My spouse had her second total knee replacement for arthritis, a bit over 3 months ago. She was doing well and recovering like the first knee until some weeks post, then it started hurting. It’s grown worse and worse and she now hurts more than before the surgery, which she regrets. She’s seeing her surgeon tomorrow and getting an ultrasound the day after (which order seems backwards to me). She’s been doing PT and the therapists and her general practitioner suspect maybe a Baker’s cyst or possibly even a clot. She has sharp pain centered in the joint, and muscle pain to the outer side and behind the joint, dependent on position and movement. Wiggling the leg sideways or rotating it seems worst.
She’s 71, diabetic, very overweight, with cirrhosis.
Any thoughts on things to ask about? Or things to investigate on our own?
My gf’s aunt had a very complicated recovery from knee replacement. I didn’t think her doctor was being aggressive enough (but what do I know) and I and other family members convinced her to seek a second opinion.
It turned out there was infection. They removed the implant and sent her home without a knee. She stayed in a hospital bed at her home and a visiting nurse came twice a day to administer her medication.
This all started when she was 79. She eventually got a new knee put in and recovery was smooth.
Diabetics in particular have very high rates of post-surgical complications, because they often heal slowly. TBH, I’m surprised they actually did the procedure with her being as high risk as she is.
How overweight is she? (Approximate height and weight is fine.)
I don’t generally get into the likelihood of specific diagnoses over the Webz. The proper ultrasound can reliably detect cysts, fluid within the joint, and deep venous and arterial clots. But here is a list of general relevant questions:
What is the best way to manage the pain?
If it is likely a clot, what interventions would be most helpful?
How long is the replacement expected to last?
If losing weight would help, are there covered diabetic medications that may make a difference?
What activities should be avoided?
What would you suggest regarding travel?
What exercises might be more helpful?
Are compressive garments helpful in this instance?
Is there benefit to other imaging modalities?
Would assistive devices over the short-term offer further benefit (if they are likely to be used)?
Is there further help that can be offered regarding sleep/ pain/ anxiety/ functioning/ mobility/ sugar control/ liver function/ weight/ any other relevant social or medical issue depending on case specifics
BMI of approximately 38. I’m guessing that 40 or more is when they get really concerned?
I once worked with a woman who was probably more like 5’7" and 300-ish pounds who was denied a knee replacement, and she told all of us at work that her doctor was refusing to do it because she was too young, at 40-ish. I’m not the only person who knew otherwise - that the doctor wasn’t going to do it until she lost some weight, or it wouldn’t benefit her.