### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
i had a d dimer blood test on thursday, the result was 1013. the following day i had a scan and was told there was no evidence of a dvt. i had a total knee replacement on May 1st which has been a great success. unfortunately I developed this evil pain and swelling behind the operated calf. i can not bear to put weight on my foot/leg first thing in the morning but it does get easier during the day but my leg swells by evening. what ever could be wrong and what do i do now?

### output:

Hi, thank you for providing the brief history of you. A thorough neuromuscular assessment is advised. As mentioned you had undergone the TKR almost a year back, did you perform any physical exercises to get the optimum results of the post TKR? Usually all joint replacement surgeries are successful, but the post TKR rehabilitation is not followed properly and later stages there are issues. Also, since you mentioned you have pain in the calf muscle, and you cannot apply weight, first thing to do is to take an x-ray of knee and see if the prosthesis is intact. As in 99% of cases they are intact. Performing clinical test like - SLR will help guide further. As you already have a TKR, there will be a change in the gait mechanism and the abnormality in the spine due to abnormal weight-bearing on either side. Like if you had TKR on right then the left has more load and vice versa. Now TKR was performed due to pain in knee joint due to Osteoarthritis and reduced joint space. So it can be possible you have the OA knee from at least 5 years ? These 5 years have changes the biomechanics of the weight-bearing joints and may be tilting of the pelvic. Now to not go much deeper into the technical aspect of the situation, I will advise you to take an MRI of the lumbar spine to see any soft tissue abnormality. If the test comes positive the treatment will be guided for the same - rest, medication and physical therapy. So mention little brief here - that there is change in the anatomy of the spine due to OA knee and the symptoms arise before or after surgery. This is my personal clinical experience with patients. So when TKR is performed in our clinical practice we strengthen not only the muscles of the knee but also the core, spine, pelvic floor and whole lower limbs on each side. As we believe in our clinic that body functions as a single unit and disturbance in the unit may lead to symptoms at later stages. Our TKR cases in clinical setting are 100% success without any aches and pains for years. I recommend you to undergo an MRI of the lumbar spine and undergo physical therapy later. I am sure you will be 100% fit and back to life. RegardsJay In Chat Doctor. 