Wednesday, June 15, 2022

Why Is Knee Replacement So Painful

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Why is a total knee replacement so painful? (Audio Fixed)

Lajam asks her patients to come in for an x-ray, or at least call and check in, every year or two for life. Mechanical pieces can fail, or you could trip or fall and knock something loose and damage it and make it wear faster, she said.

If your implant gets worn or damaged, you can consider a revision knee replacement surgery. Whats a revision knee replacement surgery? Its a procedure to replace some or all of the artificial joint if it becomes damaged or worn. Surgeons can replace just the plastic piece if thats whats needed, or the entire implant if the damage is more severe.

Its Not My Knee Replacement That Is The Problem It Is My Other Knee Expanding On The Other Knee Problem

In Australia, doctors at the University of Wollongong, examining why patients who should be able to kneel after knee replacement, did not kneel, wrote in the Journal of Orthopaedics and Traumatology , about the problems of the other, non-replaced knee.

Here is what they found:

  • Seventy-two percent of patients in this study could, or thought they could kneel at 12 months post knee replacement
  • However, some did not because of the pain and discomfort they felt during kneeling.
  • BUT, it was not the pain and discomfort in the replaced knee, 75 % of the patients in this study had other health concerns why they could not kneel including obesity, other health problems, but the number one reason was problems with the other knee.

Common Symptoms Of A Failed Knee Replacement

The majority of patients who undergo knee replacement surgery experience successful outcomes, with long-lasting improvements in pain, mobility, and knee function. However, complications following knee replacement can occasionally arise for various reasons, resulting in what is commonly referred to as a failed knee replacement. When a knee replacement fails whether its shortly after surgery, or many years later it may require a revision, or re-do, knee replacement surgery.

In this blog, Ill address the common reasons why a knee replacement may fail and the signs and symptoms that may suggest complications following knee replacement surgery.

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Is It Normal To Still Suffer Knee Pain Months After A Total Knee Replacement Surgery

Immediate post-surgical pain is expected, but were talking months here.

Knee replacement patients are given powerful narcotics to numb the post-surgical pain.

However, for how long after knee replacement surgery is it still normal to feel pain?

My father had knee replacement surgery in March of 2009, and afterward, the pain in the surgical joint never disappeared.

Of course, the pre-surgical pain of osteoarthritis went away. But now, he was left with a newpain, and the joint didnt feel right.

The pain wasnt just in the knee it was in the area above it, and was most pronounced every time he stood up from a chair or climbed stairs. Many times, hed say, It just doesnt feel right. I know something is wrong.

A few times he speculated that it was infected. Signs of infection would include swelling, redness and fever, of which my father had none.

He even wondered if the surgeon had made a mistake with the knee replacement procedure, even though the same surgeon performed the procedure on my fathers other knee about a year prior to the second operation.

My father adhered to all the prescribed post-knee replacement surgery exercises, which included physical therapy and stretching.

He regularly went to the gym to do leg presses, leg extensions and seated leg curls. He had been doing these leg exercises long before even the first surgery.

The surgeon told him he was absolutely NOT to do any leg extensions.

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Looking For Alternatives To Total Knee Replacements

Why You Have Pain Soon After Revision Knee Replacement ...

We’re also funding research which is investigating alternative approaches to total knee replacement. For example, total knee replacement is not recommended for many young people. This study aims to develop a new method called ToKa®, which uses images of the patient’s joint and specially designed software to design a patient specific implant that will be made via 3D printing. If successful, this technique could prevent osteoarthritis patients from needing total joint replacement.

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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.

    Reasons Why Youre Not Sleeping At Night

    Depending on the stage of recovery youre in, there may be a few things contributing to your lack of sleep. Pain is a likely underlying reason youre awake at night. In addition to the pain culprit, there are other contributors that are creating your perfect storm of sleeplessness. Lets break em all down.

    When will I start sleeping again? Theres no clear-cut answer for this. However, around the 6 week mark you should be experiencing less pain, be off pain medications that cause side effects, and you will likely get the green light from your care team to sleep in more comfortable positions.

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    What Happens During Total Knee Replacement

    Your provider can help explain the details of your particular surgery. An orthopedic surgeon will perform the surgery aided by a team of specialized healthcare professionals. The whole procedure may take a couple of hours. In general, you can expect the following:

  • Most likely, you will be given spinal or general anesthesia so that youâll sleep through the surgery and wonât feel any pain or discomfort during the procedure. Or you may receive local anesthesia and a medicine to keep you relaxed but awake.

  • A healthcare professional will carefully watch your vital signs, like your heart rate and blood pressure, during the surgery.

  • You may receive antibiotics, during and after the procedure, to help prevent infection.

  • Your surgeon will make an incision over the middle of your knee, cutting through your skin and underlying tissue.

  • He or she will remove the damaged portions of your thigh and shin bone, removing a little of the bone beneath as well.

  • Next, metal implants are placed into the joint space, usually cementing them into the remaining bone.

  • In most cases, your surgeon will also remove part of the underside of the kneecap.

  • A plastic spacer is inserted into the space between the metal implants, for ease of movement.

  • The layers of your skin and muscle will be surgically closed.

  • Knee Replacement Pain After 1 Week

    KNEE PAIN * Why Does Your Total Knee Replacement Still Hurt So Much #TKR

    Everything I read and heard from others convinced me that the physical therapy was important and that it would hurt. I was not disappointed.

    The range of motion exercises were tough and they take a lot of self-discipline when nobody is watching over you. There were many times I had to talk myself out of cheating.

    I am glad that I persevered. I was surprised that I was up and walking so fast in the hospital. I was also surprised that I had two physical therapy sessions in the hospital.

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    After only two days home the home therapist made her first visit and the work began. I saw her twice the first week and each time she added exercises and they became harder and harder to do.

    During my first home physical therapy session the therapist measured my range of motion from 180 degrees flat to 70 degrees bent. By the end of the first week I had improved to 78 degrees.

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    A Realistic Assessment Of What We Can Do To Help With Your Pain After Knee Replacement

    In our clinic, we try to provide information on helping people explore other treatment options before joint replacement. One of those options is simple dextrose Prolotherapy. This regenerative injection technique helps rebuild damaged ligaments and tendons.

    When the patients have already had a joint replacement, we will do a physical examination of the knee to assess how we may be able to help.

    • Prolotherapy fixes soft tissue, it cannot fix hardware failure,
    • Prolotherapy works by stabilizes the knee by strengthening the natural muscle and bone attachments, ligaments, and tendons.

    Summary Of This Video: A Patient With Back Pain And Clicking In The Knee

    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 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.

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    Studies Have Demonstrated That Poor Management Of Acute Pain After Total Knee Replacement Is Strongly Associated With The Development Of Chronic Pain

    In March 2017, researchers went further, writing in the medical journal Clinic in Orthopedic Surgery:

    • Study:postoperative pain is a major cause of dissatisfaction among patients after total knee replacement. Studies have demonstrated that poor management of acute pain after total knee replacement is strongly associated with the development of chronic pain, emphasizing the importance of appropriate control of acute pain after total knee replacement
    • Our Comment:
    • The patient has knee replacement
    • The patient suffers from acute pain after surgery
    • Painkillers and other medications are prescribed to control a patients pain. Acute pain turns into chronic pain as the joint continues to degenerate. Pain is an indication of tissue damage that needs repair.

    Can You Run After Knee Replacement Surgery

    3 Simple Exercises That Heal Knee Pain Without Surgery Or ...

    Like any mechanical device, your knee replacement will wear out sooner if you put more stress on it. Wang says some surgeons want their patients to avoid running or high-impact activities.

    I dont necessarily mind patients trying to get back to what they loved, Wang said. If youre more active you can potentially shorten the life of your implant. But you might’ve decided to have the implant so you could get back to what you love doing.

    Springer said some people ask, Can I wear a brace after knee replacement surgery? He said most people dont, but its fine if you want to. He added that people who ski or play tennis sometimes like to wear one as a reminder.

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    Research: Patients With Persistent Pain After Knee Replacement Are Dissatisfied

    That is an obvious statement, but what are the patients dissatisfied with and how can we help them? Here is the study that statement came, 2016 research in the journal Osteoarthritis Cartilage:

    In the most dissatisfied knee replacement patients:

    • the pain was associated with instability in the coronal plane in other words difficulty in:
    • maintaining balance.
    • depression .

    What Should You Expect After Knee Revision Surgery

    Most patients who undergo revision procedures can expect to have good to excellent results. Although expected outcomes include pain relief with increased stability and function, complete pain relief and restoration of function is not always possible.

    Up to 20% of patients may still experience some pain following revision knee surgery. This can persist for several years after the procedure. Additionally recovery after revision total knee surgery is heavily dependent on the state and function of the knee prior to the revision surgery.

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    Recovering From Knee Replacement Surgery

    You’ll usually be in hospital for 3 to 5 days, but recovery times can vary.

    Once you’re able to be discharged, your hospital will give you advice about looking after your knee at home. You’ll need to use a frame or crutches at first and a physiotherapist will teach you exercises to help strengthen your knee.

    Most people can stop using walking aids around 6 weeks after surgery, and start driving after 6 to 8 weeks.

    Full recovery can take up to 2 years as scar tissue heals and your muscles are restored by exercise. A very small amount of people will continue to have some pain after 2 years.

    People Should Be Able To Kneel After Knee Replacement Why Arent They Research: It Has Nothing To Do With The Knee Replacement

    Painful Total Knee Replacement – Why Does It Still Hurt?

    Lets look at a January 2019 study in the Journal of Knee Surgery. It comes from the Department of Orthopaedic Surgery, Johns Hopkins University.

    Here are the summary points:

    • The ability to kneel is one of the many patient goals after total knee replacement.
    • Given the altered biomechanics of the knee after total knee replacement, the various implant designs, and multiple surgical approaches, there is a need to further understand the patients kneeling ability after total knee replacement.
    • In patients who do kneel after surgery, data show that increased range of motion promotes improved kneeling performance. Targeted interventions to encourage kneeling after total knee replacement, including preoperative education, have not shown an ability to increase the frequency with which patients kneel after total knee replacement.
    • Reasons for patient avoidance of kneeling are multifaceted and complex. There is no biomechanical or clinical evidence contraindicating kneeling after total knee replacement. There are insufficient data to recommend particular prosthetic designs or surgical approaches to maximize kneeling ability after surgery. Musculoskeletal health care providers should continue to promote kneeling to allow patients to achieve maximum clinical benefit after total knee replacement.

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    When A Knee Replacement Is Needed

    Knee replacement surgery is usually necessary when the knee joint is worn or damaged so that your mobility is reduced and you are in pain even while resting.

    The most common reason for knee replacement surgery is osteoarthritis. Other health conditions that cause knee damage include:

    • knee deformity with pain and loss of cartilage

    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:

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    Waking Up After Knee Replacement Surgery

    When I woke up in the recovery room I actually felt pretty good. I was still heavily sedated and the spinal block was still effective.

    As my hour and a half in the recovery room came to an end I was beginning to regain feeling in my lower body. As the recovery room nurse removed my compression stockings he told me that my IV included intravenous pain medication and that once I reached my room my hospital team would develop a plan for future medication.

    Once I reached my room the nursing staff attached air cuffs to both of my legs to promote circulation. The air cuffs used air to gently squeeze and release my calf muscles in a similar way as walking .

    They also hooked up a machine to circulate cold water around my knee to reduce pain and swelling. At this time I still had the IV with pain medicine.

    I was encouraged to wiggle my toes and move my ankles. At this point I did not feel any pain. After the IV was empty, the nurse asked me what my pain level was.

    I was able to move my surgical knee with the help of the other leg by putting the good leg under the bad and moving it slightly when needed. This was a technique that I had learned years ago when I had broken my leg. I was also able to sit up and adjust positions with the aid of the automatic bed.

    At this point we decided that the oral pill Percocet would be right for me. A few hours later when she asked me about my pain level I responded again that it was 5 to 6.

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