6 months later I was bone on bone and rather than use this surgeon and get a THR I found a different surgeon and got the BHR instead. Additionally, your muscles will take some time to recover from surgery. After this surgery, the warming sensation is usually present for a few months. She had undergone a left total knee replacement six years previously with a metal-backed implant to resurface her patella. I am sure this will improve. Introduction. New York, NY: Springer International Publishing; 2015. -, Langton D. J., Joyce T. J., Jameson S. S., et al. I am sorry to hear you are having difficulty. It never occurred to me that I might be allergic to the metals, but I now realise I cannot wear anything but gold in my pierced ears and I never told them this. I'm very active in push mowing our yard and yes I've done this every since about 4 months after surgery. Generally infections cause pain, swelling, poor range of motion, drainage from the wound, fevers, chills, etc. Should I have any concerns? 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? Ive stretched it and massaged it to no end. Eventually 2 years following the 1st surgery I had revision surgery with a nickel free implant. 2016 Dec 14;2(4):e143-e146. If a wound is still draining past one week after surgery, you may need additional surgery to prevent infection and ensure there is no sign of a deeper infection. A primary ligament-guided knee joint prosthesis was implanted in the patient 14 years ago. The average ALVAL score of the cohort was 3.1 1.9, of a maximum score of 10. My knees are still warm to the touch and I am often awakened at night with pain. Swelling is normal at this stage, particularly as you continue to work on range of motion exercises. I had a patellafemoral replacement about 6 weeks ago. There are some assistive devices/braces that can help you with motion at this point. He said he could do revision surgery and replace the nickel with another metal but the titanium is in all devices so it could not be changed out. MRI of spine was normal, MRI of hip did show chronic bursitis. Help, please give me a reason for this and how I can get over it. It feels like there's something catching and I hear it clicking when I walk. While your symptoms could be related to allergy, there are some other possible diagnoses that are more commonly diagnosed, however. 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. This is particularly true for people at high risk for healing complications after knee replacement surgery. Not to worry you, but perhaps another opinion is warranted here as it seems you are doing significantly worse than we would normally expect at this stage. While walking is encouraged to help prevent blood clots, 2 miles every day within a couple weeks of surgery is perhaps more than necessary. Minimizing Blood Loss Bruising around your knee may last 1 to 2 weeks following surgery. It is normal to have pain, warmth, and swelling immediately after total knee replacement. Other than the pain when I lie down or ice, it has been keeping me up at night and I haven't been able to sleep in about 3 weeks now. He looked sad and said it was avascular necrosis and ordered a STAT MRI. Overall Id say Im 90% back. Metallosis results in metallic debris which causes tissue staining, often hidden within the soft tissue envelope of the hip, but more apparent in the knee. Knee replacement incision healing is an important concern for anyone undergoing knee replacement surgery. I would continue stretching on a daily basis, several times per day if possible. There is instability. Thanks so much. Had left TKR 7/31/18 Went to therapy for 9 weeks and have a good range of motion. Lee- I am happy to hear about your successful early knee replacement rehabilitation. Extension Do my numbers seem within the norm at week 4? Tried ice treatment and a bit helpful for 2 hours. A bit of background: I suffered several patellar subluxations in my late teens and early twenties -- it turns out that I had no patellar groove in my femur, so my kneecaps were especially prone to slipping out. The pain I have is soft tissue, burning, soreness and weakness - Glutes, sides of the thighs and occasionally the groin. Disclaimer. Sometimes I just feel like I may not be progressing like I should. For simple malalignment, a single stage reconstruction can be done, correcting the prosthetic position. What does a hot knee mean and what causes it? National Library of Medicine An MRI scan with metal artifact reduction sequencing (MARS) is necessary. After returning to regular activities, it can take between 12 months and a year for you to fully recover. Discoloration is not uncommon for several weeks or longer after knee replacement. 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. Please enable it to take advantage of the complete set of features! I have not been back to my dr. This is, unfortunately, impossible for me to answer in this format. This is not normal. Ive consulted my surgeon and my PT and they have no answer. It is possible you have a sensitivity to one or more materials used in the prosthesis. My concern is if I possibly traumatized or caused some other soft tissue damage to hamstrings or tendons/ligaments during my activity in the snowstorm that has inhibited healing and progress. Meniscus These numbers are totally fine for week 4. This is a particular problem when the prior incision is located where it cannot be reused, so a new incision needs to be placed over the knee joint. By the next morning I was back at about 20% more swelling than before all this started. The next day I had a PT session and after about 10 minutes of light therapy, it swelled again. The Birmingham cup must not be retained. Before surgery, the most important factor you can reduce is your glycemic index. There are several stages of healing that occur after a knee replacement (or any surgical incision) is performed: The signs to look out for when inspecting an incision suspected of having a healing problem include: The most common signs of a wound healing problem arepersistent or worsening drainage after surgery. Bookshelf He said some sounds are normal and there's probably a lot of scar tissue and to give it time but it's going on 6 months now. I had total left knee replacement 3 months ago and was doing great. As far as pain control- NSAIDS tend to work better than narcotic pain medication for post-surgical inflammatory pain. I also have like a spot that's puffy in just a small area like to left of my knee could that be fluid? Assuming your surgery was fairly recent, I think you may be walking a bit too much. Any total joint replacement that has been performing well and then becomes hot, stiff, or swollen requires an urgent evaluation by an orthopedic surgeon. Until that barrier is healed, there is the potential risk of bacterial entry and infection. It is common for discoloration after knee replacement for several weeks or longer. Concentrate instead on walking, and gentle, progressive strengthening exercises. In general, patellofemoral replacements tend not to last as long as total knee replacements, but should be considered in the younger patient with isolated patellofemoral arthritis. 2, pp. Getting this implant fabricated took a long time and many steps, but this is a potential solution to your predicament. At 4 months from surgery it is normal for the knee to still feel a bit warm. If your knee actually does not have what I would consider full range of motion as described above, it is important to continue working diligently on regaining it. Went to him the end of August 2021 he did an x-ray and the Tibia implant on the sides were black under them just on the sides though and he ordered a 3 phase bone scan. Bruising is often a sign of inflammation following surgery. My right knee not so much. This means healing complications aren't rare. Bleeding into the soft tissues is common, resulting in a deep bruise or darker skin. 452, pp. While return to low impact sports is reasonable, I would recommend avoiding high impact activities, and try to minimize the chance of falling directly on the front of your knee as there would be a slightly increased chance of sustaining a fractured patella after resurfacing. Since both of your knees are affected, it is unlikely for this to be due to infection. doi:10.1371/journal.pone.0091755. I realised the implant was toxic to me and that I was being poisoned by the implant. Metal-backed patella implants, despite their poor track record [2], are still used to address the difficult scenario of patella deficiency at knee replacement. A knee replacement is a life-saving procedure that can improve the quality of life and mobility for many people. Journal of Biomedical Materials Research. 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. I asked my surgeon what the blotchy marks was, he said that he has never seen that before and was unsure. Should I still have the feeling that s tight band is around my knee. Knee replacement done because of playing traveling softball and too many slides! I agree that infection workup always makes sense for a joint replacement that is not improving (and no mechanical explanation can be found.) I would encourage you to avoid high impact activities for another month or so. Clipboard, Search History, and several other advanced features are temporarily unavailable. Is the alignment and soft tissue balance in the knee optimized? Substances and items that irritate the skin vary among. Scientific Articles Then you might want to see a doctor. I think I am progressing well, no pain except for the swelling. The surgeon wants me to continue therapy but I cant do many of the exercises. Adequate nutrition may be present if the patient exhibits symptoms such as malnutrition, low protein levels, or other deficiencies. They use zirconium routinely in femoral heads and femoral knee components. https://www.yourorthomd.com/orthopedic-knowledge/metal-sensitivityallergy#108747411520362981 Asked the surgeon about my prosthesis and of course it containes metals I am sensitive to. I went to er, had labs with mildly elevated CBC, so was treated for cellulitis with antibiotics for 7 days. Thanks in advance- frustrated as I have more pain now than before my surgery. 10117 Berlin Im going to have a blood test at my cost for additional information regarding a possible allergy as to why my knee is not healing. Metal allergy testing unfortunately isn't perfectly reliable, and is often quite expensive. I noticed that if I put my weight on that knee when I take weight off it it causes pain and now its started to hurt more and when bending it. Most concerning is the deterioration in function you describe. This can be challenging for some patients. Dr said the xrays look fine and it's not infected. Patients may reveal family histories or previous metal allergies if they reveal a history of metal allergies. I been 9 month of total knee replacement and i still have pain , swalling and only 50 rom. However it can occur in any metallic implant subject to wear. That I would have to learn to live like this. Rehabilitation I cant seem to walk more than quarter if a mike and it hurts so bad to get up out of a chair. It sounds like you are actually off to a good start. I agree with your surgeon recommending decolonization with mupirocin prior to surgery, and would also recommend adding vancomycin to the preoperative antibiotic given in the hospital. Arm site still has rash and itchy. Thank you cary. I had total right knee surgery 2 months ago. Thanks for the reply. This site needs JavaScript to work properly. Warmth after knee replacement surgery is normal and expected to persist for several months, sometimes even for nearly the entire first year. The rash usually lasts two months or two years after it has been surgically repaired. I will do my best to answer. Willert H. G., Semlitsch M. Reactions of the articular capsule to wear products of artificial joint prostheses. 2 Days after surgery appeared a large red hard lump on upper thigh size of an egg - after ultrasounds found it was a solid fatty mass, but no idea why it showed up. Will it become straight after disappear of swelling or permanently deformed. In general, pain following hip or knee replacement is mild, with redness and warmth around the joint and a slight bruise or ecchymosis. Other than some time, there is really no downside to this test. This allows perfect alignment of the femoral component in all planes, restoring the patients unique anatomy as accurately as possible. There are several stages of healing that occur after a knee replacement (or any surgical incision) is performed: 2 Inflammation: The first stage begins immediately following closure of the incision. The https:// ensures that you are connecting to the know and also I dont know where to do an allergy test and if its reliable. I can't complain because I have NO pain, which I'm so thankful for. I don't believe my ortho doctor knows what to do with me. Do you feel any instability with side-to-side stress of your knee? Surgeon and PT are surprised by my continued pain, swelling and stiffness and both expected better progress at this point. Good luck, and please update us with your progress. I had significant nerve pain at 1 and 1/2 yrs out which was cured by several sessions of acupuncture. Thank you, While it could just be inflamed, the differential diagnosis also includes:, infection, loosening, and stress fracture. An x-ray would help to evaluate this, a hip joint injection could be done to confirm this diagnosis. More information is needed to formulate a diagnosis and plan. The effusion may cause stretching of the joint capsule, which can cause some discomfort. Your surgeon should be monitoring your progress, particularly when your progress seems to be slower and less pleasant than normally expected. How concerned should I be about this? The technical term for this is. Metallosis is a phenomenon most commonly associated with hip replacement. I am 8 weeks post TKR and Ive had this swelling in my calf about the size of a plum, just below the bend in my knee, that spasms and causes my leg to weaken and fold until there is a popping and the spasm releases. It is also of interest as a rare differential diagnosis for advancing pigmentation around a joint, pain, and effusion. Bruising is a purplish discoloration that indicates blood gathering under the skin. According to WebMD, increased redness or discoloration after surgery is the most common sign of a blood clot. Aljawabra A: Skin discoloration . Platelet Rich Plasma According to the American Academy of Orthopedic Surgeons, nearly 90% of knee replacement surgeries continue to work well 15 years after the procedure. I am 70 yrs old excellent health, no arthritis in other knee or other joints. On January 25, 2018 I had a total knee replacement. If so, an off the shelf solution is available from Smith and Nephew- this uses oxinium (oxidized zirconium) and titanium. I do have a call in to my surgeon and will call my internist if needed but since this has been so long standing and I have no fever etc., I'm not sure if this is of concern post surgery or not. I had both total knee replacements 15 months ago and I have had what I think a slower recovery. Generally, a well rehabilitated total knee should become close to, if not completely, pain-free. To decide whether a knee replacement is right for you, a surgeon checks your knee's range of motion, stability . I still have some swelling and discomfort but I am able to function well by doing my exercises daily, going to outpatient Physical Therapy, and icing. 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 Anyhow, we'll keep in mind to watch out for any swelling and redness as well. I had TKA a little over 5 months ago. Therapy started2 weeks after surgery. Normally, the meniscus is located directly at the joint line. Do you have any opinion in that regard? Jonathan Cluett, MD, is board-certified in orthopedic surgery. When this does not occur we need to make sure the alignment of the prosthesis is optimal, there is no infection, there is no loosening, and there is no referred pain from another joint or nerve. I had complete knee replacement 4 months ago. While these are rare, prompt treatment is needed. I was doing extremely well up until a week ago. 2013;1(1):e10-e19. I am most unhappy that my declaration of metal alloy allergies was ignored and to compound this..my private allergy test results were either not read or simply ignoredI now have had revision surgery and suspect I am reacting to the new implant done 2015. Telefax: +49 (0) 30 246267 - 20 Six months is the average time required for knee replacement surgery to heal. Disclaimer. Dark knees are usually not regarded as a health risk, and they are not known to cause health problems. (Map) (570) 861-8710. There is a small risk of infection- which is a big deal. Has infection been considered and investigated? I am confused can you please explain? Bethesda, MD 20894, Web Policies If you don't take any blood thinning medications or supplements, perhaps your blood clotting factors should be checked. Warmth following total knee replacement is normal, sometimes this persists for several months. Neither LTT stimulation index as a continuous variable nor as a categorical variable (mildly reactive, moderately reactive, highly reactive) was correlated with ALVAL score, pre-revision function (as assessed by KSS-clinical, KSS-functional, and range of motion), or change in function at the most recent follow-up (0.015 < r < 0.30, 0.13 < p < 0.95). Infection Your doctor should be able to tell you if you have a bacterial infection in your body, which is a good sign. I barely can walk, sleeping is difficult due to stiffness and pain, especially when trying to change positions. 2016 Jul 13;6(7):e011139. It does not sound like you are reporting this. In patients who have surgical dermatitis, the skin may appear scaly, erythematous, papular, pruritic, and itchy on both sides of the scar. You do not mention your current range of motion, if you do not have at least 0-120 degrees by now, this is likely the issue. I don't have other issues like hotness when touching, although I do sense a low level warmth and no other infection symptoms. I think most hospitals have now mandated that all elective cases are shown to be negative for COVID prior to entering the hospital. I was sent to my family doctor and did blood test again same thing. It is extremely difficult to get an outstanding result when trying to play "catch up." This is because bending the knee increases the pressure on the tissues around the scar. doi: 10.1002/jbm.820110202. I am a 52 year old female who had a TKR on my left knee 4.5 weeks ago. My surgeon was nice and said he wanted me to be settled in my mind that I will be ok before I have surgery. If you have hip arthritis (you mentioned hip pain) this often causes pain that radiates into the knee, and thus I am suspicious of this. Systemic effects from raised serum-metal ion levels, particularly cobalt, include neurological deficits: declining sight, hearing, and cognition, cardiac failure/cardiomyopathy, and hypothyroidism. But for 1.5 years I had heat, swelling, and stiffness, which worried me a lot (and also worried my PT) because everyone else i talked to seemed to heal much faster. Dr G, Sometimes I think if they would just cut off my leg I would be better off. About 3 weeks post op I developed a rash on the operated leg. Thank you very much for your detailed and informative response- it is very much appreciated! I would not recommend additional surgery at that time. 3- Material sensitivity testing. You should be around week 10 now, how is your progress? Chronic knee pain makes it difficult to function on a daily basis. I have had 5 knee cap dislocations since surgery numerous buckling. Also consider material sensitivity testing. If you were to see me I would examine your knee, test the stability and range of motion. Roger C, Debuyzer E, Dehl M, Bulad Y, Lamrani A, Havet E, Mertl P. Orthop Traumatol Surg Res. I had tkr in January 2019, and know we are in april 2020. Unfortunately, my surgeon has had zero interest in my post op care. If you can use anti-inflammatory medication like ibuprofen (ask your surgeon), this could also improve your symptoms. Can't stand for long periods of time without it hurting and getting very stiff. Have went for second opinion and surgeons report the rarity of metal hypersensitivity. When the spasm is not occurring, how is your ability to walk coming along? This is not a normal result following knee replacement surgery. The patient already had a zirconium femoral component. Based on your question, however, I think it is best that you schedule a visit with your orthopedic surgeon. Anterior Approach PMC In general, worrisome signs include: fevers, chills, drainage, shiny red skin, extremely poor or progressive loss of range of motion, and increasing pain. The likelihood of healing problems after knee replacement surgery varies according to different studies. In rare advanced cases, there may be skin color change along with gangrene. Is the area of swelling tender? Warmth after surgery will gradually resolve over months. I showed him the report that I had tried to get his Nurse Practitioner to pay attention to and he said he was so sorry I had suffered so long. Range of motion can be regained for a longer period following trauma than after knee replacement surgery. Is ROM a concern at this time, or is more time and weight bearing needed? Bursa If it hasn't been done- consider aspiration of the knee to obtain synovial fluid for gram stain and culture. Difficulty sleeping is a common complaint early after knee replacement surgery. How is your wound healing? Buy Now . In general, there is little harm that can happen with gentle exercise, even early in the postoperative period. I am told to elevate and ice, but anytime I lay down to elevate or even keep it level, I get lots of pain in my foot (same foot as knew with TKR). Have you considered aspirating/injecting the cyst? How long should I continue with all of the exercises? This also can assist with sleep. Our orthopedic surgeons understand that when it comes to knee replacement, making the right knee choice is a very personal decision. Needing advice please. Why do medical "experts" refuse to acknowledge that things can go wrong and admit to ignoring my metal alloy allergy should not have happened. Total knee replacement has become a very common elective surgery, and patients are often amazed at how quickly they can get back to "normal" life after surgery. This removes excess blood from the knee after surgery. 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. In the knee, more melanin is produced than in the rest of the body. My question is do other people have an issue with the band and does the pain go away? Home health reported my issues and they received no answers back either. I had a TKR 3 months ago and am at 125 degrees bending. In the hospital, your healthcare team. two syllable italian words; who left channel 7 news boston. Your range of motion will spontaneously improve as your nerve recovers. Peppy Walsh. I don't want to have another surgery. I am 61 years old, and had a TKR on my left leg almost 18 months ago (Oct 2017). I would complete the entire workup prior to surgery to remove as many variables as possible. Post-surgical contact dermatitis is a localized rash that is almost always a reaction to something that came into contact with your skin. 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. How to spot a problem and what you can do to prevent healing concerns. Running, jumping, and climbing should be avoided if you have a history of knee pain. Hip Replacement The lower limb was disfigured after wear bone on bone. No change in diet, meds or anything. Sometimes, unfortunately a custom implant, or other solution like a knee fusion (arthrodesis) needs to be considered. I'm back in TED hose per the ortho. It trys to fall out from underneath me all of the time and its hot I cant lay on left side all I stand nothing touching my knee at all on the door it goes numb The doctor doesnt like to answer questions and when he does all he has to say is I guess my pain doctor said theres something seriously wrong with the knee you can tell by looking at the color of it the knee doesnt look right he use to to knee surgery s and hips shoulder s I where to go from here. Your surgeon needs to understand what is going on. They seem to be on track for my care as I am seeing improvements but my recovery has been horrifically painful. Regardless, I highly doubt bone demineralization is causing any pain. I'm told I'm doing well, but swelling in the joint persists, particularly at the end of the day if ive been standing around a lot, or sitting in the office chair. One issue I've had that no one has an answer for is that I've had pain in my foot ever since the 2nd day of my surgery. A diagnosis of metallosis was made; the patient underwent debridement of the stained soft tissue and primary revision of the prosthesis. It is my opinion that because robotic systems allow joint replacement surgeons to do a much better job during surgery, eventually this is the only way they will be done.
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