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Diabetic And Has Heart Stents. Knee Pain After Total Knee Replacement. Diabetic Neuropathy?

Posted on Tue, 5 Mar 2013

Question: My husband had a total knee replacement and also a revision on the same knee. He had fluid retention before the revision. He is still having pain in the area of the bone beneath the replacement. He is a diabetic and has 4 heart stents. He has had a bone scan before the revision. He still has pain in the knee. It is driving both of us crazy because we get nowhere with his PCP and Orthopod. Could it be diabetic neuropathy? Cancer was ruled out on the first bone scan. Now his PCP has ordered another bone scan and blood work. Is there such a test for nerve damage/conduction in the knee area like for carpal tunnel? Please help!!

Answered by Dr. Dr. Praveen Tayal (1 hour later)

Hello,
Thanks for posting your query.
Persistent pain after total knee replacement can be due to neuropathic pain, XXXXXXX scarring (arthrofibrosis), loosening of the prosthesis, patellofemoral instability, postoperative stiffness, etc. A direct clinical examination and investigations like MRI and arthroscopy are needed to identify the exact cause. The treatment usually involves pain killers under guidance of a pain therapist, physiotherapy, occupational therapy, etc.
You need to consult your surgeon for proper diagnosis and further management.
To rule out a nerve damage or neuropathy, a nerve conduction study of the lower limbs will be helpful under the guidance of a neurologist.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Regards.
Dr. Praveen Tayal.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (17 hours later)

Our PCP has ordered a triple phase bone scan of the knee. Upon revision the knee appliance was not loose. The pain is around the kneecap and down the front of the leg on the right side. How can an MRI help if the knee has been replaced with some metal in the appliance? This man has suffered with this problem since the replacement almost 3 years ago. All appears in order but the pain is still there. Any ideas other than what you have already stated would be a help.

Answered by Dr. Dr. Praveen Tayal (2 hours later)

Hello.
Thanks for writing again.
If the knee appliance is not loose then XXXXXXX scarring or stiffness might be causing the pain. Oral pain killers and hot fomentation in the area will help in reducing the inflammation. Regular physiotherapy exercises will also help in reducing the stiffness.
A bone scan and arthroscopy are the best ways to diagnose any XXXXXXX structural problem. MRI is not possible with a metal appliance.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (33 minutes later)

We can only hope the insurance will allow another bone scan. He has had rounds of PT to no avail. The knee is definitely stiff so maybe we are on the right track with the bone scan. Could he have an allergic reaction to the replacement? What would the sx be if he was allergic to it?

Answered by Dr. Dr. Praveen Tayal (9 minutes later)

Allergic reaction is also a likely possibility. It will present with inflammation, pain and swelling. Accumulation of fluid in the joint space is also likely. But allergic reactions to such implants are not commonly seen.
Regards.

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar