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How To Control Pain After Knee Replacement

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Will Your Bones Even Allow For A Revision Knee Replacement

How to Control Pain After Knee or Hip Replacement

An August 2019 study in the Journal of Orthopaedic Surgery and Research offered this warning to surgeons concerning the problems of identifying whether a patients bones were strong and dense enough to withstand another knee replacement procedure.

Revision total knee arthroplasty is a demanding procedure, with a high complication and failure rate and a high rate of bone losses and poor bone quality. Different classifications for bone losses have been proposed, but they do not consider bone quality, which may affect implant fixation.

Look at the study findings:

  • Fifty-one patients were included .
  • The most frequent cause of failure was:
  • aseptic loosening of the implant .
  • 18.9% of the cases demonstrated poor bone quality.

What the researchers of this study were seeking to point out is that if revision knee replacement is required, a plan to address and repair the possibility of bone loss, bone weakening, a loss of bone density should be undertaken. This would significantly increase the success of the replacement.

Malpositioning Of The Implants

Surgeons make an effort to balance the knee at the time of surgery. This means finding the proper size and alignment of the knee replacement so that the knee joint is not too tight, and not too loose, and so this balancing is the same with the knee straight and bent.

This is precisely why a knee replacement is a difficult procedure, and the art of perfecting this takes many years. Errors in the positioning of an implant may not be apparent on the operating table and only become evident when the recovery is stalled.

Newer patient-specific knee replacements are tailor-made and may reduce the risk of malpositioning.

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Possible Benefits Of Total Knee Replacement Surgery

Regardless of whether a traditional total knee replacement or a minimally-invasive partial knee replacement is performed the goals and possible benefits are the same: relief of pain and restoration of function.

The large majority of total knee replacement patients experience substantial or complete relief of pain once they have recovered from the procedure. The large majority walk without a limp and most dont require a cane, even if they used one before the surgery. It is quite likely that you know someone with a knee replacement who walks so well that you dont know he even had surgery!

Frequently the stiffness from arthritis is also relieved by the surgery. Very often the distance one can walk will improve as well because of diminished pain and stiffness. The enjoyment of reasonable recreational activities such as golf, dancing, traveling, and swimming almost always improves following total knee replacement.

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Pain Control After Total Knee Arthroplasty: Comparing Intra

Shengchin Kao

1Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou, Taoyuan City 333, Taiwan

2Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City 333, Taiwan


Background. Direct intra-articular injection of low doses of local anesthetic after closure of the joint capsule remains controversial for pain control after total knee arthroplasty . Methods. A retrospective study comparing patients receiving IALA with high doses of local anesthetics or FNB in addition to intravenous patient-controlled analgesia with opioids for pain management after TKA was conducted. The primary end point was to compare the analgesic efficacy and early ambulation between the two groups. Results. No significant differences between the two groups in pain intensity, cumulative opioid consumption, incidences of opioid-related side effects, the time interval from the end of operation to the first time the patient could walk assisted with a walker postoperatively, and postoperative hospital stay were identified. Three patients in the IALA group but none in the FNB group walked within 12 hours after the end of operation. Summary. IALA with high doses of local anesthetics provides comparable analgesic efficacy as single-shot FNB after TKA and might be associated with earlier ambulation than FNB postoperatively.

1. Introduction

2. Materials and Methods

3. Results

When Can I Get Back To My Everyday Activities After Knee Arthroplasty

New smartphone app may help manage pain after surgery ...

Your doctor will give you specific instructions. But many people can get back to their everyday activities three to six weeks after surgery.

Your healthcare provider will give you specific instructions about recovery. You will gradually increase activity, starting with a slow walking program. You will be encouraged to stand, climb stairs and perform other normal household activities as soon as possible.

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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.

Can Rehabilitation Be Done At Home

All patients are given a set of home exercises to do between supervised physical therapy sessions and the home exercises make up an important part of the recovery process. However, supervised therapywhich is best done in an outpatient physical therapy studiois extremely helpful and those patients who are able to attend outpatient therapy are encouraged to do so.

For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.

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Better Pain Relief After Knee Replacement Surgery

Study suggests injected drug might ease pain while maintaining mobility, but more research is needed

HealthDay Reporter

TUESDAY, Dec. 30, 2014 — Postoperative pain is always a concern after knee replacement surgery, but a new study suggests a strategy that might give patients another way to ease discomfort.

Researchers at Henry Ford Hospital in Detroit note that the painful recovery process following knee replacement surgery is a persistent problem.

However, the research team found that injecting a newer, long-acting numbing medicine, known as liposomal bupivacaine, into the area surrounding the knee helps patients recover more quickly and boosts their satisfaction with the procedure.

“Patients had pain relief for up to two days after surgery and better knee function compared with the traditional method,” said the study’s senior author, Dr. Jason Davis, a joint replacement surgeon at Henry Ford West Bloomfield Hospital, in a hospital news release.

The study involved more than 200 patients who underwent knee replacement surgery and were then tracked for pain control during the first two days after their procedure.

Half of the patients received traditional pain control, in which a common numbing medicine is injected via a pump into the groin area. Although this method can cause leg weakness, it prolongs pain control for two days after surgery, the researchers said.

Two experts not connected to the study had mixed opinions about the results.

Pain Control After Joint Replacement

Pain Management After Knee Replacement – Central Sensitization

Joint replacement surgery, such as knee and hip replacement, is often done to reduce the pain caused by arthritis. However, in the days following surgery, some patients pain is just as bad or even worse than their original arthritic pain. While we understand that surgery without any pain is the exception and not the rule, we take pain very seriously and take a multidisciplinary approach to limiting pain to maximize recovery.

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How Long Will It Be Before I Feel Normal

You should be able to stop using your crutches or walking frame and resume normal leisure activities 6 weeks after surgery. However, it may take up to 3 months for pain and swelling to settle down. It can take up to a year for any leg swelling to disappear.

Your new knee will continue to recover for up to 2 years after your operation. During this time, scar tissue will heal and muscles can be restored by exercise.

Even after you have recovered, it’s best to avoid extreme movements or sports where there’s a risk of falling, such as skiing or mountain biking. Your doctor or a physiotherapist can advise you.

Why Is My Knee Replacement Clicking And Popping

Ask U.S. doctors your own question and get educational, text answers â its anonymous and free!

Ask U.S. doctors your own question and get educational, text answers â its anonymous and free!

HealthTap doctors are based in the U.S., board certified, and available by text or video.

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Here Is An Overview Of What You Can Expect During These 12 Weeks:

  • Days 1 3: In the hospital, you will work with a physical therapist and occupational therapist to work on straightening and bending the knee.
  • Discharge Day: Most people are discharged from the hospital within a few days. You will be sent home with specific instructions for care, medication, and therapy.
  • Week 3: By the time you reach week three, you will be able to move around a little more, and the pain will be decreasing.
  • Weeks 4 6: The most noticeable improvements in your knee happen during this time if you are consistent with your rehab and exercise activities.
  • Weeks 7 11: Physical therapy and rehabilitation continue. At this point, you will be working on range of motion, mobility, and strengthening the muscles.
  • Week 12: You can start to return to normal activities but still need to avoid high-impact exercise .

Beyond this initial recovery time, you will notice that the pain will continue to decrease, and your function will improve.

Should I Use Muscle Relaxers After Knee Surgery

New procedure that relieves knee pain

Many surgeons use muscle relaxants on patients who undergo surgeries. They do so to restrict muscle movement while patients are unconscious. However, researchers now associate them with increased risks of lung complications.

As such, you may want to avoid over-the-counter muscle relaxants after your surgery. You should only use them if your doctor prescribes them.

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Your Pain Prevents You From Doing Normal Activities Or Caring For Yourself

If you cant get relief from other treatments, your knee pain may start interfering with your daily life.

In general, the timing of a total knee replacement is determined by the impact the knee is having on your quality of life, says Jay Lieberman, MD, chief of orthopaedic surgery at Keck Medicine and chair and professor of orthopaedic surgery at the Keck School. If conservative treatments are not working and you have significant pain while walking, you may be a good candidate for surgery.

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What Are Some Types Of Knee Surgery

The most common knee surgeries involve arthroscopy â a surgical technique used to repair many different types of knee problems â or knee replacement.

Arthroscopic surgery

Arthroscopy is a type of keyhole surgery used to diagnose and treat a wide range of knee problems. A keyhole surgery is one in which long, thin instruments are inserted into the patientâs body through small incisions.

For arthroscopic knee surgery, the surgeon inserts a probe with a small camera, called an arthroscope, into the knee joint. The scope displays pictures on a video monitor to help guide the surgeonâs work. Surgical instruments are inserted into the joint through a second incision.

The American Academy of Orthopaedic Surgeons describes the following as the most common arthroscopic procedures for the knee:

  • Removal or repair of a torn meniscus â a type of cartilage in your knee that cushions and stabilizes the joint
  • Reconstruction of a torn anterior cruciate ligament , which is a ligament that helps stabilize the knee joint
  • Removal of inflamed synovial tissue
  • Trimming of damaged articular cartilage
  • Removal of loose fragments of bone or cartilage
  • Treatment of patella problems
  • Treatment of knee sepsis

Knee replacement

In a knee replacement operation, the surgeon removes damaged parts of the knee joint and replaces them with new parts made of materials such as metal, ceramic, or plastic. Contrary to the name of the procedure, the surgeon does not replace the entire knee joint.

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The Patient Problems After Knee Replacement Surgery Are Many At Caring Medical We Can Address Many Of These Problems We Cannot Address All Especially When The Problem Of Knee Replacement Is Caused By Hardware Failure And Hardware Placement Failure

  • PROBLEM: The knee replacement hardware is wearing out and loosening or it was not placed in the knee correctly and stress is causing the device problems. This problem will need surgical consultation and possibly revision surgery.
  • PROBLEM: Infection. This is during the initial recovery period. On prosthetic devices, bacteria can form and colonize. This problem will need a consultation with the surgical group and possibly emergency medicine.
  • PROBLEM: The implant or the surgery caused fractures in the thigh or shin bone. This problem will need a consultation with the surgical group and possibly emergency medicine.
  • PROBLEM: Knee prosthesis instability and loss of range of motion , this can also lead to considerable pain.

Step #1 Take Your Pain Meds As Directed

Managing pain after hip or knee replacement

Expect large amounts of chemically induced pain-the kind your body normally secretes in response to trauma, the first two weeks.

Trying to bend your knee with pain levels greater than 5/10 is like banging your head against a wallyou simply wont do it or youll do it very infrequently until the pain lessens.

This is a huge waste of down time. A large majority of my patients are able to recover 110 to 120 degrees range of motion post-surgically in the initial two week period. Any veteran of knee replacement surgery, will tell you that getting the knee to bend fully is arguably one of the most difficult tasks after surgery.

This is why you should use your narcotic pain pills to their fullest advantage.

In most cases, you can be off the narcotics in two weeks. Once range of motion has been restored, building strength into the knee is a piece of cake by comparison and narcotics are overkill.

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How The Study Was Performed

The study involved 80 patients undergoing total knee replacement. It concluded that continuous infusion of a local anesthetic 0.2% ropivacaine) through a catheter in the adductor canal of the mid-thighrather than higher up near the femoral nerveprovides better pain control and prevents temporary weakness of the leg muscles. This allows recovering patients to walk sooner with less weakness in the legs, resulting in improved physical therapy participation. Patients in the study also needed less morphine to control post-surgery pain.

Virginia Mason anesthesiologists Neil Hanson, MD, and David Auyong, MD, were members of the research team and co-authors of the article. No one in the world has shown all these possible outcomes in the same study with the adductor canal technique, Dr. Hanson said in a release from the Virginia Mason.

Dr. Auyong added, Use of the adductor canal for pain-block infusion appears to improve safety and clinical outcomes, and reduces the length of time needed for hospitalization. All patients now get this nerve block at Virginia Mason as part of our standard work for knee replacement surgery.

Will I Need To Use Crutches Or Other Assistive Devices After Knee Replacement Surgery

Yes. And depending on the type of surgery youve had , youll probably need to use an assistive device for at least a few weeks during recovery.

Assistive devices make certain activities like walking, using the restroom and dressing easier to do. They also help keep you safe.

The types of assistive devices youll need after knee replacement surgery depend on your condition, but common devices include:

  • Walking aids like crutches, canes or walkers
  • Shoehorns and sock aids
  • Raised toilet seat
  • Tub chair

The good news is some assistive devices may be covered by your insurance, so be sure to check with your insurance provider before you go in for surgery.

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Step #2 Take Your Pain Meds As Directedif You Can Get Them

Unfortunately todays strategies for controlling pain after knee replacement are being overtaken by political crusaders against opioid addiction. Trust me, I get it: opioid addiction is real.

However, I just happen to be old enough to remember the misguided home health emphasis undertaken by the Centers for Medicare Services . They determined that no one suffer with unmanageable pain. We were to investigate pain levels every visit.

Most older patients instinctively knew that suffering with pain was better and more healthy than getting hooked on narcotics. However, persistent sanctioning can eventually dull the most sensible among us.

Narcotics started flying off the shelves like candy on Valentines Day, spawning a whole new industry of pain management specialists, a direct result of this official destigmatization.

Of course we have an opioid addiction problem, the medical establishment helped create it. But I digress

In some states, you will now have to run the gauntlet like a convicted felon to get a narcotics supply that covers you for the initial two weeks. The best thing to do is to talk to your surgeon to find out his exact method for controlling pain after knee replacement.

Then find out how to deftly navigate the logistics of getting the help you need to succeed and thrive, not just survive this period.

State by state prescribing guidelines and whether they have the force of law behind them , can be found here.

Opioid Use Before Surgery Leads To Longer Use After Surgery

How to control swelling and pain after knee replacement?

Only 8.2% of opioid naïve patients were using opioids at 6 months, while 53.3% of knee replacement patients who reported opioid use the day of surgery continued to use opioids after knee replacement at 6 months.

The strongest predictor of long-term opioid use was taking high-dose opioids before surgery or anything greater than 60 mg of oral morphine a day.

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