Hii , Welcome To HCM & Thanks For Asking Your Query Here Cough is our body s reflex action The Muscles of back, shoulders and chest all are involved During cough, As you are coughing Badly, the muscles might have get tired due to accumulation of lactic acid (due to continuous Over work). Any further action involves overworking of the muscle and it feels like pins and needles further you want to know about whether u should post pone Total knee replacement (TKR) because of this - i would suggest you to get it evaluated by your GP as it depends upon the underlying cause of your cough , like if it is common cold it will improve within 3-7 days with medication and rest , but if there is a underlying pathology involve than it needs thorough medical examination and investigation to rule it out and your TKR Surgeon will definitely look into it i would advise you to get it evaluated by your GP as well as Also consult with your TKR surgeon about it I hope it help Thanks & Get well Soon