but the PT can push my leg way back--so they think thats great--nobody seems to think its a problem that I scream and burst in tears when they push it?? I seriously dont know what Im supposed to do now---- I don't want my whole life to be about my knee--and I agreed to the surgery because they said Id have a functional and pain free knee--I have neither---and because we couldn't find a non narcotic pain medicine that I could take, we thought this would be a good thing---- so the irony is that I had the surgery so I wouldn't have to take tylenol 3 every day to function---and end up barely functioning with 10 to 15 mg of hydrocodone????and now the dr wants to just leave me hanging with NO pain relief???? I cannot live like this--- it is just too too much for me to take.....
the drs PA told me that this could be this painful for 12to 18 months--but the dr said he is a surgeon, not a pain manager!! I dont want to be stuck with this awful pain without pain medicine--Im wondering if I make a complaint to the hospital if they will make him be responsible for helping me get through this---its not like I can just go to any dr and say, excuse me, but Im in a ton of pain and the surgeon knows it, but he wants me to be someone elses responsibilty....How do I find a dr that can help me >
doctor
Answered by Dr. Dr. Praveen Tayal (49 minutes later)
Brief Answer:
Needs second opinion to find cause.

Detailed Answer:
Hello,
Thanks for posting your query.
I can understand the acute pain and discomfort you are having after the surgery. Such an acute pain 6 months after the replacement surgery is not normal.
Persistent pain after total knee replacement can be due to neuropathic pain, internal scarring (arthrofibrosis), loosening of the prosthesis, patellofemoral instability, postoperative stiffness, etc.An inflammation in one of your muscles or ligaments also needs to be ruled out. A direct clinical examination and investigations like CT scan and arthroscopy are needed to identify the exact cause.
The treatment options like pain therapist, physiotherapy, occupational therapy, etc. will not help you much the cause of the pain id determined.
Wearing a compression stocking that goes above the knee can help temporarily.
Right now i will advise you to have a second opinion from another surgeon to find out the cause of acute pain. The treatment options can then be discussed depending on the cause.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Dr. Praveen Tayal (29 minutes later)
Thank you... I went to see the surgeon last Monday and he didn't even try to figure out what was going on.. He only looked at the X-rays... My knee got "caught" right in front of him... I can't make it happen... And I cried out.. Then fell... He didn't seem concerned.. PT PT days she thinks that there is a problem with the tendon behind my knee.. It's like something allows the corner of my knee to be pulled.... I can't find a dr hete who will see me ... Like nobody wants to day he's missing something...??? The knee moves side to side and gets stuck and makes a clicking sound.. He said that's normal... It's really so frustrating... Howitzer feel like the physical therapy is very important so I do it... But it causes my knee to hurt very badly fit the rest if that day and done times the next day.. The surgeon said. " well, then why do it ? Why put yourself through it?". Z. How can I find a dr that can help me with the pain and also be keeping an eye in it? I also want whatever test can show soft tissue damage... But he won't. Order one .... I'm really scared of having to handle this alone....so I've been taking the hydro codeine for about. 5 months..the first medicine they gave me made me really sick... I was talking 20 mg 4 tines a day.... Now I take 5/10 mg about. 4 times a day.... If I've been taking this firb5 months and I have tons of allergies, doesn't it make sense to stay with what we know I can take ? I'm pretty sure that if I'm going to get dependably on it, I probably already am by now... But until this pain abates i truly cannot handle the pain... This dr is a big wig in boston and I feel lithe he just wants to be rid of me !!!!
doctor
Answered by Dr. Dr. Praveen Tayal (34 minutes later)
Brief Answer:
Avoid all painful movements.

Detailed Answer:
Hello.
Thanks for writing again.
You are in a difficult situation. Stopping the pain medicines will not help you as that will hamper all your routine activities. If the physiotherapy sessions are painful then it is better to do a mild exercise at home and avoid all the painful activities. A CT scan to assess any soft tissue damage or an arthroscopy will help.
You can also try TENS therapy to decrease the pain in the knee.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Dr. Praveen Tayal (44 hours later)
I apologize.. I didn't realize your follow up answer was here... Everything you're saying makes sense to me but I'm completely dependent on a surgeon who just wants to check me off his list... Like I stated, it seems to be impossible to get a second opinion.. No one wants to say he's handled this wrong.. And yes, you are correct, in that just stopping the pain medicine will only keep me from doing anything .. And trying to get back into my normal life is too important .. This whole surgery and slow and painful recovery has been pretty traumatic.. I NEED to know what's going on. And I need to be able to function.. How am I supposed to continue the hydrocodone ( which btw, doesn't take away all the pain.. It makes it more bearable..I seriously havnt had a day without pain since November 2013!! So how am I supposed to keep taking the medicine if he won't prescribe it? Like I said , it's not like I can go to another dr who doesn't know me and expect him or her to just give me pain medicine... Massachusetts is very strict on controlled medications... The irony is that they had to keep insisting I take the medicine every four hours .. Cuz sometimes if it wasn't hurting as badly, I wouldn't take it.. I thought I was doing the correct thing and being careful .. But then the pain would get so bad and it would take a longer time to get somewhat on top of it.. I feel very frustrated and angry that he did this to me and he won't see it through ? I don't know how to get a orthopedic surgeon to order those tests, and I don't know how I'm supposed to get the medicine prescribed for me ? I checked with the psin clinics and they can only give recommendations .. A dr has to be willing to actually follow their recommendation ... I feel so alone in this.. This us not what they told me I would have... And now I understand what I used to read and not think much about it... Drs here ARE under prescribing pain meficines and making decent hardworking people like me have to suffer.. I don't even drink for Pete's sake.. So do you have any advice on how to find a dr that will order those tests and prescribe the pain medication till I don't need it anymore .. Which honestly , until I know WHY this is hurting , I don't know when that would be.. I never thought I'd still need it. 6 mos post op , yet here I am.... And I also thing it's important that a dr has to be willing to draw me down slowly and carefully from this medicine if the time comes that I can handle it with just Tylenol.. Or nothing .. I have an anxiety disorder so it's really important to me that a dr understand that this is affecting me... And it's hard on my family... They don't like seeing me hurting, and also , the pain makes me pretty grumpy.. Not too much fun to be around these days :/. I'm getting to the point where I want to go to another state where this dr isn't such a big wig.. I just want to get better!! I want my life back... Does your group give referrals .. I don't need a Drs referral to go see another doctor.. I just need to know WHO to go to see... I'd appreciate any ideas you have, cuz I'm at my wits end.. This has been such a nightmare!!! Also , after the radiologist manipulated my knee for all the X-rays , etc.. The pain was overwhelming.. I told you it feels like it gets caught on sonething and like it's locking up.. And I fall ... Usually first I scream and burst into tears.. That's so embarrassing to me.. So I asked him if he'd do a numbing shot in my knee.. He said no cuz the risk for infection ... So if you can't have a numbing shot because they worry about infection , how can a dr do an arthroscopy?
Sincetely, XXXXXXX XXXXXXX
doctor
Answered by Dr. Dr. Praveen Tayal (3 hours later)
Brief Answer:
No online prescriptions.

Detailed Answer:
Hello.
I do not have a group practice. I am from India and online prescriptions are not allowed. The pain medicine can be prescribed either from a pain clinic or from your primary physician.
It is best to try alternative therapies hot fomentation rest elastic knee support for relief. This will decrease your need of hydrocodone.
Since the rules there are stringent it is difficult to get the pain medicine without a prescription. You will have to arrange for a second opinion to know the cause.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Praveen Tayal (13 hours later)
I think we have a mis communication here.. I asked if your site gave referrals.. As in knowing of an orthopedic surgeon that I could get a second opinion, and also one that would manage my pain.. And I wanted to know how an arthroscopy could be performed if they won't even just do the numbing shots because of risk of infection?
I wish you were here in the US though... I feel like you understand why I am so scared and why I need answers?
doctor
Answered by Dr. Dr. Praveen Tayal (5 hours later)
Brief Answer:
Referrals not allowed.

Detailed Answer:
Hello.
Online referrals are also not allowed on this site. You can consult Dr. XXXXXXX XXXXXXX at Massachusetts General hospital. He is likely to understand your problem.
For arthroscopy if numbing shots are not feasible then it can be done under epidural anaesthesia or a short general anaesthesia. The anaesthetist will choose an anaesthesia best for you.
Regards.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 12314 Questions

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What Causes Persistent Knee Pain After Total Knee Replacement?

Brief Answer: Needs second opinion to find cause. Detailed Answer: Hello, Thanks for posting your query. I can understand the acute pain and discomfort you are having after the surgery. Such an acute pain 6 months after the replacement surgery is not normal. Persistent pain after total knee replacement can be due to neuropathic pain, internal scarring (arthrofibrosis), loosening of the prosthesis, patellofemoral instability, postoperative stiffness, etc.An inflammation in one of your muscles or ligaments also needs to be ruled out. A direct clinical examination and investigations like CT scan and arthroscopy are needed to identify the exact cause. The treatment options like pain therapist, physiotherapy, occupational therapy, etc. will not help you much the cause of the pain id determined. Wearing a compression stocking that goes above the knee can help temporarily. Right now i will advise you to have a second opinion from another surgeon to find out the cause of acute pain. The treatment options can then be discussed depending on the cause. I hope this answers your query. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out. Wishing you good health. Regards. Dr. Praveen Tayal. For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal