Learn exactly what you should do, tests to have, etc., if you have knee pain and swelling long after TKR.
If you have knee pain despite having “recovered” from total knee replacement surgery, and especially if there’s swelling and warmth about the joint, then you should immediately suspect loosened implants so you don’t waste time on a wild goose chase.
My father was led astray by a litany of doctors, when all along, a simple test could have nailed why he was having pain in both knees after having TKR in both.
Knee pain right after, and for a few weeks following, the surgery is normal.
After a few months you should be feeling great, and my father was, but then he began noticing pain in the surgical knee.
He also had a TKR on the other knee, and that joint never felt good at any point afterwards, and ultimately, that joint developed the most pain.
He didn’t receive follow-up treatment with his original orthopedic surgeon about this, because by the time he realized there was a knee problem, he had switched medical plans.
Following is a faulty time line that YOU should not have to endure.
January 2010: Knee pain begins, despite having TKR.
June 2010. Sees Dr. “Wardell,” the PCP; X-rays show TKR okay. Doctor suspects spinal issues causing knee pain and recommends consult with neurosurgeon, especially since pain escalates in leg and back.
MISTAKES: My father waited six months to see a doctor; though the primary physician suspected an implant problem, he did not order two tests that could have revealed this: a bone scan and a Marcaine injection.
Making the issue trickier was that my father had spinal stenosis, which played a role in various diagnoses.
September 2010: Spine surgery recommended.
MISTAKE: Waiting another three months without aggressively pursuing possibility of a failed TKR.
October 2010: Non-invasive back surgery. This corrects the leg (quad) pain (which by then had developed in both legs) but the knee and low back problems remain.
February 2011: MRI.
MISTAKE: Letting another large chunk of time (four months) go by, during which the quad discomfort returned and bilateral knee pain continued.
The neurosurgeon who did the spine operation reviews MRI and sees no further reason for back surgery.
Recommends nerve pain block and visit to a physiatrist (MD who treats pain in nerves, muscles and bones).
March 2011: Physiatrist Dr. “Mueller” diagnoses nerve irritation and recommends continuation of exercises (all along my father had been doing various gentle leg exercises).
Later that month: A different orthopedic surgeon, Dr. “Switzer,” examines knees and hips via X-ray, revealing good TKRs but also hip osteoarthritis. Sharp hip pain had, indeed, developed over past few months. A pain block suppresses it.
June 2011: A Dr. “Seibold” says knee and quad pains could mean spinal problem.
MISTAKE: Letting three months go by without aggressively pursuing possibility of failed TKR. Remember, an X-ray is NOT the gold standard for diagnosing loosened implants!
Later that month: Hip replacement by Dr. Switzer.
September 2011: Visit with a Dr. “Martin” who sees no cause for leg/knee pain; sees no spine problem.
MISTAKE: Letting another three months lapse.
Later that month: Had EMG (nerve conduction study) by Dr. Mueller, showing some nerve damage, and MRI of low back.
MISTAKE: Waiting this long for an EMG; this test should have been recommended early on, even though ultimately, in my father’s case, it did not reveal the root problem.
October 2011: Dr. Martin sees no cause for knee pain and does NOT recommend further investigation!
WARNING: Beware of doctors who do not make referrals for further investigation of an unresolved problem.
November 2011: A clinic specializing in minimally invasive spine surgery performs endoscopic surgery; cost is out of pocket. Quad pains alleviated but knee problem persists.
PAIN UPDATE at this point: My father’s bilateral knee pain is worse, swelling continues; walking is more difficult despite pain blocks, NSAIDs, excessive rest, therapy exercises and ice packs.
February 2012: Dr. Switzer takes X-ray of hip implant; okay, thinks knee pain is related to hip bursitis.
March 2012: Returns to original TKR surgeon, Dr. “LaPiens,” who takes X-rays and orders blood test to rule out infection. Dr. LaPiens says implants might be loose.
MISTAKE: It should not have taken 26 months to finally hear this from a doctor!
April 2012: Bone scan.
MISTAKE: It should not have taken 27 months to finally get a bone scan!
Later that month, Dr. LaPiens confirms loosened TKR. Draws synovial fluid for infection check.
New primary care doctor recommends appointment with a new orthopedic surgeon, Dr. “Ganzelli.”
May 2012: Dr. Ganzelli disagrees with Dr. LaPiens’ diagnosis of loosened knee implant, and tells my father to see him again in three months, with no further recommendation for investigation!
MISTAKE: What does Dr. Ganzelli think might happen in the next 90 days, being that for nearly two and a half years, my father has been suffering from progressive knee pain?
June 2012: Acupuncture, which didn’t work. Dr. Switzer takes hip X-ray; okay; evaluates knees, blood test for infection and inflammation are negative.
PAIN UPDATE to this point: Every three months there’s been pain blocks (not always in same lumbar region) but they haven’t done much good.
August 2012: Primary doctor and Dr. Ganzelli say new X-rays of knees are okay; suspect allergy to metal part of implants; test for this is negative.
September 2012: Consult with neurosurgeon Dr. “Chung.” Diagnosis: lateral recess stenosis, recommends traditional back surgery (screws and bolts), 75 percent sure it will resolve knee pain.
October 2012: Another ortho doctor, “Lichtenstein,” disagrees with Dr. Chung, saying he’s never seen knee pain result from spinal stenosis.
Later that month: Dr. Switzer gives Marcaine injection and more X-rays. An immediate relief of pain, following Marcaine injection, strongly points to failed TKR.
My father had instant pain relief and his walking was significantly improved. This effect wore off several hours later.
MISTAKE: Why didn’t any of the doctors (especially Dr. Switzer and Dr. LaPiens), recommend the Marcaine injection sooner?!
I asked this question to knee replacement surgeon whom I consulted specifically for this site; read his response.
PATIENT BEWARE: If you have persistent knee pain after TKR, you should suspect a failed implant and DEMAND a Marcaine injection! Also insist upon a bone scan. This is NOT the same as an X-ray.
