Femoral Damage After TKR

Bones, joints and muscles
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I posted a discussion "It's going to be one of those nights" and this discussion was prompted by questions about my diagnosis of Femoral Nerve Damage/Palsy at 7 weeks post op (or 6th week) TKR.

From my perspective, if you need the proper terms and medical explanation Chico is your guy!😬

Surgery on December 16, 2016 went great! Previous ACL surgery about 35 years ago after field hockey injury. TKR for OA. Severe birth deformity of the patella discovered during surgery.

Once the nerve blocks wore off severe pain. Still normal. Worrying at that point - couldn't lift my leg for all the $$$ in the world - the straight leg raise.

Got home after 3 day hospital stay. Abnormal - my toes would hardly move if I tried to wiggle them. Home therapist told me to sit on side of bed and "walk" my toes forward. Almost impossible. My foot was like a dead fish. OS said come in. Sounds like "drop foot". After examination still vague, did not diagnose it as drop foot but says "it looked like it".

Had all the other symptoms of TKR recovery. Except severe pain continued, not just my knee but my leg. Entire leg and foot. Poor rehabilitation even though I started physical therapy on Day 1 after surgery. Most significant symptoms - inability to do a straight leg raise and severe, ongoing pain in leg not just knee.

Physical therapist called OS re: poor rehabilitation etc. OS did EMG (painful/Needles) and a nerve conduction test. Results showed femoral damage, nerve damage and excessive weakness of the quads beyond "normal" damage that occurs as a result of the surgery.

Femoral damage causes severe pain, areas of numbness, sensations all over the leg and restricts movement, weakness and instability. Pain is in entire leg (I get a lot of pain where the nerve block was done), my ankle and foot hurts too. Ultimately it is a toss up between the nerve block and tourniquet that causes this damage.

Prognosis - Ongoing severe pain over the leg, poor rehabilitation (especially with weakness of the leg and rehabilitation of the quads.), immobility. Electrical stimulation twice a week, physical therapy 2 a week.

Ultimately time is the main factor in this healing. It is a rare complication but not that rare. Used to be a heavy smoker as well and cannot help to wonder if this was a contributor.

So I feel like everyone else going through a rough recovery but with added ongoing strong pain over the entire leg and foot. My progress is at a snails pace but at least I am making progress!!!

I never feel like I am worse off than all you guys except that I am going at a really slow crawl with recovery and that I just have a different pain level at times. YET I have seen so many TKR patients still suffering from severe (and worse yet- relentless) pain without any complications.

In hindsight - if you cannot or barely do a straight leg raise; severe ongoing pain and pain and weakness in foot - see someone!!!

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hi there

dont know if you have seen any of my posts....im 48 and had a "routine" arthroscopy 4 years ago....and ever since i have quads palsy...cannot lift my leg at all!!!

no real pain except in the kneecap but my knee gives way a lot and i did fall and break my kneecap 2 years ago...

ive had xrays/scans/mri s/nerve conduction studies and all they can say is femoral nerve damage resilting in a problem at the muscle/nerve juction....and paralysis of quad.

nooone seems to know why/how this happened..

saw my consultant last week who said now its been so long since the op its highly unlikely of any recovery

i am in a full leg brace and continue to try...but how can you strengthen the quad if theres nothing to work with and i cant even lift my leg???

sorry to hear of all you are also going through

good luck

helen x

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Femoral nerve...geez...  The femoral nerve derives from the nerve roots exiting the spine at L2 through L4.  Have you considered an MRI and then a definitive CT/Myelogram with contrast focusing on that part of your spine?  Have you seen a neurosurgeon about this?

Had really bad sciatica about 5 years ago...nothing worked.  Chiropractor, PT, pain shots, zippo.  MRI showed something but nothing definitive.  So the neuro went in and found a bone spur "crushing" (his word) the nerve root at L4/L5.  Got rid of the spur and shaved back the calcified L5 disk a bit.  Walked out...zero pain.  Poifect!

If this is nerve related and emanating from your spine, I'd look into it with a neuroSURGEON.  Also, if the problem turns out that the nerves have to be decompressed (I just solved my stenosis problem), there is an alternative to fusion with its 10-day hospital stay and 6 months of rehab.

Go to YouTube and search for "Globus RISE-L".  Cute little animation of what I just had done.  Overnight stay...zero rehab.  Expanded the space between the vertebrae and took all the pressure off the nerves.  Instant pain relief although there's about a 2-3 week recovery period with some temporary nerve pain because they "move a lot of stuff around" getting to your spine from the side and not the back.  May work for you.

There are options, Milla...you should not live your life in pain.

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Milla, my heart goes out to you!  Thank you so much for telling us all that - it helps us put the bits and pieces together to understand what's happened to you!  I'm so pleased that you ARE making progress, even though it's slow.  The fact that it's going in the right direction is so good!  Thinking of you!

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Helen, as with everything there's degrees of severity and your case seems way more severe than mine.

I was told that surgical intervention is a possible remedy but my OS felt that the reaction time was not bad enough to justify it. Personally I also would like to avoid surgery. In your case it seems like it might be your salvation. After 4 months of physical therapy, the exercises and the electrical stimulation my quads are barely starting to fire.

My therapy includes a lot of "re-conditioning" therapy. It is no excercise for my quads per se but to "fool" it into responding.

Sounds like you have been through hell but you must get the strength to find a remedy/relief for this. I know some palsy have a very bleak prognosis but I hope you don't lose hope!

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Chico, at this point I think I have a better shot at getting help going to the pain management clinic for further diagnostics. My OS is very intimidating (albeit super available). I have asked and asked and he said to carry on with electrical stimulation and re-conditioning therapy aside from physical therapy. This seems to be a matter of ego to him. He was very defensive when he explained my diagnosis to me and seemed more intent on placing emphasis on the fact that he was not to be blamed for my complication.

From my surgery report and comparing it to some medical data I am inclined to agree with him. Problem is he seems to want to remove himself from the situation as much as possible.

Also my pain starts in the buttock and goes all the way into the foot. No back problems. He has never suggested any other tests and said the EMG and nerve conduction is conclusive.

It is also not just sciatica but severe pain.

Plus I think I have been too complacent in accepting whatever he is saying. I have to coach My husband down every time I have a consultation because he is extremely angry at the OS. More so for not doing more to alleviate my situation. I am going to print out your post and take it with me to the pain management clinic to help me ask more pertinent questions.

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Thank you!

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ahhhh thanks for that...

my quads wont fire at all....even when my physio and i use farradic current through the muscle....nothing happens on that leg....the muscle just wont contract!!!

but you are right...i \always cling on to hope

really hope you recover well

h xx

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Hi Milla,

Thanks for your explanation now I get it. Very clearly put.

I hope the pain clinic sorts the pain out and hope your recovery albeit slow is good. You sound very determined and still young so it might be slow but sure.These days there is no.need to have uncontrolled pain.

I guess if you are not satisfied you'll get a second opinion.

I have had a relatively smooth recovery at 17vweeks but RA inflammation got in the way some days 😯.

Certainly reading Oldatguys and Chicos posts have helped. Admiration for the philosophy there so true you have to stay strong.

All the best Lee.us all posted, Jan.

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Hi Mila, I understand your situation. I do not get ain daily but pain occurs when I try to lift my leg for my extension exercises It feels like there is a badn below the knee, not sure if tit's the implant but it feels like something is sitting there preventing it from lifting further. I then will nootice swelling in my feet along with numbness especially to my toes1-3. I will restart PT and thinking of a second opionion..hang in there

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Hi Milla,

​I've had a number of these symptoms although toes are OK, ankle feels as if broken at times.  Not to say I have anything as bad as your diagnosis but certainly more severe neuro pain all over leg than I'd expected and leg does not lift etc.

​3 weeks now since surgery. Getting checked out as progress has been slower than expected. I do hope you will continue to make a good recovery, even if it is gradual. Just not having the severe pains at night would be wonderful for me now.

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Hi Mila, My test showed neuropathy. Certainly t will take a long time to heal.Keep on with your exxercises and Let's keep the faith!!

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Well probably my case is not as bad as yours, but lots of similarities. . however, I've never received any sort of definition. after the op, couldnt put my foot to floor or move the foot at the ankle . .it just sort of hung there. the specialist even came in to see me on a sunday, driving some seventy miles from his place of residence.  He told me later he was afraid that the nerve had been severed . .  they kept on at me to walk, but it was impossible . .while I could lift the leg, the foot just dragged . .rather like your wet fish! . . .Pain in the thigh area was excruciating . like someone ripping the flesh off with a hot knife. . after a couple of days, tingling and burning in the foot, like a very strong pins and needles. . . . i couldn't do the straight leg lift for about fifteen days.  A month or so later I was  diagnosed with polyneuritis, but I honestly think it was a side effect of the operation, although they hum and haw and say probably not . . strange though how it all started the day after the operation!  Two years post op, the thigh is still numb, and yet painful to press  . .the foot still tingles and burns especially at night . . but I have movement and a good knee, so all in all I am quite happy! I realise that it could have been a lot worse!

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You say it is not just sciatica, but severe pain . . but believe me, sciatica IS severe pain . . . It may not always be,  but it certainly can be. . .

​

 

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Your buttock is the location of the "sciatic knot" (one each side), a bundle of nerves from your spine that meet in one place in each "cheek" before running down your leg.  I've had sciatic problems that didn't give me a lot of back pain but from the sciatic knot on down it was murder.  The other problem is that nerve pain is treated with Lyrica, Neurontin and Gabapentin. The first one does nothing for me while the latter two put on 20 pounds in a month.  Not gonna happen.

Right now, I'm dealing with the nerve pain from the surgery two weeks ago.  All the stenosis pain is gone.  A few T3 pills and a lot of heat is keeping it at bay.  Luckily, it's only temporary...can see a big change in the last week. Honestly, this nerve crap is the absolute worst.  I wish you well...

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Get better soon! 

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Sciatica is nerve compression or swelling in the lower back region. 

Or another option feels just like sciatica nerve issues ,see Pariformus Syndrome. This is under diagnosed by professionals pain is very similiar to sciatic nerve compression. It is a tendon in the lower back region located over the sciatic nerve. From surgery and recovery swelling can cause the periformis tendon to pinch the sciatic nerve located under this tendon causing sciatic nerve pain. 

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My sister had spinal surgery late last year (I think it's her second one). She has not been rid of nerve problems since the first surgery. I think she is on Lyrica. And a million other meds. She was finally put on permanent disability. I had Neurontin with Topamax. I am not easily medicated. You name the side effect I get it. Got severe numbness in my hands, flushing and nausea and that was the end of that. I can't say that it made a difference. Plus it had a dangerous interaction profile with another anti seizure med I am taking.

Hope you feel better and those nerves heal. I heard the healing causes a lot of pain (like the "zappers" I get).

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Nights are tough! Especially that early. I found that setting my alarm in order to make sure that I keep pain under control helped me. Had to wake up to take it but tried to avoid the pain level going up too high and spending the rest of the night icing and all sorts of tricks to bring it down. It is hard though, very few people sleep well for a long time. Hang in there!

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Absolutely!