Thursday, August 11, 2022

How To Deal With Knee Pain After Surgery

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Knee Replacement Complications In Former Athletes

Total Knee Replacements – How to Deal with Longstanding Pain After Surgery

In a recent paper, doctors from NYU Langone Medical Center, Hospital for Joint Diseases suggest that total knee arthroplasty is often the best answer for end-stage, post-traumatic osteoarthritis after intra-articular and periarticular osteoarthritic fractures the knee.

However, total knee replacement in the setting of post-traumatic osteoarthritis is often considered more technically demanding surgery and the surgical outcomes are typically worse for these patients. The goal of the NYU paper was to create a new classification label for post-traumatic osteoarthritis patients and improve medical documentation and improve patient care.

  • The researchers looked at post-traumatic osteoarthritis patients who suffered from osteoarthritis as a result of high demand or athletic activity. These were on average were younger and healthier than the primary total knee replacement population .
  • The healthier post-traumatic total knee replacement group had the following complications:
  • higher rates of superficial surgical site infections,
  • bleeding requiring transfusion,
  • increased length of hospital stay,
  • and 30-day hospital readmission.

In a similar study, doctors at Duke University also recognized that Total Knee Arthroplasty as an important treatment for post-traumatic arthritis. However, these researchers also found complications that should not be expected in a mostly healthy patient population.

This included:

  • knee wound complications
  • need for revision surgery.

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 therapy–which is best done in an outpatient physical therapy studio–is 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.

Problem: Neuropathic Knee Pain After Surgery Nerve Damage Caused By The Surgery

Above we discussed neuropathy, nerve damage, as occurring in a small portion of knee replacement patients. A study from doctors in the United Kingdom published in the Bone and Joint Journal suggests that while a small percentage of patients suffer from neuropathic pain caused by knee replacement, it is still an underestimated problem in patients with pain after total knee replacement.

The same research team had more to say in a 2017 study that will be discussed below.

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Immediately After The Operation

Doctors have made big advances in pain management after total knee replacement over the last 10 to 15 years due to advancements in using regional nerve blocks, spinal blocks, and other methods of pain control.

During knee surgery, your healthcare team might either use a general anesthetic, where you will be fully asleep, or a localized anesthetic, where youre numb from the waist down but still awake.

After the surgery anesthesia wears off, your healthcare team can provide pain medication either orally or through an intravenous tube.

These medications may include a strong opiate or opioid such as morphine, fentanyl, or oxycodone, and are intended only for short-term use. Its important to note that larger doses over time can lead to physical dependence and addiction. Follow your doctors instructions to avoid adverse effects.

Problem: Fixing Pain After Total Knee Replacement May Include Amputation

Precautions after knee replacement surgery

Three in 1000 patients will need to have their leg amputated.

The causes of the amputation were:

  • infection around the implant ,
  • soft-tissue deficiency surrounding the implant ,
  • severe bone loss ,
  • fracture around the implant ,
  • circulatory damage .

In 80% of the cases, there were more than 2 of these factors for amputation.

In research from April 2017, doctors writing in the European Journal of Orthopaedic Surgery and Traumatology wrote:

Treatment for prosthetic knee replacement is becoming more common. Infection is an arthroplasty-related complication leading to prolonged hospitalization, multiple surgical procedures, permanent loss of the implant, impaired function, impaired quality of life, and even amputation of the limb.

The purpose of this study was to identify risk factors for amputation in the periprosthetic infected knee through a case-control study, analyzing patients treated from January 2012 to November 2016 in a hospital with a high incidence of this diagnosis. We included 183 patients with periprosthetic knee infection 23 required amputation as definitive management .

They found that patients with:

  • Increased surgical time > 120 min,
  • smokers,
  • diabetes mellitus had an increased risk of amputation.

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Research Continued: After The Surgery The Researchers Found Patients Had To Alter Their Recovery And Post

  • The amount of pain and discomfort in recovery and post-op became the greatest impact of post-surgical patient non-satisfaction.
  • Compared with preoperative health problems, postsurgical health problems were associated were a bigger problem than anticipated.
  • Significant differences in thinking before surgery and surgical outcomes were observed including
  • Greater problems than anticipated in:
  • Mobility,
  • Not being able to perform usual activities,
  • anxiety/depression.
  • It is important to know that the purpose of this research was to assign a set of values to these patient problems in order to be able to come up with a formula that would better help the patient with their expectations before and after the surgery. The researchers had to conclude in the end that:

    Our systematic review highlights a lack of evidence about the effectiveness of prediction and management strategies for chronic postsurgical pain after total knee replacement.

    In the end, there is no way currently to predict who will benefit and who will get worse from knee replacement surgery and patients should be counseled that there is no guarantee that knee replacement will work for them.

    Opioid Benefits And Risks

    • The medicine works quickly.
    • You will feel less pain.
    • You will be able to be active to speed your recovery. For every day you stay in bed, you need 3 days to regain your strength.
    • You will be able to sleep or rest better.

    Potential risks are:

    • Taking an opioid can lead to addiction.
    • On average, more than 130 people die each day in the U.S. from an overdose of opioids, according to the Centers for Disease Control and Prevention.
  • The longer you take opioids, the more your body gets used to it , and two things happen:
  • They may not work as well.
  • You may have more side effects when you stop them. These are not problems in the first three days of use.
  • Taking too many opioids can cause side effects, such as:
  • feeling dizzy, itchy or both
  • making you feel groggy or sleepy
  • feeling sick to your stomach
  • throwing up
  • being unable to have a regular bowel movement
  • having breathing problems.
  • Some opioids contain acetaminophen , such as Norco® or Percocet®. Acetaminophen is an over-the-counter medicine. Do not take more than 4,000 mg of acetaminophen in 24 hours.
  • Allergic reactions to opioids or acetaminophen include:
  • hives, itching or a flushing feeling
  • swollen lips, tongue or both
  • nasal congestion, feeling like your throat is closing or choking
  • shortness of breath, wheeze or cough
  • feeling faint, lightheaded, dizzy or having a racing heart
  • upset stomach, throwing up, diarrhea and belly pain.
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    Thoughts On Pain I Experienced After Knee Replacement

  • Sandra Hores

    Hi Ken, I just finished reading your experience of your knee replacement. I found it very informative. Im 76 and Im having tkr surgery on march 12. Of course its scary knowing the pain thats coming, but you laid it out great as to the best way to handle it. I feel much better knowing what to expect and the the plan of attack. Ive heard stories about people who get hooked on the pain meds and I do worry about that, but i know i will need them. Im more worried about the recovery than the surgery. Anyway, thank you for all the good advice. Maybe Ill document my experience too! Hope youre doing well. Sincerely, Sandra Hores

  • Good to hear my blog has helped provide some insight to the process. Youve got a solid month to prepare. If I could go back Id concentrate on my weight and leg strength prior to surgery and Id remind myself to work hard for at least 8 weeks post surgery . Yes, the pain meds are a serious issue and I used my sparingly, however, I always took one before doing my exercises in the first few weeks. I transitioned to OTC meds pretty quickly but the prescription meds will help you stay more active early on . Wishing you a speedy recovery!

  • Ken

    Thanks for the feedback. Glad my experience can help. Get yourself in good shape going into surgery and recovery should be a little smoother. Expect the first 2 weeks to be tough, but be diligent with your recovery exercises. Best wishes!

  • Ken
  • Waiting For A Hip Or Knee Replacement Here Are Some Tips To Control Pain And Stay Active

    Dealing with knee pain

    In some countries with universal or nationalized health care, a joint replacement is considered an elective procedure. That means the person chooses to have the operation but it’s not an emergency procedure. So despite pain and loss of motion or function, that individual must wait in a queue until the resources are available to them. This could take weeks to months. In the meantime, they are advised to stay active. What’s the best way to do that? Should patients exercise on land or in a pool? Is one better than the other? That’s what the researchers involved in this study wanted to find out.

    Physiotherapists from down under compared patients with hip or knee osteoarthritis exercising either on land or in a pool-based program while waiting for surgery. The patients were randomized into one group or the other. They were all found to be medically fit and able to exercise.

    Both groups engaged in their respective exercise twice a week for six weeks. The sessions lasted one hour and were supervised by a physiotherapist. Each exercise session cost $6.00 per patient. They were also asked to continue exercising at home at least three times a week for 30 minutes. Exercise could take any form: riding a bike, walking, or doing land-based exercises similar to what they did in class.

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    Reasons For The Procedure

    Knee replacement surgery is a treatment for pain and disability in theknee. The most common condition that results in the need for kneereplacement surgery is osteoarthritis.

    Osteoarthritis is characterized by the breakdown of joint cartilage.Damage to the cartilage and bones limits movement and may cause pain.People with severe degenerative joint disease may be unable to donormal activities that involve bending at the knee, such as walking orclimbing stairs, because they are painful. The knee may swell or”give-way” because the joint is not stable.

    Other forms of arthritis, such as rheumatoid arthritis and arthritis thatresults from a knee injury, may also lead to degeneration of the kneejoint. In addition, fractures, torn cartilage, and/or torn ligaments maylead to irreversible damage to the knee joint.

    If medical treatments are not satisfactory, knee replacement surgery may bean effective treatment. Some medical treatments for degenerative jointdisease may include, but are not limited to, the following:

    • Anti-inflammatory medications

    • Cortisone injections into the knee joint

    • Viscosupplementation injections

    • Weight loss

    There may be other reasons for your doctor to recommend a knee replacementsurgery.

    The Pain Strikes Back

    I started having the pain back again. I had pain, sharp pain in three areas of my knee, on the outside front right of my knee, on the back of my knee on the right side and on the left side. What ended up happening when I went back into physical therapy on Tuesday, they said that my muscles have spasmed. I irritated the tissues underneath the kneecap where all the muscles attached and that the muscle had pulled the patella medially to the left and it was displaced and it was causing all of that discomfort. They could not bend me. My flexion decreased to a 105. For the past four or five days, I called the doctors office and they told me to do muscle massage and try to get the muscle loosened up using a heating pad and a cold pack and ice, elevate the knee and go back to therapy on Monday and see how your knee is feeling.

    Im in a holding pattern right now. Im a little more philosophical about it. I still have made great progress, and maybe this is just a temporary blip in the road and everybody says its going to come back. Dont worry, this happens. Im taking it that way. Im taking it as a temporary blip and things will get back on track.

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    Keep The Knee Straight

    While it may not be incredibly comfortable, it’s important that you keep your knee joint completely straight immediately after your surgery. You should minimize the amount of time you’re on your feet, and be sure to use crutches or a wheelchair if you must move about. When seated and lying down, keep your leg straight out in front of you, with no bend in the joint. It’s important that you give the joint ample time to heal your doctor will let you know when it’s safe to begin bending and moving the joint.

    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

    Know all about Knee Replacement Surgery  What to except ...
    • 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.

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    Emerging From The Extreme Challenges Of Knee Recovery

    When I got in that 90 to 95 range of the flexion, I started being able to put on my own shoes. I was able to get off the walker and start with the cane. I got to 100 and I started to go back to work. In that range, in that weeks time, thats where really the mental outlook changed.

    Yes. I did not expect nor my wife expected what was going to happen and how incapacitated and I felt like a burden. I felt I couldnt even go to the bathroom myself. I could not reach down to bring my shorts up after going to the bathroom. Its very humbling, very humiliating, and I didnt want to be a burden to anybody.

    Dr. Green had told me that he believed that I would regain 130 degrees flexion. I may be an outlier and get a little bit more, but he thought I should be able to get back to 130. Last Monday when I was in physical therapy, I reached 120, and I was only 10 degrees away, and it was like Im almost there. Im back to where I couldnt do 40 degrees and in a months time, five weeks time, I did 104. I left physical therapy that day saying Im going to make it and I cant wait. Im going to get normal, coming back faster only to wake up the next morning and realize that that wasnt the case.

    How To Treat Knee Pain That Persists One Year After Meniscus Surgery

    Individuals with meniscus injury face many treatment options, but the list can run out leaving them with the option of surgery.

    Read on to learn about how meniscus surgery is conventionally treated, how surgery works, and alternative treatments for knee pain.

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    How To Manage Pain Before And After Surgery

      Most people think of pain from surgery as something you deal with after the operation, but there are things you can do beforehand to decrease your discomfort and manage your pain. Researchers have found better ways to control pain before surgery, at the hospital and when you come home to recuperate. Many people have an operation at some point in their lives, so it can help to know what you can do about pain before and after surgery.

      The old school way of managing pain after surgery was to drug up the patient on heavy duty painkillers, like opioids, for days or weeks after surgery until the body healed itself enough to no longer hurt very much. With the prescription painkiller addiction problem and related heroin epidemic in the United States, researchers have been searching for better options that also do not carry the opioid side effects of nausea, constipation and dizziness.

      Benefits of Avoiding or Minimizing Opioids

      You can relieve pain, decrease your risk of gastrointestinal and respiratory complications and spend less time in the hospital by using three other drugs together with limited use of opioids, as compared to using the traditional doses of opioids and not using the three other medications. Researchers found that people who did not take opioids at all before, during, or after surgery, were released home faster than those who did use the strong painkillers.

      General Anesthesia and Opioids

      The Non-Opioid Pain Prevention Cocktail

      After Surgery

      References:

      What Is A Knee Replacement Surgery

      Are you still having knee pain after surgery? Learn how to do a self assessment and fix it.

      Knee replacement, also called knee arthroplasty or total knee replacement, is a surgical procedure toresurface a knee damaged by arthritis. Metal and plastic parts are used tocap the ends of the bones that form the knee joint, along with the kneecap.This surgery may be considered for someone who has severe arthritis or asevere knee injury.

      Various types of arthritis may affect the knee joint. Osteoarthritis, adegenerative joint disease that affects mostly middle-aged and olderadults, may cause the breakdown of joint cartilage and adjacent bone in theknees. Rheumatoid arthritis, which causes inflammation of the synovialmembrane and results in excessive synovial fluid, can lead to pain andstiffness. Traumatic arthritis, arthritis due to injury, may cause damageto the cartilage of the knee.

      The goal of knee replacement surgery is to resurface the parts of the kneejoint that have been damaged and to relieve knee pain that cannot becontrolled by other treatments.

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