Doctor insights on:
Hip Pain After Total Knee Replacement
I am 31 with avn in both knees and hips I recently had a total knee replacement. Is there anything I can do to stop the progression?
Depends on the cause: There are several conditions that cause avn. Corticosteroid use is the most common. Once the bone has lost the blood supply, there is a regenerative process that starts and can lead to pain and collapse of the articular surface. This will depend on the extent of involvement in the affected joint. Not all cases go on to joint replacement as some will resolve over time. ...Read more
Activity progression: Recovery from hip replacement is straight forward. The pain is easily managed with medications and rapidly eases. Most patients can walk with a walker or crutches within hours of the surgery. The muscles in the hip will rapidly regain their function. Specific exercises strengthen the abductor and flexor muscles and can be done at home or with pt. Gait will improve over the next few weeks. ...Read more
Strengthening, etc: The cornerstone of therapy protocols following hip and knee replacement centers on gait training and strengthening. Hip replacement patients should focus on walking, abductor and gluteal strengthening, while knee replacement patients should focus on range of motion of the knee, quadriceps strengthening program. ...Read more
I had a total knee replacement on the right side 6 months ago and now my right hip is very sore. I had it xrayed with no result.
Hip pain: Some disorders of the hip like tendonitis or chronic sprain won't show up on simple xrays. It's possible that simply walking improperly has strained muscles around the hip. Also arthritis or cartilage derangement may be present and not detectable by convention xray studies. Your orthopedic surgeon may order more imaging, steroid injections, physical therapy, etc after another examination. ...Read more
10 weeks ago I had a left total knee replacement and now I have a dull, achy pain in my left hip and left foot ankle. What could this be?
Expected pain: The postop course after a knee replacement is challenging! Pain can often be up and down the entire leg. A rare but real concern can be that of a blood clot which can occur for up to 6 weeks out. Any such concerns should be conveyed to your treating surgeon asap. Let me or her know and get direction in what to do next! ...Read more
Yes: I'm assuming you are referring to the low impact exercise machine. A gazelle would be very good exercise, as would most other low impact machines such as an elliptical, stationary bike, etc. Generally anything that isn't high impact is a safe option for exercise and sports participation after knee replacement. You should avoid high impact activities such as running, jumping, etc. ...Read more
Strength and motion: Patients lose 30-50% of muscle strength after tka and have to exercise to regain that strength. Leg raising, walking, and progressive exercises to improve the quadriceps function will help. Motion exercises include bending the knee to regain flexion and full extension (straightening). These should be done 3-4 times/day. Bending, biking, and pulling on the leg in flexion will help. ...Read more
You will do many: Different exercises. However, there are two main areas that a pt will work with you. First, you will need to work on stretching your hamstrings, making sure you get your knee in full extension. The second, which is very close to this, is quadriceps strengthening. Overall gait stabilization is also important. Pre-surgery exercises programs have demonstrated success in better post-surgery outcomes. ...Read more
Potentially: I would discuss any concerns with your surgeon, but there certainly is some degree of healing that must occur in the patella after a knee replacement. The patella is actually inverted inside out to expose and replace its undersurface with a polyethylene bearing surface, then the medial aspect of the quadriceps mechanism, which helps in tracking of the patella, must be divided and then repaired. ...Read more
Scar tissue: After a knee replacement, achieving maximum knee motion is often a race against your bodies natural healing process. Though your pre-operative range of motion can ofter predict your maximum expected post-op range of motion, aggressive physical therapy is crucial to achieve the best result. ...Read more
Research: The orthopaedic community continues to improve outcomes through a variety of avenues. It is necessary to speak to your surgeon directly. After surgery, most people spend 3-4 days in the hospital, and then go home or to an extended rehab stay. Therapy is typically 8-12 weeks. Weight bearing is started immediately, with a rapid transition from a walker to a cane to independant activity. ...Read more
Many things: There are a number of things that can cause pain. Infection should be ruled out first. If it is not infected, xrays should be done to verify the components are not getting loose, a bone scan is also a possiblity. A rare cause is metal sensitivity, but this is controversial. Sometimes impinging scar tissue in the knee can cause it, or it can be refered pain from the hip. ...Read more
Knee locking: You should have this discussion with your surgeon. If he does not give you a satisfactory answer and solution, it is okay to get a second opinion. ...Read more
Forceful bending: A total knee replacement that has not regained adequate knee flexion after surgery can by treated with a manipulation under anesthesia. This procedure involves the manual disruption of fibrous scar tissue that can sometimes develop within the knee joint. Dedicated range of motion exercises, with a physical therapist and done independently, are critical to the success of this procedure. ...Read more
Fairly: It is not terribly uncommon, especially with the hips. The recovery from a total knee replacement does involve some degree of limping, favoring one leg over the other, and not uncommonly causing a bursitis of the hip. Thankfully they usually it resolves over time as recovery progresses. ...Read more
Pillow: There is no physical reason preventing you from sleeping on your side. You might try a pillow between your legs if you find it uncomfortable while your knee recovers. ...Read more
Your PT should be --:
Able to help you, as he/she'll be able to determine which (or all)muscles need to be strengthened in your thigh (both quads ; hamstrings). They'll be gauging your response to the pt and giving you a home exercise program, all in an effort to rehabilitate you, to attain the best function you can achieve after rev surgery.
Do them religiously ; you'll enjoy the results of the surgery.
Good luck. ...Read more
What would cause a thickness/swelling/pain above the knee cap 5 yrs. After total knee replacement along with meds for RLS are not working now?
Not from RLS: Your symptoms are complex and need interview and exam but seems not related to rls. The nature of RLS is progressive so discuss with treating physician to consider optimizing your treatment plan. ...Read more
My mother has pateller cluch after total knee replacement, which is better for her-either othroscopy or open excission?
Either can work: Patellar clunk syndrome occurs when fibrous scar tissue grows around the patellar implant in posterior stabilized total knee implants. The scar tissue catches in the recessed box of the femoral implant when the knee flexes and pops or clunks when the knee extends. It can be painful and treated with either arthroscopic or open removal with great success. ...Read more
Yes, but not often: Knee replacements can feel like "seizing" or "locking up" on rare occasions and they are usually not due to the device. The most likely phenomena you are experiencing is either "crepitus" or "clunk" which is when scar tissue surrounding the front of the knee gets trapped within the device creating a sensation of locking up. When severe enough, it can be alleviated by removing that scar tissue. ...Read more
May not be complete: Some are fortunate to have the surgery and shortly there after once the wounds healed, they have no pain at all. Many will have great improvement of pain, but never completely resolved after the replacement surgery. It is a big surgical procedure with significant risks/benefits, so do your research and discuss with doc thoroughly. Good luck to you. ...Read more
Recovery: Typically is about 2-3 months. It is an inpatient surgery you are in the hospital 2-3 days and then either go home with PT or to Rehab. You are up walking either the day of or after surgery. Stitches out at two weeks. Typically off crutches in 3 weeks once you can stand walk with good quad strength. ...Read more
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