Femoral Damage After TKR

Posted , 11 users are following.

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!!!

3 likes, 37 replies

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37 Replies

  • Posted

    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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    • Posted

      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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    • Posted

      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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  • Posted

    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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    • Posted

      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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    • Posted

      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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    • Posted

      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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    • Posted

      Neurontin made me very strange. . even stranger than I usually am!  couldn't stop talking, felt absolutely hyper. . Lyrica, strangely, doesn't give me any side effects.  not sure that it does any good either, but as i said, I sleep . . sometimes all night!  I haven't done that since 1966 when my first child was born!

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    • Posted

      I hear you! Also felt like my hair was standing on end. I got prescription for Meloxicam today and a topical compound. The reviews for Meloxicam very good. Decided to first treat my GERD with Protonix and Lidocaine Viscous before we try other meds. My bedside table is getting ridiculous😜.

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    • Posted

      I CAN SYMPATHISE WITH THAT! MY HUSBAND TAKES SEVEN IN THE MORNING AND FOUR AT NIGHT, AND I TAKE SEVEN IN THE MORNING, AND THREE AT NIGHT.  WHEN I PICK THEM ALL UP FROM THE CHEMIST,  Oh no, sorry about the capitals, can't be bothered to type it all again . . . When i pick them up, there is a large carrier bag full of boxes, and a couple of hours work putting them into little individual boxes.  I hope Meloxicam works for you . . I haven't heard of that one. Have to google it!

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    • Posted

      I ended up getting out one of my little travel makeup cases and put it all in there today. Kept knocking pills over and off the table. I swear if I have to ask my husband just one more time to fish medicine out from underneath the table... Lol. He said looks like we have to create a spreadsheet of what to take when. Some of my meds have interactions so I have to wait a certain amount of time inbetween taking it. Some on empty stomach others not. Getting way too much nonsense!!!
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    • Posted

      Hi Milla, Hang in there. I started PT again. Mt PT said he will get me walking again. I told him I just want to be able to walk. I am keeping my fingers crossed. I am also praying for everyone in this forum for safe recovery. We all have individual challenges but we cannot give up. Let's keep the faith!!

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    • Posted

      Liz that is great news!!!

      So glad you saw someone and restarted the pt. I am excited for you. Please keep me updated. I would like to hear what you are doing in pt and how it is going. 🎉🎈🌟

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