skin discoloration after total knee replacement

The question of metal sensitivity is legitimate- In addition, the ALVAL score did not correlate significantly with either pre-revision or post-revision KSS or range of motion (0.061 < r < 0.365, 0.09 < p < 0.88). Whenever a patient experiences ongoing pain after total joint replacement, they need to follow-up with their orthopedic surgeon for evaluation and guidance. Other conditions and medical treatments that can cause skin discoloration include: Bleeding into the skin. Any sudden decline in function should be closely managed by your surgeon. My surgeon assures me that the knee replacement went well, but I know that something isn't right, and my physical therapist agrees. My concern is that operated leg the knee and bellow knee looks a little beat more swollen than my other one (measured it with a meter) is this normal. Is the area of swelling red? Unfortunately, the treatment would be to remove the offending component/device and replace it with a device that is made without the material. Surgery was 1-29-2020. Metallosis is a phenomenon most commonly associated with hip replacement. Clunk The workup should include thorough evaluation for infection including possible aspiration, possible imaging studies. I have and still do some therapy at home. See this image and copyright information in PMC. 8 weeks ago I had total knee replacement on my right leg. Roger C, Debuyzer E, Dehl M, Bulad Y, Lamrani A, Havet E, Mertl P. Orthop Traumatol Surg Res. Mechanical Sensations Total knee replacement is generally a successful procedure that lasts between 10 and 15 years. If there are concerns with the healing of your skin, let your surgeon know immediately. Multiple incisions can leave areas of skin without sufficient blood supply. B. Vivegananthan, R. Shah, A. S. Karuppiah, and S. V. Karuppiah, Metallosis in a total knee arthroplasty, BMJ Case Reports, vol. Difficulty sleeping is a common complaint early after knee replacement surgery. The skin and soft tissues need to heal to prevent the entry of bacteria from the surface of the skin and the external environment. Nicely done. GP. While some spotting on a bandage after 72 hours may not be a cause for concern, more than 2 centimeters of drainage on a gauze bandage is not considered normal. In rare cases, skin discoloration can be a sign of an infection. She remained symptom-free five years after revision. It is important to see a doctor if you notice any unusual changes in the color or shape of your leg. This problem will gradually fade away as your body recovers from surgery over the next few months. Typically, bruising around your surgically repaired knee will last 1 to 2 weeks. I've had both my knees replaced and nearly 2 years later both are still hot and wake me up 'every' night" sweaty and have to expose them to cooler air out from under the blankets. The most common symptoms are swelling of the face, difficulty breathing, and chest pain. Flexion without push to 105, with push 112-115. My problem is at bed time. This is obviously to help prevent spreading this disease within the hospital. At age 78 I had a replacement of my left knee. 1977;11(2):157164. 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. Also consider material sensitivity testing. A year later I went back and the same Dr. did an in and out surgery. Joints. This was resolved by first ruling out other issues. I have had 2 x TKR in the last 2 months, last being 4 week ago. Occasionally a patient may have an allergic reaction to the materials/chemicals used during surgery. Metal allergy testing unfortunately isn't perfectly reliable, and is often quite expensive. I've had both knees done (2 years apart, in my late 50s) and the healing process turned out to be similar for both. Epub 2019 Jun 15. If you notice any changes in the color of your skin, you should contact your doctor. I was initailly told my TKR would change thing for the better its much worse than I could have possibly imagened. So- when a total knee replacement is performed, both medial and lateral menisci are removed. People experience many kinds of skin changes over time. I also think it is reasonable to use some pain medication before bed to help you get the rest you need while your body recovers. I would recommend a manipulation under anesthesia if adequate range of motion has not been regained by 6 weeks. thanks. My surgery was on 10/30/18. Has infection been considered and investigated? It is normal for bruising to develop over time in the foot and/or toes, and this will only get worse as the weeks pass. I would recommend workup to rule out low grade infection, or reaction to materials. Keep stretching-soft tissues will gradually yield/remodel. 5- Your surgeon is correct in that your operation might need to be repeated. I agree that infection workup always makes sense for a joint replacement that is not improving (and no mechanical explanation can be found.) Should I go and see a Dr about this and what could the iissue be? To reduce the risk of falling and twisting your knee during exercise after knee replacement surgery, avoid activities that are prone to falling or twisting. I went to er, had labs with mildly elevated CBC, so was treated for cellulitis with antibiotics for 7 days. Common materials used in total knee replacement include: Cobalt, chrome, nickel, titanium, polyethylene, polymethylmethacrylate. Your range of motion will spontaneously improve as your nerve recovers. Your knee also needs to heal and adjust to the prosthesis. My surgeon put me on a lateral knee brace and crossed fingers that the dislocations would not happen again. How concerned should I be about this? -, Doom P. F., Mirra J. M., Campbell P. A., Amstutz H. C. Tissue reaction to metal on metal total hip prostheses. Please look through this website as I have written a variety of articles with regard to knee rehabilitation, manipulation, viscoelasticity, and anatomy. In general, total knee replacement is a successful procedure that has a higher than 90% survival rate. It is absolutely appropriate to be tested for COVID and MRSA prior to knee replacement surgery. Her ROM is low 90's at 9 wk postop. The case also demonstrates the importance of knowing the individual implants. Unauthorized use of these marks is strictly prohibited. I feel my knee is really not right. Surgical intervention with revision and debridement can have good functional results. While kneecap dislocation (patellofemoral instability) can occur, this suggests possible suboptimal rotation of the femoral component. doi: 10.1136/bmjopen-2016-011139. It takes about six months to fully recover from a joint infection following joint replacement. 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. While our bodies can fight off other infections on their own, infection with our joint replacement joint does not require surgery. My impression is that you may need further surgery. I have seen and treated it, but it is rare. How was your range of motion prior to this setback? Metallosis may cause pain, effusion, and systemic symptoms because of raised levels of serum-metal ions. 0 and 145. Assuming your surgery was fairly recent, I think you may be walking a bit too much. I recently, March 11, 2020 underwent a revision of a failed TKR. Dental Work I had complete knee replacement 4 months ago. Thanks. 2013. I was told no joint swelling, though knee was still mildly purple, and mildly painful and swollen. My surgeon told me yesterday that if I don't improve to 90+ within 4 weeks that I will have to have an additional surgery that will include a scope to help clean up scar tissue and to manipulate my knee while under anaesthetic. I ice it twice a day and after therapy, but the swelling doesnt look like it going down. As far as pain control- NSAIDS tend to work better than narcotic pain medication for post-surgical inflammatory pain. It was almost 3 weeks before I could sleep longer than 15 minutes at a time. I have had 5 knee cap dislocations since surgery numerous buckling. The .gov means its official. Most patients, once rehabilitated, tell us they wished they had decided to have their joint replaced earlier. I had total left knee replacement 3 months ago and was doing great. DVT is widely recognized as a major risk factor facing patients who undergo total hip arthroplasty (THA) and total knee arthroplasty (TKA). During this recovery period, the reaction time and force may be somewhat abnormal and your muscles may be less able to protect your joint. If I apply ice to my knee, then after about 3-4 minutes, the pain in my foot gets even worse, to the point where I can't stand it and have to massage my foot and try to stay distracted just to get to about the 10 min. For material sensitivity/allergy, a prosthesis that does not include the offending material is needed. This type of surgery, also known as knee arthroplasty, involves the use of plastic and metal components to permanently attach the ends of the bones that make up the knee joint. The left knee still hurts alot but aches most of the time. I see no reason to wait for 6 months if the prosthesis has been damaged somehow and you are having pain. I don't think this is the problem with my left knee, though I have large amounts of scar tissue from previous injuries and surgery -- could this be causing problems? Clinical photograph of the discoloured soft tissue and large effusion secondary to metallosis in the replaced knee. I have 115 degrees of flex and it appears to be doing well but the knee is very very hot, the wound itself stands up a lot and the discomfort is not yet decreasing. Incidence of symptomatic venous thromboembolism in 2372 knee and hip replacement patients after discharge: data from a thromboprophylaxis registry in Montreal, Canada. Any total joint replacement that has been performing well and then becomes hot, stiff, or swollen requires an urgent evaluation by an orthopedic surgeon. My life is inhibited and I fear another surgery is in my future. The best way to do this is by CT or MRI scan with metal artifact reduction sequencing. Should I have any concerns? My Blood ion tests showed slightly elevated but very low for a bi-lat replacement. What can U do to help with the pain? The patient already had a zirconium femoral component. Before It feels like there's something catching and I hear it clicking when I walk. google-site-verification: googlee8ce9aaf537c901b.html. Unauthorized use of these marks is strictly prohibited. I hope this helps a bit. The site is secure. 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. What does a hot knee mean and what causes it? Difficulty with range of motion can also cause pain. In this case the patient underwent early revision knee surgery where the stained soft tissues of the knee were debrided and patella component was revised with an alternate bearing surface. Metal Allergy While some discomfort is normal in the early postoperative period, this is expected to improve over time. 2018 May 8;14:81-89. doi: 10.2147/VHRM.S150474. Try to regain more flexion, 107 is a bit tight for good function. If your surgeon used a tourniquet during surgery, it could have compressed/irritated the fatty mass causing it to become symptomatic. I am 61 years old, and had a TKR on my left leg almost 18 months ago (Oct 2017). If you have a knee replacement, you might consider getting it done. Patients that work diligently on their own rehabilitation from the beginning do best. Arch Orthop Trauma Surg. The skin is usually covered in a red, warm, and swollen rash. I go to the gym to help with my exercises.. Why would this still be happening? Dr said the xrays look fine and it's not infected. Buy Now . This is usually due to bruising from the surgery, but it can also be caused by an allergic reaction to the materials used in the replacement joint. A plain radiograph revealed loosening of the patellar prosthesis. Sometimes the pain doesn't go away and last the entire night. Orthopedic surgeons performed about 520,000 hip replacements and about 581,000 knee replacements in 2006. My knee still hurts bad I limp all the time and the knee has been warm to touch since I had theTKR 3 years ago. On 11/5/19 I had a meniscus repair to my left knee. This is a significant risk factor for development of infection. I figured there was some nerve damage during surgery. Just be sure to maintain long duration deep flexion stretching on a daily basis. Thanks. While walking a bit helps to prevent blood clots, it also adds stress to your healing knee. Since then I have not been able to lift my leg up like the leg lift exercises and am very unsteady. This is not normal. Clipboard, Search History, and several other advanced features are temporarily unavailable. Introduction. I had hesitated about having this done at my age, but had been getting injections in both knees for six years, for the arthritis. Can't stand for long periods of time without it hurting and getting very stiff. I go to a regular check ups everything is ok except the level of my D dimers which now with therapy are close to the normal values. The patient was discharged 9 days after surgery. 2016-2023 Christopher Gorczynski, MD, PLLC. This leads to many local adverse reactions including, but not limited to, implant loosening/osteolysis, pain, and effusion. Ultimately this led to atrophy of my quads and muscle imbalances, and this contributed to signficant migration of my patella during flexion. Recovery goes very well, i am walking without crutches since 1 month after surgery. 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. It is very uncomfortable and stiff at night. Do you have any hip or groin pain? Little Relationship to Histopathologic Findings and Revision Outcomes Bruising is a purplish discoloration that indicates blood gathering under the skin. Hi i just had tkr jan 22 2020. Should I take prescription drugs before bed time? 2016 Jul 13;6(7):e011139. This is an open access article distributed under the. After each incident, the swelling slowly went down on it's own with ice and sitting with it raised. The quality of my life is limited. This leads to many local adverse reactions including, but not limited to, implant loosening/osteolysis, pain, and effusion. Keeping the leg straight may help dry the incision. 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. I have experience dealing with sensitivity to both nickel and titanium in a total knee patient. Accessibility I had a TKR in October 2022. This is expected at this point, and will gradually resolve with time. While some pain and swelling is normal immediately after major surgery, the trend should be one of gradual improvement after the first couple of weeks. Then the knee is manipulated as described above. 1- Blood work. LVPG Orthopedics and Sports Medicine-Station Circle. Platelet Rich Plasma This is normal. Is that normal. Scar tissue tends to try to contract for many months after surgery. The maximum flexed knee range of motion should be 105 to 110 degrees. The pain I have in my replacement knee has got worse and the heat of my knee is terrible. Ft tkr don at Kim's secunderbad Telangana on 26/4/2028 now it's fine Lt tar on12/09/2018 still stiff knee and warm why. Most people have swelling and pain in their knees after having them replaced. Metal allergy is a known issue. A purplish discoloration typically occurs as a sign of blood in the area (bruising may also appear blue, brown, yellow, or black). If you're going to have this procedure, it's important to understand and know how to recognize them. There is a small risk of infection- which is a big deal. A hip replacement surgery is an operation that involves surgically removing the painful joint and replacing it with an artificial joint made of metal or plastic. My physiotherapist says that as long as I keep working hard that he believes that I will be fine in terms of being able to increase my range of motion over the next month. 10117 Berlin Nine patients were treated for skin necrosis after total knee arthroplasty. I have several articles within this blog discussing this and providing strategies to facilitate a good outcome. Within hours of their surgery, my patients are often able to begin walking with the assistance of a physical therapist and a walker. Bookshelf Surgeon and PT are surprised by my continued pain, swelling and stiffness and both expected better progress at this point. Any ideas of how I should proceed?? Peppy Walsh. There is a normal inflammatory reaction to surgery that tends to peak around 10-14 days from surgery. After surgery, it's typical for the knee to technically be able to bend between 70 and 90 degrees, though it may be difficult due to pain and swelling. I recommend you contact your surgeon for an urgent appointment ASAPeven if it only results in reassurance that all is well. I am 6 weeks out of knee surgery after the robotic process and cell replacement. My range of motion is 117 degrees with physiotherapist pushing it, I can get it to 105 degrees myself. Surgeon says that effusion is common and the demineralization will improve with weight bearing, but I am pretty active as it is right now. The concern would be: what if your symptoms are not indeed due to the prosthesis? Furthermore, early patellofemoral dislocation following surgery basically guarantees the arthrotomy incision (incision in the extensor mechanism used to open the knee joint) has failed to heal or has ruptured. I went back to therapy with still some pain but continued to work it. The CT/MRI scan could also help assess the relative position of the tibial tubercle (insertion point for the patellar tendon which connects the patella to the tibia). Individuals indicated for total knee arthroplasty (TKA) are most often elderly, among whom limb arterial diseases are not uncommon 1.In fact, chronic lower extremity arterial insufficiency is estimated to exist in 2% of patients undergoing total knee arthroplasty 2.Popliteal artery occlusion after total knee arthroplasty occurs at a low incidence (0.03-0.17%) 3, 4, 5 but can be . J Bone Joint Surg Am. Has this pain been present ever since surgery, or is it new? After 2 or 3 hours asleep Im awaken by sharp and serve pain. It sounds like you are actually off to a good start. Lateral radiograph of the replaced knee demonstrates the loose patella prosthesis and surrounding osteolysis. Hip Replacement Sanna M, Sanna C, Caputo F, Piu G, Salvi M. Surgical approaches in total knee arthroplasty. A rash around a surgical incision is fairly common. Aggressive and early treatment of skin healing problems are critical to preventing a more serious complication. I don't know what the future holds for me and the medicals don't care. Lee- I am happy to hear about your successful early knee replacement rehabilitation. First, the swelling showing about 2" greater girth on surgical leg, a small Baker's cyst that seems stable in size. My therapist had never seen this in 25 years. It is normal for a surgical wound to have some drainage immediately following surgery. Vasc Health Risk Manag. Each incision causes a disruption to the normal blood supply to the skin tissue. Depending on the results, simply choosing a different prosthesis could prevent a problem. A diagnosis of metallosis was made; the patient underwent debridement of the stained soft tissue and primary revision of the prosthesis. I had a patellafemoral replacement about 6 weeks ago. My knees are still warm to the touch and I am often awakened at night with pain. My knee is really warm. It seems that my metabolism has kicked up, more fluid intake is noticeable and my overall well being seems improved - but no improvement regarding reduced swelling. Introduction. Today I did some super light PT, and about 5 minutes in, my knee swelled again. My surgeon (in another state) says everything normal based on X-ray. Manipulation Under Anesthesia Make sure your hips are as strong as possible (check out the patellofemoral article on this website), consider patellofemoral stabilization bracing, and injections (cortisone, hyaluronic acid, and even platelet rich plasma.) Hazleton, PA 18202-9726. This delay allows your tissues to recover, so that when you ultimately return to all desired activities, you can do so with the lowest chance of injury. 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. Thanks. If you decide to undergo surgery, focus diligently on rehabilitating well. She says that's the nerve endings connecting back together again, which is a good sign. Nothing seems to be helping. I feel I have been decieved, feel like my health problems resulting from the initial knee implant were ignored. If these are elevated an infection is more likely. This time I had a low grade fever 100.6 F), mildly elevated CBC, but not elevated in other inflammation markers.. It's common and normal to develop bruises in your thigh, calf, ankle and foot because that is where blood pools in the leg. I have had a blotchy look on my upper thigh since my surgery. The lower limb was disfigured after wear bone on bone. Since then 3 of my fellow co-workers have had the same procedure and they are pain free, no swelling and are can perform normal day to day activities. It is possible you have a sensitivity to one or more materials used in the prosthesis. The swelling in my new knee is still pretty extreme and there is still consistent pain. ti jean petro day. While material allergy is a possibility, the most important thing to consider is infection. -, Langton D. J., Joyce T. J., Jameson S. S., et al. My sister would like to try the knee replacement procedure because she got into a serious accident, which affected her knees. Metallosis should be considered early in the differential diagnoses where discolouration to soft tissues is apparent about a replaced joint. I am 8 years post bi-lateral Birmingham Hip Resurfacing. FOIA It contains abundant references. If your leg begins to change color, shape, or size, you should see a doctor as soon as possible. I had 50 or more some nights, but they're rare now. Running, jumping, and climbing should be avoided if you have a history of knee pain. I can not really give you much advice based on this. Recently I notice a change with this red area. This is not a normal result following knee replacement surgery. Is it normal that my knee is very warm in the afternoon and I am also in extreme pain everyday around 5pm. A positive LTT may not indicate that an immune reaction is the cause of pain and stiffness post-TKA. This is a nuclear medicine study that helps identify site of infection. Ceramic and Poly were not tested. I recommend you have your orthopedic surgeon evaluate the wound as soon as possible. The explanations for your situation (differential diagnosis) includes: infection, stress reaction due to poor bone quality or malalignment of prosthesis, early loosening, sensitivity or allergy to the metals or other materials used in the prosthesis. Can scar tissue still cause pain if you're able to fully bend and straighten it ? Stuart Hershman, MD, is a board-certified spine surgeon. Your experience is not typical. I agree that improvement can continue for a long period of time, but I would also expect you to be doing quite well by this point. If left untreated, discolored legs can become a sign of vascular disease and cause other problems. At just 2 weeks- heat and pain is normal and anticipated. The top of the sock come to that area and also am concerned if there is more pressure placed on that area exposed above the sock level that might cause swelling at the knee and on the red area. He is the founder and main author of brandonorthopedics.com, a website that offers valuable resources, tips, and advice for patients looking to learn more about orthopedic treatments and physiotherapy. Her principle complaint was skin discolouration, associated with pain and swelling over the left knee, on the background of a previous total knee replacement with a metal backed patella resurfacing six years. (Map) (570) 861-8710. The next day, my knee swelled up again on 3 different occasions. Undergoing bilateral simultaneous knee replacement is challenging.

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