Richard Haynes PTA/CPT - 5/5/2009

Question
Hi Dr. Haynes:

I had a total left knee replacement on 12/17/2008 and now, almost 5 months later, I am still having pain and swelling.  My doctor performed aspiration surgery a week ago and drained 25 cc of fluid from my knee and afterward it was wonderful - I could bend it, lots of flexability, and had almost no pain at all for about 4 days, but now the swelling and stiffness and pain is back.  My doctor is scratching his head and doesn't have a clue.  Can you tell me what might be the problem?  I think it has something to do with the fluid my knee is creating.  What are some of the reasons my knee would be creating fluid?  Thanks.  

Answer
Hi Judy,

Thanks for the question. I just want to let you know I am not a Doctor. I am  a Physical Therapist Assistant here in the state of Florida. I have worked with all types of joint replacements now for 14 years.
I had a knee replacement myself in 1999. Thanks for the promotion though.
In getting to your question,generally if your knee is producing fluid that is a sign that something in the knee is acting like an irritant to it.

Did your doctor run any test on the fluid to see what if the white blood cell count is high? I am sure your orthopedic surgeon has checked into these things but its always good to ask if you are not sure.

Have they put you on or have you been on any type of antibiotics?

If in fact the knee or surrounding area is swelling there can be other reasons as well. Most knee replacements will take close to a year to fully heal so, some swelling and irritation is not unheard of months after surgery.

How was the rehab? did you complete it without difficulty? And how did the knee behave regarding edema control during rehab?
Does your body retain fluid? Have you taken or do you take water pills like lasix for instance?

Some people will have trouble with excess fluid build-up months after surgery for no reason, our bodies all react a little differently to this type of surgery.
If this continues either have the doctor dig into this a little deeper for the root cause or if all else fails seek another opinion.

You just want to be sure that there is not a low grade infection or irritant in the joint itself causing this your doctor however will be aware to look for that as well.

If there is no other explanation then it can be a case where with more time and healing, that the swelling and pain should decrease, this could go out to the six-eight month period. Thats sometimes is  rare but again not unheard of.

Good Luck
Richard Haynes
Punta Gorda, florida. 33950