Tollestrup ForumCategory: Neuropathy PainIs therer any relief from permanent nerve damage and CRPS from a total knee replacement?
Laura Barrera asked 2 months ago
Laura Barrera replied 2 months ago

I have had no relief from a knee replacement 2 years ago. I was told it would get better. It has gotten worse and the pain is horrible and has been life changing. I have had a thorough work up, including 3 MRI’s, 3 EMG’s, acupuncture, PT, medications and creams, 3 orthopedic doctors, 3 nerve blocks. Nothing has worked and I feel that my doctors have given up on me as they don’t know where to go and say this kind of problem is very rare for a total knee replacement. I have been told to wait for it to heal but it continues to get worse and has moved from my knee into my calf and shin. My foot is cold and numb since surgery and I have limited use of walking. Any suggestions what I do from here. I walk with a cane and must keep my leg up because of the pain. Eureka, Montana

Tim Tollestrup, MD Staff replied 2 months ago

Hi Laura. There is actually a very good solution to your problem. What orthopedic surgeons don’t realize is that all of the small nerves that give sensation to the original knee joint as well as the soft tissue envelope around the old knee are still present even after the bony joint has been replaced. These nerves can form painful neuromas or become entrapped in scar tissue. Either way, the end result can be much worse pain after the knee replacement than before. IN addition, the larger nerves that go down into the lower leg and foot can become compressed near the knee area due to the swelling and inflammation that accompanies a knee replacement. Once nerve pain starts, it can then become a vicious cycle because none of the patient’s doctors understand what is happening. The initial problem can then lead to alterations in how the patient bears weight on the leg, etc. This can lead to additional nerve compressions (pinched nerves) developing in parts of the leg that are remote from the knee. The symptoms you are experiencing in your calf and shin, as well as the foot are due to additional nerve becoming involved. A thorough peripheral nerve evaluation will be able to pinpoint the peripheral nerve problems. Fixing the pain will involve two different approaches. The original knee pain will need to be resolved by finding and disconnecting the small sensory nerves that have been damaged by the knee replacement surgery. The other symptoms in the lower leg and foot are due to larger nerves that have become compressed but were not directly injured by the knee replacement surgery. These nerves will have to be surgically “decompressed,” which involves opening up the tight spaces where they are pinched to relieve the pressure on them. Here is some additional information on chronic joint pain after surgery:

Also, your “CRPS,” if you want to use that term is the Type 2 variety. You simply have injured nerves. The treatment is to identify those nerve and treat them appropriately. Here is some additional information on CRPS as well:

Laura, please call my office 702-666-0463 and schedule a time to come and let me evaluate your problem. You do not have to live with this pain for the rest of your life.

Dr. T