TKR - sunburnt shin

Bones, joints and muscles
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Hi folks.  It's been interesting reading this forum - thanks for all the contributions.

There has been some mention of my specific problem some months ago on here but rather than resurrect that I thought it may be useful to start a new specific thread.

Im 56 yo male.  16 days post-op of left TKR.  Operation went well.  Had epidural and when that wore off pain was off the chart and after about 5 hours waiting eventually got some oxycodone which helped.

I had significant swelling and bruising BELOW my knee - on my shin, calf and foot - much more than the average displayed on a search on Google images for TKR.

I was discharged after 3 days as once pain under control I was managing to exercise and got 90 degrees and leg raises and as knee itself wasnt cause of any undue pain they were happy to let me go.

Swelling remained at discharge.  I was told to take self injected Fragmin as precaution for DVT which made the swelling even worse...and the pain with it significant.  I went back for a scan to see if there were any indications of a clot but that was inconclusive as the leg was so swollen the scan wouldnt go deep enough so DVT doctor increased dosage of DVT drug to treatment level (as opposed to precautionary dose)

Wow...that made my leg swell even more...and pain increased again.

Oxycodone didnt touch it.  So after second dose I made decision to stop taking it....and slowly the swelling came down over following days....and I actually managed to get 2 hours sleep.  (Have since had another scan which was negative for clots - so yes, I know not following orders to take Fragmin is definitely not advised - but it was my decision)

It left me with some reduced swelling on my lower leg but that is now very hard and VERY tender to touch and constantly uncomfortable.  The skin on my shin resembles sunburn....like the worst case I ever had.

The original post which prompted mine suggested their GP prescribed Neurontin...and following a phone call with my GP he agreed to let me try it....and it came in form of gabapentin.  It certainly worked and took the pain away from the sunburn....or rather reduced it to bearable levels.

I cant get in to see my GP until Friday.  Whilst the gabapentin is dealing with the pain nothing is being done to treat the condition.

Has anybody else had this?  Did you find a cure?

Im supposing the excessive swelling has done some damage to circulation or nerves and that it will sort itself out, hopefully, eventually, but its really stopping me doing any advanced exercises I wanted to do.  I can walk half a mile with sticks....yay it's sooo good to get out in fresh air but wanted to work more on flexing my knee sooner rather than later..

 

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Goodness you are really going through it .Its bad enough going on the joiurney as it is .. I am 14 weeks post and still have lots of aches and pain especially in my calf .. The meds is still being taken at night but try to not take in the day .. The sunburn feeling is new to me , I do feel for you, but early days  

Take care and wish you better 

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Hi Doug, firstly, well done on being able to walk half a mile at 16 days, you're doing really well.

I haven't experienced the sunburn feeling you described, but something else came to mind - you said you phoned your GP and they prescribed Gabapentin - has he/she seen your leg since surgery? It's just that the hard, burning, redness you described sounds to me like a typical description of the early stages of Cellulitis. Obviously I could be way off, but you're seeing your GP on Friday, so hopefully they'll be able to sort you out.

Keep up the good work; I've had considerable swelling this time around so can really understand how frustrated you are at not being able to do the more advanced exercises.

Take care and let us know how you get on xx

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Hi Doug

Yes, you are going through a bad time.

Did the doctor not suggest changing the anti-coagulant medication in case you were allergic to it?  I've taken Rivoroxaban after all of my surgeries.

When I came out after my second TKR, my leg became very swollen the next day and I went back into hospital...as a precaution.  However, my consultant just said that I needed to keep it elevated.  It did calm down eventually.

Has the doctor considered anything else?  You mention nerves and circulation...could it be phlebitis (my Dad has had that on both lower legs for almost a year now)?

Hope you get the answers (and relief) that you need.

Patsy

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Thanks for replies. Ive not seen a doctor specifically about the problem yet The last one I saw was in the DVT clinic attached to hospital (but not part of it) and she was only concerned about essentials of preventing clotting. After she told me she was increasing my dose I expressed my disappointment and suggested that it would make swelling worse She didnt suggest any alternative - I did ask.

So when swlling did become worse I simply stopped it.

There was no face to face appointments available at GP but they did have a phone appointment I apologised for being another "internet medic" (which he chuckled at) and after listening to my plea for neurontin he agreed to try it.

Im looking forward to friday face to face and will report back then.

Thanks again

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Sorry if I have missed the plot somewhere, am I reading correctly that you had a TKT 16 days ago

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sorry should say TKR

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Yes - I had TKR 16 days ago

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Did they say anything about or suggest that damage from turniquent might have caused this. Durnig surgery they have a system to to cut off or slow down blood supply. This often times can take a long time to heal itself. Are you elevating your leg every time you sit and icing several times a day to keep the swelling down as much as possible. Unfortunately this can take some time and rest any elevation is important.

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Walking half a mile 2 weeks after surgery are have to expect painful issues.  Your leg has been broken, tendons, ligaments and nerves have been, pulled about, cut, spliced, stitched, you name it.  It all needs time to settle down. Exercise is still key, but walking is just a tad too adventurous right now. 

When you are sitting down keep you leg raised. At night keep your leg raised, if you can't use a pillow, put something under the mattress.  The more you aggravate the healing process the longer it will take to settle down

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No I disagree that my walking so far has exacerbated the problem.  It was there before I started walking any distance and has neither improved or worsensed because of it.  When I say walking it is more hobbling on a crutch anyway - I should have made that clearer.  

On return I go back to bed where leg is raised with a suitcase under mattress.

But anyway...back to the problem...see main thread

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@oldfatguy1 - nobody has discussed anything with me yet to be honest - only medical people I have seen since discharge were DVT clinic who are only concerned with clotting.

There's a small but significant update.   I get prickly heat a lot when in the sun.  I never tan...just burn - so always do my best to stay covered or in shade.  Tiger balm is usually very good for me to treat the prickly heat I get.

I thought I'd try some as the symptoms are very much like sunburn.  I popped up to Boots to buy some and applied it and within minutes the pain and soreness has abated much more than the gabapentin.  Now I dont know if this is co-incidence and the condition is beginning to settle down....or the Tiger Balm has had the desired effect.  I just thought I'd mention it here for any others who experience similar symptoms.

Gabapentin now in the bin - it worked a little bit, and deffo helped, but I wasnt keen on the long list of possible side effects (none of which I experienced thankfully)

 

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Doug....I just re read your original post. Just because you can do something doesn't mean you should when it comes to re habing joint replacement. Everyone is different and every surgery different, even on the same person. Just a quick background on me, due to a rare tumor I have had 11 surgeries on the leg included 3 different prosthesis and 5 complete rehabs. Personally, I think the mile at a time is too much in one walk this early in the process. You have to take into consideration the amount and extent of the damage done. Just the way the bone has to be modified is severe trauma the

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damage to the blood supply is extensive and add to that muscle damage. It takes a certain amount of time and rest For all of this stuff to repair and when you push it beyond normal limits you are continually suffering a back set. Be sure and tell your Dr about the walking and get a professional opinion. I guess its your body and your pain so toy have to be the ultimate decision maker

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Yes of course.  Thanks

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I am one those on here who tends to go sideways, and then fellow forum-ers have a "shout at me". However at the risk of repeating myself, one of your issues is "I had significant swelling and bruising BELOW my knee - on my shin, calf and foot - much more than the average displayed on a search on Google images for TKR."

You then go on about walking,(hobbling, crutch, walking stick) for a distance, all very admirable, but...  You are then saying because of what you found out, you are telling your own doctor what meds you need.  As Oldfatguy1  says, everyone is different, so even recommended meds will/may not work on you.  Trawling through the internet will also give you different answers; this leads you to be confused and frustrated as comments will always be contradictory. If you really are not happy, treat your symptoms individually, for the pain, yes you need meds either go back to your doctor or see your consultant (or pain management consultant if pos, they really are the best).  If your consultant cannot help get a second opinion, The heat in your leg is telling you there is something wrong, if it does not settle down after RICE (Heat: Heat makes blood vessels get larger, which is called vasodilation. This action helps to flush away chemicals that are making your knee hurt. It also helps to bring in nutrients and oxygen which help the area heal. True heat in the form of a moist hot pack, a heating pad, or warm shower or bath is more beneficial than creams that merely give the feeling of heat. Hot packs are usually placed on the sore area for 15 to 20 minutes) then go to A&E if your doctor will not/cannot help you. The pain in your shin/calf is where they cut your bone, think of all those severed nerves  I am not having a go at you, but you are being a tad impatient, you may know your own body, but you have had a serious operation, which is not the same as just breaking a bone.  A couple of weeks behaving and just doing what the professionals tell you and you should notice a huge difference.  The guys on this forum (excluding myself here, as this is where I back off) are always here to back you up, pick you up when you are down and and between the lot of them suggest helpful means of geting back to normal.  But initially you can't break the rules and think you know better.  Good luck x

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Well I thought I'd pop back on here just in case anyone has these same symptoms of the "sunburn" shin.  That all cleared up quite quickly after a few days on the gabapentin.  Of course I dont know if it would have cleared up without it but anyway they did seem to help.  It's still there....very slightly now and not enough to bother me.

In other news I'm walking well...with crutches but only there for when I need them (ie not putting weight on them much) about a mile a day - in fits and starts (shopping trips)

Hospital hasnt sent me any appointments for physio so Ive just been doing minor exercises.  For me I'm not bothered if it leaves me with a limp or I cant quite bend the leg as much as the other - the progress Im making is enough for me and my goal is to take my dogs on the beach by week 12.  I'll only do that if I'm safe enough to be able to control them - and at 5 and a half weeks...thats looking very likely.  Considering I hadnt harldy been out of the house for 2 and a half yearsI'm quite chuffed with that.

The worst thing about this whole situation, for me, apart from that horrendous swelling and subsequent "sunburn" was the insomnia.  My GP has eventually given me a 7 day course for 7.5mg of sleeping pill an last night I had 8 glorious hours sleep.  Today I feel like a new man and, I guess, the reason for this further post is up until yesterday my answer to "was it all worth it?" was a resounding "NO!"   But today has really been a boost and the pain of the last 5 weeks has been forgotten.  If my recovery continues at this rate I'll be doing a Michael Flatley when I see my consultant in 3 weeks and shake his hand.

Thanks EVERYONE for relating your experiences and advice - they have helped me enormously in making decisions that have been right for me.

 

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Hey Doug, that is wonderful news, Isn't it so elating when you suddenly realise there is no more pain (well, there is, but a different kind of pain)

Well done for getting out there with the added bonus of a nearby beach.

Just a few words of caution, you are not at the 6 week mark yet,  that is when a normal broken bone should be healed.  Yours is more complex and will take a little longer, so when you reach the 6-8 week mark and you feel as if you have stopped reaching your goal, do not lose heart/patience.  You are one of the very few that have taken the meds prescribed and felt better for it. Keep relying on them for as long as you need; they are there to help not hinder. I wish you all the very best and can imagine you irish jigging on the beach, crutches (preferably walking stick) in the air with your dogs chasing after you.