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Pain from hip to ankle after TKR

I had TKR surgery on Dec 1st and was told how wonderful I was progressing.  I had been trying to wean myself from the pain Meds during the day for starters. This was my last week for home therapy, and the therapist pushed me really hard. My knee has started swelling more and tonight the pain is so severe than I am having a hard time managing it. The pain starts at the knee and runs down to my ankle and up to my hip bone. I have yet been able to sleep a full night in the bed and have taken to sleeping in the recliner each night. Is it possible to push and bend that knee too much? After my first week of therapy, I measured at 115. This week, my third week, after being pushed so hard, I dropped to 108. Today was my last in-home session and she was determined to get me back to 115 ... I actually made 114 but the pain now won't subside. Too much too fast??
7 Responses
Avatar universal
Hi Jwilliams722.  :)

First, I want you to know how glad I am that you have found our PM (Pain Management) Forum.  :)
I, too, have just had Orrhopedic Surgery.  I had a THR (Total Hip Replacement) on Oct. 28th.  Please don't try to push this too fast or it will really set you back.  The best thing that you can do is to BE SURE you do your excercises EVERYDAY that you are supposed to do.  Your range will come back if you do this.  I went to a live in re-hab straight from the hospital and I had 1 therapy session where the therapist forced my hip and leg too far PLUS had it at MORE than a 90 degree angle and set me back a long way in my therapy.  Sometimes with a therapist you have to speak up and let them know when it's too much.  Are you going to be going to out-patient therapy now that your home therapy has ended?  If you are let them know how much pain you are having and when it hurts too much TELL them as they can tone it down for you.  You need to let your Dr know what is going on with you as he/she may want you to come in and check with them to be sure your replacement is ok.  Never hesitate to contact your Dr.  They need to know these things AND they need to know if a Therapist goes to far!

I'm sorry you are having so much pain, but remember you JUST had your surgery less than 3 weeks ago.  PLEASE don't wean off your meds too soon.  They are given to you so that you WON'T have unnecessary pain.  I'm off of all my additional pain meds that were given to me for my surgery but I didn't go off of them until I was approx 5 to 6 weeks out of surgery.  I had NO problems going off of them because my body was ready for it.  Take your time and don't force anything and you will be fine!  

PLEASE stay in touch with us and let us know how you are doing.  YOUR NOT ALONE!!! We're here for you!

Looking forward to your next update......   Sherry.   :)
547368 tn?1440541785
Hello JWilliams,

Welcome to the Pain Management Community. I am glad that you found us and took the time to post. However I am very sorry to hear about your knee pain - and increased swelling.

TKRs have become a fairly routine surgery. What many ppl don't realize is that it is a still a major surgery that comes with some major pain. I've been told that it is much worse than a Hip Replacement. I am not surprised that you are having so much pain and swelling.

TKR (Total Knee Replacement) surgery requires substantial cutting of muscle and bone. It's actually all the cutting that causes the majority of the swelling to occur. It's "normal" for swelling to continue for 3-6 months post-op. It isn't rare for swelling (and some discomfort) to continue periodically up to 12 months - like when you sit for long periods of time - or are more active than normal.

The pain you describe, including the "bone pain" is also a normal and is a consequence of this extensive surgery. It too should subside in time. Every female in my immediate (and some in my extended) family either has had a TKR or are waiting for one. "Bad Knees" runs rampant in the females of my family. I've witnessed several TKR surgeries and taken care of multiple patients post TKRs. Believe me they do  a lot of manipulation and cutting during these surgeries. It has to hurt post-op. Your SX sound "normal". I hope that brings you some comfort.

Sadly in order for PT companies to receive the best reimbursement from insurance companies you must be pushed hard, too hard in my opinion. There are goals that must be met in very small time frames. If those goals are not met the PT may be denied payment - or end up receiving reduced payments. That's the short version. These are insurance and/or Medicare policies that I have real problems understanding. It seems almost inhumane to me.  It's probably best I say no more - or this could become a long winded soapbox kind of answer. :o)

Ice to your knee may help reduce the swelling. Obviously elevate your leg when ever possible. Discuss other options with your surgeon. I'm fairly certain the pain meds won't be ordered for any length of time.

I encourage you to follow PT guidelines. Ppl that remain active, bend their knees (as ordered) even when it's painful - do the best. Ppl that "baby" those knees often have more medical issues and less mobility. I've actually seen soft tissues atrophy and knees that don't bend - so please keep active as directed by your medical providers.

In short - yes you probably were pushed to over-do and that is what has increased your pain and swelling. I am hopeful that by the time you are reading this you pain has reduced.

If you still have significantly increased pain and swelling after a day or two you must contact your surgeon. I'm far from and expert - and only you know how you feel. Never let me - or anyone on the internet tell you what to do or not do. Your best answers will always come from your physician. I can't possible exam your knee - or feel your pain. Never take a chance - if you think you should consult your provider - do so.

I hope something I have offered has been helpful. If you have additional questions or concerns please feel free to ask. I look forward to hearing more from you - and wish you the very best.

Take Care,
~Tuck
Avatar universal
Thanks for responding. I am receiving out patient PT now and had been pushed to bend my knee to 117. And when The PT pushed, I came off the table crying. Now I so dread going.

This past weekend I felt like I was again making progress and was doing my excercises, then woke up on Sunday with my leg so stiff I couldn't believe it. When I returned to PT I only measured 95. The therapist again tried to squeeze my to bend more and off the table I went agin, crying.

I have since purchased an excercises bike to help loosen my leg and it seems to help. I am getting ready to leave now for PT so mill be curious to see if I have gained any sine my last measurement of 95.
Avatar universal

Thanks for responding. I am receiving out patient PT now and had been pushed to bend my knee to 117. And when The PT pushed, I came off the table crying. Now I so dread going.

This past weekend I felt like I was again making progress and was doing my excercises, then woke up on Sunday with my leg so stiff I couldn't believe it. When I returned to PT I only measured 95. The therapist again tried to squeeze my to bend more and off the table I went agin, crying.

I have since purchased an excercises bike to help loosen my leg and it seems to help. I am getting ready to leave now for PT so will be curious to see if I have gained any since my last measurement of 95.
547368 tn?1440541785
TKR can be painful - and rehab grueling. It's not unusual to have high pain levels for several hours following PT. Do you have anything to take prophetically to reduce that pain? If not you might want to discuss this with your medical provider. Ask about applying ice to the area - followed by some soothing heat. That may also help.

However, though it is normal to have increased pain following PT don't let them push you beyond your limits. In the same breath I must say, don't give up. You may have to go a bit slower than PT desires - Be sure they know the level of your pain following PT. It is true that if you don't push yourself a bit you could end up with contractions or atrophy of the supporting structures of you knee. Once that occurs it's near impossible to undo. I know you are aware of this but we all need encouragement.

I think purchasing that exercise bike was very wise. It should increase your ROM (Range of Motion) as well as your stamina. Those facts should make PT a bit easier.

I'll be interested to learn if you gained since your last measurement. Please share that with us. Good luck! A new year with a new knee! Awesome!

Happy 2016,
~Tuck
Avatar universal
I just returned from PT and was pushed to reach 114. The therapist said she was sorry to have to push so hard but there are goals that must be met in a very short time. I asked what I needed to get to and she said 130. I told her there was no way I was going to be able to do that in two weeks, when my sessions will conclude.

The therapist did say that my knee looked inflamed and they did some type of massage treatment. She said she thinks I have been on my legs too much and has stressed to do my excercises and then rest, ice and elevate.

Came home in a lot of pain ... My hip hurts the worst! Too early to take a pain pill so I took two Tylenol. Feeling a little better now.

Thanks for listening to me whine. I know it will get better with time.

Happy New Year to you!

Julia
547368 tn?1440541785
Julia, you are more than welcome to whine here any time you want! We get it. You are experiencing a long tough rehab.

As I mentioned earlier and unfortunately insurance companies, Medicare, etc set very high rehab goals. If they are not meant in a given short time frame the insurance will deny payment - or deny further rehab.

No longer is a patient allowed to go at their own pace. In defense of these companies it has been medically proven that the sooner you can return to normal function the better, for several reasons. That said I think they have gone a bit too far.

You might want to contact your surgeon - or request that the physical therapist do so. He should be informed of the "inflammation" - unless you are able to get it under control.

Of course your hip hurts too.  It's all connected. I feel so bad that you are having so much discomfort.  

A word of caution on the Tylenol (Acetaminophen). I don't know what type of opiate you are taking but Hydrocodone (Norco, Vicodin) is always manufactured with Acetaminophen (app). Short acting Oxycodone (Percocet)  also contains Acetaminophen (app). Be sure not to exceed the recommended daily intake of Acetaminophen (app) and include what's in your pain medication.

I wish you well - and know you'll reach your goals. I just wish it were a bit easier rehab. I'm very sorry you are having so much pain. I'll look forward t your nest update - or even whine! :o)

Hang in there!
~Tuck
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