Managing severe back pain after knee replacement surgery and gait changes

[Ihateslugs]

I'm looking for advice on how to cope with excruciating back pain following knee replacement surgery.

I’ve had 2 knee replacements this year so am familiar with the recovery process and both new knees have healed quite well, being pretty much pain free now unless I move awkwardly. However, after my second one I began getting really bad lower back pain after a week or so. The consultant said it was because my knee is now straight instead on turning inwards but my hip and foot are now not aligned. Apparently he had a few problems attaching the implant to my shin bone as the edges of the bone were very soft so he had to make a larger incision and cut away a lot of the damaged bone. He was also unable to fully remove a large bone spur behind the knee cap so I will struggle to get my leg fully flat - not a problem to me at my age!

However, he said I just have to wait for my hip and foot to realign with my knee so that my gait is adjusted. I am still in pain and it seems to be getting worse this weekend, it’s been almost 8 weeks since the surgery. I have some core back exercises using a wobble cushion that my physio gave me and I also have two hydrotherapy sessions a week but I am struggling to weight bear and walk around.

I’m already on strong painkillers ( tramadol) and should be tapering off them now as my knee pain is greatly reduced but they seem to be the only thing that gives me temporary relief. I’ve previously been taking Naproxen and gabapentin but have stopped as they did not make any difference - the pain is not caused by inflammation or nerve damage.

Can anyone suggest my next steps please?

Do I go back to the physio for more back exercises?
Do I try to get an appointment with my GP to discuss better pain relief?
Should I see my consultant again even though I saw him two weeks ango and he just told me to be patient?
Has anyone has this problem following a TKR and could recommend exercises or strategies I could try?

I live on my own so obviously have to keep moving to look after myself although the most comfortable place is lying in bed!

After my hip replacement, I had back surgery too.

I used a TENS machine to relieve the pain, I was doubtful but it does work and it does help.

I have tried a tens machine but struggled to twist round to put the patches on! It’s worth giving it another go though as I really struggled to cope yesterday.

Did you see a hospital physio ? My advice would be to see a sports physio privately of you can. It will be about £50 initially depending where you live then cheaper for further appts. You probably won't need many but the difference between hospital physio and private ones are like night and day in my experience.

Do you have to twist your back when putting the tens patches on, can't you just put them on by touch? When I've had back problems ( I have a similar issue to you) the GP has prescribed a muscle relaxant which really helps, Methocarbomal. Are you keeping up with regular paracetamol and Ibruprofen too?

Have you had your back and hips scanned and are they certain your back pain is coming from your back?

I have severe back pain and discs in a mess from my gait but when I get a steroid injection into the hip joint the back pain and knee pain goes away for a short period.

i have similar issues to you - a hip that won't stay in place so terrible knee pain and arthritis - and hip surgery has not aligned things up. I wondered if they had checked to see if your legs were even after your surgeries and if a leg raise in a shoe would help?

Personally, I would not see a sports physio as a previous poster suggested but try to find a physio with experience in MSK and things like EDS where there are lots of subluxations etc so the physio has the experience to adapt the standard post TKR exercises to what you need.

I use ice packs on my back for pain relief and do back exercises by putting an exercise ball on a bed as I can't get down to stretch. The other thing that helps is using two crutches rather than one and limiting the walking you are doing until you can fix where your back pain is coming from.

I am seeing two private physios already, one in her consulting room and one for hydrotherapy sessions but I had to cancel hydrotherapy yesterday as my back was too painful to cope with walking from the car park and getting changed. I think I will make an appointment to see my other physio to get her advice, she has given me some simple back exercises but that was 5 weeks ago when it was not as bad.

I'm going to try the tens machine again this morning and not turn round to put them on!

I'm torn at the moment between seeing an osteopath or my GP!

I’ve not had any scans but the surgeon who did my knee replacement operation is convinced it is down to changes in the way I’m walking now my knee is aligned correctly, X-rays done after the surgery show this and he also manipulated my knee day at my visit. I think I’ll email his secretary to ask how long the hip realignment should take and see what advice he has re physio versus osteopath. I might also try to get an appointment with my GP.

I don’t think it’s my shoes, it’s something I have been considering so have been wearing brand new shoes since my surgery although it might be worth looking into orthopaedic inserts to even out my gait. Something else to ask my consultant or GP!

I would go back to your GP,your pain is getting worse ,you can always see physio/ osteopath too but I wouldn't see an osteopath until you know what you're dealing with.

My thoughts exactly! I’ve just completed the triage form to book an appointment with my GP. Hopefully I’ll get a phone call at least!

I'd have a scan privately on your back. I speak from experience. I went to the Spire because it was the closest to me. Saw the consultant, had the MRI then back to the consultant. You'll have the answers you need then.

I’ve had extensive knee damage and the awful back pain that comes with gait change, I saw a local practitioner for Bowen Therapy, if you could manage to get to someone, a few sessions is fantastic for resetting the body.

I'm three months post second hip so had both done in eight months. Yes my gait is buggered up. Yes to back pain. But my son noticed yesterday that I was walking much better.

I do still take a stick when going out as insurance against a fall on uneven ground.

@Ihateslugs is only eight weeks post surgery. Early days. I've had physio check every three weeks. Exercises adjusted. I do those twice a day. You get a lot of muscle wastage as you become more disabled by failing joints.