Knee Replacement Pain: The Week Following Surgery
You should expect to stay in the hospital for several days following knee replacement surgery. This is often considered the most painful stage of the recovery process. Your doctor will prescribe medications to help you manage your pain level.
In addition to icing your knee, you may be encouraged to move your foot and ankle to increase blood flow and lower the risk of swelling and blood clots. Your doctor may also use blood thinners, support hose, and compression boots to prevent further complications.
Generally the day after surgery, a physical therapist will show you exercises that will help you recover your range of motion and continue to heal. You may even be asked to get up and take a few steps . Patients who get up and put a safe amount of weight on their new knee typically experience a quicker recovery.
After leaving the hospital, most patients continue to take some form of pain medication for two to six weeks. Your doctor will determine the best method of pain relief for your specific needs, whether it is over-the-counter medications or something stronger.
Total Knee Replacement & Nerve Pain
I’m 4 weeks post TKR. The joint & incision feel fine. Although the muscles are tight the range of motion is good. What has me pulling my hair out is nerve pain! The surface of my skin is unbearably sensitive to even the slightest of touch. This, coupled with the occasional burst of lightening down the back of my leg, is making life a living torture! Pain meds do precisely nothing for this nerve pain. Does anyone have any tips for nerve pain relief?
2 likes, 46 replies
Posted 4 years ago
Hi, so sorry to hear you’re in so much pain & nerve pain is nasty. Amytriptoline also is good for nerve pain. See your GP, don’t wait to see the surgeon. GP should be able to prescribe something for nerve pain.
As you’ve no doubt read on this forum TKR is a brutal operation. You’ve been diced up & sewn back together. I still have a spot on my scar, when I massage, it that twangs at the back of the knee. It felt horrible at 1st but am used to it. I never had nerve pain. I feel for you, had sciatica few years back & that is also nerve so I do not envy you.
I hope you get something to relieve it soon. Hang on on there & look after yourself, in a couple of years you will be skipping about on your new knee like a spring lamb!
Have a lovely Christmas but just make sure someone else does all the work!!
Good luck on your journey.
The Knee Cap Was Floating Because The Mcl Was Released Patellar Maltracking After Total Knee Replacement The Concern Of Catastrophic Laxity
Lets look at two studies surrounding the medial collateral ligament.
The first is from 2015, the second is from 2021
In June 2015 in the journal Knee Surgery, Sports Traumatology, Arthroscopy researchers wrote: Medial collateral ligament release is one of the essential steps toward the achievement of ligament balancing during the total knee arthroplasty in patients with varus deformity . When the varus deformity is severe, complete release of the MCL until balanced is often required. However, it is believed that a complete MCL release may lead to catastrophic laxity.
In March 2021, a study published in the journal Knee Surgery and Related Research continued that Medial collateral ligament release during knee replacement could lead to the surviving knee cap floating around the knee. Here are the studys observations: Patellar maltracking after total knee arthroplasty can lead to significant patellofemoral complications such as anterior knee pain, increased component wear, and a higher risk of component loosening, patellar fracture, and instability. . . Complete release of the MCL during surgery was associated with patellar maltracking. Surgeons should attend to patellar tracking during surgery in medially tight knees.
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What Causes Nerve Pain
Neuropathic pain comes from nerve damage. Most commonly, this is caused by medical conditions such as diabetes, side effects from drugs or chemotherapy, or injuries.
Damaged nerves are more likely to misfire, sending pain signals when there is no cause for pain. They can also put you at risk for more serious problems such as foot infections.
All the causes of nerve pain are still largely a medical mystery. Researchers have identified several different ways nerves can misfire, and this has led to treatments that help many people.
Still, in surveys of people with nerve pain, most say they still have pain despite the best efforts of doctors. If youre one of them, you may want to look beyond conventional medicine for relief. Almost half of those with nerve pain report trying complementary or alternative approaches to improve their pain.
Patients May Need Subsequent Surgeries To Maximize The Benefits Of Joint Replacement
Many patients with hip and knee arthritis have the condition in more than one of their hip or knee joints, said the studys lead author Dr. Gillian Hawker. So its not surprising that replacing a single joint doesnt alleviate all their pain and disability patients may need subsequent surgeries to maximize the benefits of joint replacement.
The study, published in the journal Arthritis & Rheumatism , followed a group of patients with osteoarthritis and inflammatory arthritis. Only half reported a meaningful improvement in their overall hip and knee pain and disability one to two years after surgery. Whats more, researchers found the patients who had the worse knee or hip pain to begin with but fewer general health problems and no arthritis outside of the replaced joint were more likely to report benefits.
According to the study authors, nearly 83 percent of study participants had at least two troublesome hips and or knees.
- In general, an estimated 25 percent of patients who undergo a single joint replacement will have another joint replacement usually the other hip or knee within two years.
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How Long Can It Take For Numbness In My Knee Or Leg To Go
As mentioned previously, it is unlikely that sensation will return if the nerve was cut. So, in majority of cases the sensation is unlikely to fully return, although it can happen.
Most people will experience a return in some or part of their sensation. This is probably because the nerve was simply stretched through the surgery. Or other nerves have grown and compensated for the other.
If the nerve is purely stretched, experts would suggest that the nerve should recover in 6-12 weeks.
My advice, is to watch the site of numbness for signs of improvement for the first 3 months. If there is no change in sensation it is likely that the sensory nerve was cut during surgery and any further progress would be minimal.
Some of you may ask if the nerves can simply be repaired since they were cut. Although the concept is sound, the nerve in question is so small that repair would be extremely difficult.
On top of this, there is always a risk of infection which outweighs the benefits of returning the patch of sensation loss.
Thankfully, most people report that it doesnt usually interfere with their quality of life.
Even still, its something that is worth mentioning to patients as one study revealed most patients were either unsure or not told about numbness post-surgery.
What Patients Want From Their Knee Replacement:
In the November 2017 edition of the journal Medical Care, a combined research team from the University of Illinois at Chicago, China Medical University Hospital, and National Taiwan University Hospital published their findings on what concerned patients before knee replacement and the type of pre-existing conditions these patients had.
Before the surgery concerns about successful surgery circled around these factors:
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Lack Of Evidence About The Effectiveness Of Prediction And Management Strategies For Chronic Postsurgical Pain After Total Knee Replacement
The same doctors also wrote in the British Medical Journal that the problem of post-surgical pain in knee replacement patients had reached a point of significance and that researchers should prioritize their studies to help people with pain. They wrote:
- Our highlights a lack of evidence about the effectiveness of prediction and management strategies for chronic postsurgical pain after total knee replacement. As a large number of people are affected by chronic pain after total knee replacement, development of an evidence base about care for these patients should be a research priority. We are going to return to this study below.
There is a significant problem. The main part of this problem is identifying what is causing people to have pain after knee replacement.
Discomfort Aching And Tightness In The Knee Grating And Pain Behind The Kneecap When Bending The Knee Or When It Is Exercised After A Period Of Rest
May be due to chondromalacia patella. In this condition the cartilage on the underside of the patella softens and deteriorates. Some people are able to ignore the condition, but it will not improve and will probably need surgery. Sometimes an unstable flap of surface cartilage may cause this pain, and may be curable with simple keyhole surgery and a chondroplasty.
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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.
Massage Or Physical Therapy
Having a massage may also help reduce physical pain and stress. Applying gentle pressure around the affected area may help relieve tension, and a full body massage can help the muscles relax.
Deep tissue massages may not be a good idea because the extra pressure may make the symptoms worse.
Physical therapy, using a combination of exercise, massage, and gentle stretches, can help relieve symptoms.
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What About Numbness Down The Whole Leg Or Into The Foot After Surgery
In rare cases, there is potential for larger nerves to have been damaged during surgery.
This article found that 23% of patients with nerve injuries had numbness down the leg in the area shown below.
This pattern of numbness results from damage to the sartorial branch of the saphenous nerve. Which is a slightly larger sensory nerve which supplies sensation to a bigger area.
Every persons nerves will be slightly different, so these body maps are good for a reference, but they will not exactly apply to everyone.
If the area of your leg numbness is largely outside the cream coloured section of the picture , it would be advisable to seek medical advice to get this checked.
As previously discussed, if your nerve was cut in surgery, the chances of a full recovery are slim. However, you may just have a neuropraxia and in this case, you will get most sensation back.
Thankfully sensation changes doesnt usually lead to strength changes as the signals come from different nerves. So there will be minimal chance of numbness leading to your knee giving way or other symptoms of weakness. If giving way of the knee is occurring, it is advisable to also seek medical advice.
What Can Cause A Pinched Nerve In The Knee
This nerve goes around the outside of your knee before traveling down the outside of your lower leg.
At the bottom of your knee, it lies between the bone and skin, which makes it vulnerable to compression by anything that puts pressure on the outside of your knee.
Traumatic injuries can lead to pressure on the nerve from inside your knee.
Common causes of a pinched nerve in your knee include:
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Patients Had Knee Pain After A Knee Replacement Because After The Fact It Was Determined That Knee Replacement Was The Wrong Surgery The Knee Was Not The Problem And The Patient Was Inappropriately Rushed To Surgery
Are you getting a knee replacement because of undiagnosed back and hip pain? Above we spoke about doctors looking for knee pain that was actually coming from the spine, hip, ankle, and feet. The knee was perhaps not the problem and the patient was inappropriately rushed to surgery
Doctors warn that in the case of chronic knee pain, a thorough examination is imperative in identifying the correct diagnosis. That sounds like common sense, but the truth is that the source of pain is often missed and treatment then will present a significant challenge with less than desired results.
One study sought to understand why up to 20 percent of patients who undergo total knee replacement still have persistent pain and why secondary surgery rates are on the rise. Forty-five patients were studied. What the researchers found was somewhat shocking. The pain was not originating in the knee here is what they said:
Safety And Tolerability Of Fentanyl Its
The safety and tolerability of fentanyl ITS have been found to be acceptable by several studies and pooled data analysis . Adverse events associated with fentanyl ITS are similar to those reported with IV opioid administration, including nausea, vomiting, pruritis, headache, and mild-to-moderate dizziness. Nausea was the most common adverse event, with the incidence ranging between 26.6 percent and 67.5 percent .
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In This Video Our Patient Jeannette Had Issues With Spinal Stenosis And Problems Post Knee Replacement
- Jeannette starts discussing the knee replacement complications at 2:30 into the video. Jeannette is 81 years old.
Jeannette describes a foot tingling problem. She cannot sit down and relax at the end of the day, it is uncomfortable for her to put her feet up or down because it is tingling. She had a nerve conduction study that shows an injury to her peroneal nerve.
The peroneal nerve branches out from the sciatic nerve. As it provides sensation to the front and sides of the legs and to the top of the feet, damage to this nerve would result in burning and tingling or numbness sensation in these areas. Further damage to this nerve would also cause loss of control in the muscles in the leg that help you point your toes upward. This can lead to walking problems and possibly foot drop, the inability to lift the front of the foot or ankle. Knee and hip replacement are leading culprits in the cause of peroneal nerve injury.
In Jeannettes case, she had two knee replacement surgeries in that knee. After the first knee replacement surgery, the implant started to protrude away from the limb. The knee replacement became loose. The second surgery to fix the first one occurred in 2015.
- It was determined after examination that Jeannettes knee ligaments were loose. Her knee was hypermobile and unstable. This was causing pressure on her peroneal nerve. Knee ligament damage and weakness is also a complication of knee replacement surgery and is discussed further below.
How Are Nerve Blocks Administered
The nerve block medication is administered through an injection delivered to nerves close to the site of surgery. In the case of knee replacement, the block targets the femoral nerve. The femoral nerve innervates the front of the thigh and knee. Therefore, pain from knee surgery is transmitted to the brain primarily by the femoral nerve. Once the nerve block is performed, the local anesthetic blocks transmission of signals within the femoral nerve that causes the sensation of pain.
Ultrasound imaging aids the doctor in placing the needle in exactly the right location, in the upper portion of the thigh in this instance. This technique is associated with minimal discomfort because the needle passes only through the skin and adipose tissue of the inguinal region.
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How Can We Help These Problems The Often Overlooked And Ignored Cause Of Pain After Knee Replacement The Knee Ligaments
When a knee replacement is performed, the joint itself has to be stretched out so the surgeons can cut out bone and put it in the prosthesis. When the joint is stretched out, the knee ligaments and tendons that survive the operation will cause pain as they heal from the surgical damage. Sometimes the ligaments and tendons heal well. Sometimes they do not heal as well.
In this video, Ross Hauser, MD explains the problems of post-knee replacement joint instability and how Prolotherapy injections can repair damaged and weakened ligaments and that will tighten the knee. This treatment does not address the problems of hardware malalignment that our patient Jeannette described in the video above.
Summary of this video:
The patient in this video came into our office for low back pain. I did a straight leg raise test, on this patient to help determine if his back pain was coming from a herniated disc.
- During the test I noticed a clicking sound coming from his knee. The patient had a knee replacement.
It is very common for us to see patients after knee replacement who have these clicking sounds coming from knee instability. This is not an instability from hardware failure. The hardware may be perfectly placed in the knee. It is instability from the outer knee where the surviving ligaments are. I believe that this is why up to one-third of patients continue to have pain after knee replacement.