Mayo Clinic Q And A: Pain After Knee Replacement Surgery
DEAR MAYO CLINIC: It has been months since I had knee replacement surgery, but my knee is still hurting. Can anything be done at this point, or does the surgery just not eliminate pain in some patients?
ANSWER: Although its uncommon, a small percentage of patients continue to have chronic knee pain after knee replacement surgery. But when that happens, you dont have to just put up with the pain. Have your situation evaluated. Several additional treatment options may ease chronic knee pain after knee replacement.
Knee replacement surgery, also known as knee arthroplasty, is one of the most common orthopedic surgeries performed today. It is most often used to repair joint damage caused by osteoarthritis or rheumatoid arthritis that causes severe knee pain and makes it hard to perform daily activities.
During knee replacement, a surgeoncuts away the damaged bone and cartilage from your thighbone, shinbone andkneecap, and replaces it with an artificial joint. For most people, kneereplacement significantly improves mobility and relieves knee pain. But in somepatients, the pain persists after surgery.
Your first step in dealing withongoing knee pain in this situation is to make an appointment to see thesurgeon who performed your knee replacement. He or she can evaluate your kneeand check for possible complications from the surgery, such as an infection ora problem with the artificial joint.
Introduce Gradual Movement To Your Knees
Bracing can help shorten the time you need to get back to your feet unaided as it secures your knee. In this way, a;post OP knee brace;helps restrict your knee joint to protect it from flexing too much. As your recovery progresses, though, you can adjust the brace’s level of restriction.
It’s important to introduce gentle movements to your knee as soon as you can after your surgery. For starters, this helps prevent your knee from developing excessive scar tissue. So, by performing;gentle knee exercises, you can keep knee stiffness at bay.
To help prevent re-injuring your knee, though, it’s best to keep using your;hinged knee brace. This way, you can give your knee more support and stability, preventing it from “buckling.”
Conventional Treatment Methods Of Knee Pain
Knee pain is treated in a variety of ways. Once the cause is diagnosed using proper techniques, a treatment plan is set in motion. Doctors use information such as a patientâs medical history, overall health, activity level, and comfort level to create a treatment plan that is unique to each patient. In the beginning, these plans typically enact the RICE method. This stands for Rest, Ice, Compression, and Elevation. Sometimes patients also take over the counter NSAIDS such as ibuprofen. Pain is often caused by a form of inflammation, so these methods can help subside the pain.
If these less invasive methods fail to relieve pain, doctors will turn to slightly more intense treatment methods such as physical therapy or corticosteroid injections. Physical therapy seeks to strengthen muscles surrounding an injury and increase a patientâs range of motion. Corticosteroid injections are used to inject a powerful anti-inflammatory agent directly into the pain area. This is most often successful at relieving pain in the short-term but has been proven to damage tissue over time. Corticosteroid injections are not considered a long-term solution to knee pain.
After undergoing slightly more invasive treatment methods and still failing to see results, doctors may discuss surgery as an option. Initial surgeries for knee pain are less invasive than a total knee replacement. These surgeries may include:
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Here Are A Few Things You Can Expect After Knee Replacement Surgery:
- Rest and Ice: The knee will be swollen and tender, which is why you need to follow doctor suggestions for keeping the leg elevated and icing the joint.
- Medications: Not only does medication help with pain management, but it is also vital to reduce inflammation. Sometimes antibiotics are needed for preventing infection.
- Follow Up: You will have follow-up appointments to talk to your sports medicine doctor about recovery. Surgical staples or stitches will be removed during the office visit. Reach out to your doctor if you notice unusual symptoms, such as redness, fever, incision drainage, or increased pain.
- Home Modifications: You might need certain modifications to help you navigate your home. Since the knee needs to heal, you must use crutches. Some patients transition to a cane or walker as the recovery progresses. Consider using other modifications, such as handrails, a shower bench, a reaching stick, and removing loose cords and rugs that could cause a fall.
What Helps Pain After Total Knee Replacement
It’s;vital to note that pain is often inevitable right after knee replacement surgery. However, you should also know that the success rate of such procedures is;90% to 95%. Successful implant placement also lasts for over a decade.
With that said, there are many ways to manage and ease pain following knee replacement. Here is a general guideline, including a timeline, of what you can do to reduce knee surgery pain.
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Swelling After Knee Replacement: 5 Things To Know
by Kneereplacementrehab·May 29, 2020
Are you worried about swelling after knee replacement surgery for your right or left knee? Or you have heard about swollen new knees from others so much that you have decided to understand it better before you plan for your knee surgery.
One of the blog readers asked me the following question by contacting me: Hi, my name is Mary, and I am a 60-year-old person whose right knee was replaced six months ago. I am pleased with my knee replacement recovery, but I am concerned with swelling in my right knee. Early in the morning, my right knee is normal; but by the evening, my knee swells become stiff and bothers me! Why is that happening and what can be done about it? Please guide me.
Does it sound familiar? May be duration will be different for you when compared to Mary, but the swelling is bothering you. And thus you are searching on the web about this issue.
First of all, let me assure you that swelling after knee replacement is widespread and happens to all patients to some extent. Swelling to any part of the body after surgery or any injury is a widespread occurrence. So dont worry too much about it.
Let me help you understand this situation by explaining to you about:
- Why does it happen?
- For how long it remains.
- How to relieve swelling after knee replacement surgery?
- Icing after knee replacement
- Warnings and precautions
What Is Revision Total Knee Replacement
Revision total knee replacement is the replacement of a failed total knee prosthesis with a new prosthesis. In simple terms, it is the replacement of a knee replacement .
Knee revision surgery is a complex procedure that requires extensive preoperative planning, specialized implants and tools, prolonged operating times, and mastery of difficult surgical techniques to achieve a good result.
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Infections Of The Surgical Site
By 2030, experts estimate that there will be up to;3.48 million knee replacement;surgeries in the US alone. They also say that a rise in knee replacement revisions will contribute to this growth. All in all, they project knee revisions to grow by 601% from 2005 to 2030.
Infections are some of the possible causes behind knee replacement revisions. Most infections occur within the surgical wound itself. However, harmful germs can also invade the area around the artificial knee implant.
Researchers say that infections can affect between;0.4% and 2%;of primary knee surgeries. This goes up to 3.2% to 5.6% in patients who undergo knee replacement revisions.
In any case, an infected knee replacement can result in both swelling and sharp pain. If you experience these two together, make sure that you let your doctor know. Your surgeon can determine if your knee has developed an infection.
Preparation For Total Knee Replacement Surgery
Patients undergoing total knee replacement surgery usually will undergo a pre-operative surgical risk assessment. When necessary, further evaluation will be performed by an internal medicine physician who specializes in pre-operative evaluation and risk-factor modification. Some patients will also be evaluated by an anesthesiologist in advance of the surgery.
Routine blood tests are performed on all pre-operative patients. Chest X-rays and electrocardiograms are obtained in patients who meet certain age and health criteria as well.
Surgeons will often spend time with the patient in advance of the surgery, making certain that all the patient’s questions and concerns, as well as those of the family, are answered.
The surgeon’s office should provide a reasonable estimate of:
- the surgeon’s fee
- the degree to which these should be covered by the patient’s insurance.
Total Knee Replacement Surgical Team
The total knee requires an experienced orthopedic surgeon and the resources of a large medical center. Some patients have complex medical needs and around surgery often require immediate access to multiple medical and surgical specialties and in-house medical, physical therapy, and social support services.
Finding an experienced surgeon to perform your total knee replacement
Some questions to consider asking your knee surgeon:
- Are you board certified in orthopedic surgery?
- Have you done a fellowship in joint replacement surgery?
- How many knee replacements do you do each year?
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How Long Does Knee Pain Last After Knee Replacement Surgery
One of the most common questions we hear is, How long does pain last after knee replacement?
Traditional total knee replacement will typically require one to three months of recovery with the use of a walker or a cane; while partial knee replacement surgery requires significantly less time. But there is more to consider when trying to figure out how long pain will last after surgery.
How long the pain lasts after knee replacement surgery depends on a wide range of factors, before and after the surgery.
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What Are The Odds Of Chronic Stiffness After Knee Replacement
As many as;4% to 35%;of patients can develop chronic knee stiffness after ACL surgery. Known as knee arthrofibrosis, it’s one of the most serious side-effects of knee surgery.
Arthrofibrosis, or stiff knee syndrome, occurs due to excessive scar tissue build-up. If this happens, the knee joint can shrink, tighten, and become stiff and painful. In more severe cases, this condition can have a massive impact on;a knee’s range of motion.
Arthrofibrosis can also cause the following symptoms aside from chronic knee stiffness.
What Does The Doctor Do Prior To Revision Surgery
When the decision for revision knee replacement is made, the surgeon will do a thorough clinical exam and order and laboratory tests. If infection is suspected, aspiration of the knee may be required. The aspirated fluid will then be sent to a laboratory for analysis to identify the specific type of infection.
In addition to X-rays, other imaging modalities may be helpful, such as bone scans, or . These advanced imaging technologies can demonstrate changes in the position or condition of the prosthetic components as well help to pinpoint the cause, location and the amount of bone loss to help plan for the surgery.
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Helping Patients To Make Informed Decisions
We’re funding research to improve patient experience;before, during and after;knee replacement surgery. This includes a project based at the University of Sheffield which aims to help patients make informed decisions about their surgery. The research team will use the UK National Joint Registry dataset to develop and validate a personalised, web-based decision aid to help patients considering knee joint replacement to make informed choices about their treatment.
What Can Cause Sharp Pain After Knee Replacement
When people feel “sharp” pain, they usually refer to a sudden, shooting kind of pain. The pain can also feel like stabbing, piercing, or cutting sensations. Either way, the highly unpleasant feeling can be quite intense and may also fade and reoccur.
Sharp pain can occur in patients who’ve had a knee replacement. Such cases often arise from surgical complications, such as infections.
An implant that becomes loose can also cause stabbing pains. The same goes if a misalignment of the operated knee occurs.
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Characteristics Of Severe Arthritis Of The Knee
Pain is the most noticeable symptom of knee arthritis. In most patients the knee pain gradually gets worse over time but sometimes has more sudden flares where the symptoms get acutely severe. The pain is almost always worsened by weight-bearing and activity. In some patients the knee pain becomes severe enough to limit even routine daily activities.
Morning stiffness is present in certain types of arthritis. Patients with morning stiffness of the knee may notice some improvement in knee flexibility over the course of the day. Rheumatoid arthritis patients may experience more frequent morning stiffness than patients with osteoarthritis.
Swelling and warmth
Patients with arthritis sometimes will notice swelling and warmth of the knee. If the swelling and warmth are excessive and are associated with severe pain, inability to bend the knee, and difficulty with weight-bearing, those signs might represent an infection. Such severe symptoms require immediate medical attention. Joint infection of the knee is discussed below.
The knee joint has three compartments that can be involved with arthritis . Most patients have both symptoms and findings on X-rays that suggest involvement of two or more of these compartments; for example, pain on the lateral side and beneath the kneecap . Patients who have arthritis in two or all three compartments, and who decide to get surgery, most often will undergo total knee replacement .
Here Are Some Of The Reasons You Might Need Knee Surgery:
- Stiffness in the joint and pain makes it difficult to walk, stand up, or climb stairs
- You often have swelling in the knee area
- Chronic pain bothers you when resting
- The pain is disrupting your sleep
- The knee has defects or is bowed
- Medication and physical therapy havent been effective in managing the pain
If you can relate to any of these symptoms, then its time to talk to a sports medicine doctor about your treatment options.
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What About Exercise Following A Knee Replacement
Exercise and sport are recommended after knee replacement, apart from;contact sports,;which may weaken the cement and lead to loosening of the joint components.;Recreational sports including golf, tennis and skiing will gradually become possible depending on how fit and sporty you were before the operation. Cycling is a very good way of building up strength and mobility after knee surgery.
Exercising the main muscle groups around your knee is very important both before and after having a;knee replacement. You can download a selection of exercises that are designed to stretch, strengthen and stabilise the structures that support your knee. Try to perform these exercises regularly, for instance for 10 minutes six to eight times a day. However, its important to find a balance between rest and exercise so you dont overwork your knee. Its a good idea to get advice from your doctor or;physiotherapist about specific exercises before you begin.
Technical Details Of Total Knee Replacement
Total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection. This is followed by inflation of a tourniquet to prevent blood loss during the operation.
Next, a well-positioned skin incision–typically 6-7 in length though this varies with the patients size and the complexity of the knee problem–is made down the front of the knee and the knee joint is inspected.
Next, specialized alignment rods and cutting jigs are used to remove enough bone from the end of the femur , the top of the tibia , and the underside of the patella to allow placement of the joint replacement implants. Proper sizing and alignment of the implants, as well as balancing of the knee ligaments, all are critical for normal post-operative function and good pain relief. Again, these steps are complex and considerable experience in total knee replacement is required in order to make sure they are done reliably, case after case. Provisional implant components are placed without bone cement to make sure they fit well against the bones and are well aligned. At this time, good function–including full flexion , extension , and ligament balance–is verified.
Finally, the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement. The surgical incision is closed using stitches and staples.
Length of total knee replacement surgery
Pain and pain management
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Pain After Knee Replacement: Six Months
If you are still experiencing pain six months after surgery, you may be wondering how long it will be until you feel normal again. Unfortunately, there is no easy answer.
In some cases, it may take up to a year for all of your swelling to completely go away. Your knee will continue to recover for years to come, as scar tissue forms and your muscles become stronger with continued physical therapy and light exercise.
As previously mentioned, if you are still experiencing debilitating levels of pain at this stage, you could be suffering from chronic pain. While you may be tempted to tough it out, its important to talk with your doctor. Together, you can find what is causing your persistent pain and come up with a plan to fix it.