Knee

How Long Does Pain Last After Knee Replacement Surgery?

By October 10, 2019 No Comments

Our knees are used in almost all daily activities, from standing to sitting to walking and even sleeping. It can be particularly devastating when knee pain occurs. Quality of life and enjoyment of daily activities can be altered quickly when experiencing knee pain. The causes of this pain vary from person to person, but treatment options are generally the same. This article will discuss basic anatomy of the knee and where knee pain may be coming from, how knee pain is typically treated, a brief overview of total knee replacement surgery, what to expect after surgery, and how regenerative medicine could alter the recovery timeline in a beneficial way.

Anatomy of the Knee and Associated Ailments

The knee is comprised of three bones, the Tibia (shin bone), the Femur (thigh bone), and the Patella (kneecap). These bones align in such a way that allows them to bend. The muscles, tendons, and ligaments surrounding the knee serve as stabilizing agents. There is fleshy cartilage between the bones which acts as a cushion, preventing the bones from rubbing against one another called bursa.

When someone experiences pain in the knee, there are several potential causes. The three most common are:

  • Osteoarthritis: soft tissues in the body degrade naturally over time. When the cushions between bones begin to deteriorate and the bones begin to rub against each other, this is called arthritis. This condition can cause a great deal of pain and occurs predominantly in people over the age of 50, but can occur to anyone at any time.
  • Injury: an injury can occur for many reasons, including a sports injury, falling, or a traumatic injury such as a car accident. When these occur, the bones not only experience trauma but may realign in such a way that causes pain. These can include torn cartilage, a torn ACL, or broken bones.
  • Overuse: repetitive motion in the knee can lead to more rapid degeneration of the soft tissue.

Certain individuals may be more prone to knee pain than others due to their lifestyle. These people include:

  • Athletes: the aforementioned overuse of a joint can contribute to pain over time, as well as make someone more prone to injury.
  • People who are Overweight: the more weight that the knee joint has to bear, the more stress it will be under. Over time, this added stress can lead to more rapid degeneration.
  • Seniors: as soft tissue degrades over time, arthritis begins to set in, leading to joint pain and discomfort.

There are many more potential causes of knee pain, as the network surrounding the knee is intricately composed and there are many different things that can go wrong. Having an open discussion with a doctor about it is the first step to proper diagnosis and treatment.

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 patient’s 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 (Non-Steroidal Anti-Inflammatory Drugs) 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 patient’s 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:

  • Arthroscopy: using tiny surgical tools, doctors are able to repair some damage, realign muscles or tendons, remove problematic items, and many more. This type of surgery is minimally invasive as the tools are very small, but is not always capable of correcting all of the damage that has occurred.
  • Partial Knee Replacement: depending on the nature of the injury or damage, doctors may elect to perform a replacement of certain aspects of the knee which are causing pain. Whereas arthroscopy is mostly rearranging or removing structures that already exist, partial knee replacement does use foreign objects made of metal or plastic to replace parts of bone or muscle with a more functional piece.

The recovery time for these procedures varies from patient to patient but usually takes anywhere from a couple months to over a year. An individual’s commitment to the healing process, dedication to physical therapy, their body’s healing properties, and many more all play roles in the recovery process.

In some cases, knee pain will persist even after the initial surgery. When this is the case, the option of total knee replacement is discussed.

Total Knee Replacement Surgery

Total knee replacement begins with removing the damaged parts of the femur and tibia. They are then shaped in such a way that will best accommodate the foreign objects that are used. The ends of both the tibia and femur are fitted with a piece of metal. The piece of metal that is on the tibia is attached to a piece of plastic. The patella is also sometimes fitted with a piece of plastic.

These foreign objects allow for smooth motion in the knee, and by removing the damaged parts can prevent further degeneration or injury.

Life After Surgery

Patients who have undergone total knee replacement surgery will each have a different recovery process. Typically, being able to stand up and even walk to the bathroom can occur hours after surgery. Patients will most often be discharged from the hospital after a matter of days, but will be encouraged to continue specific exercises. Many of the initial exercises can be done from bed. As the patient becomes more able to move around, the recommended exercises will change. Some of the goals of these exercises are:

  • Strengthening Muscle: muscles surrounding the knee are there to provide support, and if they lay idle after surgery they can become weak and no longer provide support. If they are exercised as recommended, the healing process will be more efficient overall.
  • Prevent Blood Clots: immediately after surgery, as the body is attempting to heal, patients become more prone to clotting. Sometimes an anticoagulant medication is prescribed briefly to further prevent this from occurring.
  • Improve Range of Motion: if knee muscles are not being used, they will begin to stiffen. This interferes with the recovery process and makes it more difficult for patients to undergo physical therapy.

Physical therapy is recommended for several months following surgery. Pain management is key to having a successful recovery, as managing pain leads to more fruitful physical therapy. Pain management post-operation typically consists of prescription painkillers to begin with, then as time goes on and the body heals, patients are recommended to wean off prescription painkillers and begin use of over-the-counter drugs.

Many patients will employ the use of an ambulatory aid such as a cane or walker in the beginning of their recovery process. The use of these tools allows patients to relieve some of the pressure that would be otherwise placed on the knee. Many patients begin with a walker and switch to a cane later in the recovery process once the knee is capable of withstanding more pressure.

Recovery Timeline

The amount of time it will take to feel no pain is different for everyone. This is generally referred to as a “recovery timeline”. Patients usually report reduced pain within three to five weeks. After six weeks, patients begin to enjoy increased mobility, and some can return to driving. At this time, pain becomes less of an issue but is replaced with stiffness and soreness which can cause discomfort. By the time that the 11th week occurs, patients should almost be able to return to how their life was before surgery.

The aforementioned timeline for recovery is dependent entirely on a patient’s commitment to physical therapy and dedication to following their doctor’s recommendations. Pain management using medication will allow this process to run more smoothly. There are alternative therapies on the market which may actually help with pain management as well as speed up recovery time.

Benefits of Regenerative Medicine in the Healing Process

The relatively new field of regenerative therapies is offering patients with a myriad of ailments new hope. The two forms of therapies offered at CELLAXYS are:

  • Stem Cell Therapy: this form of therapy involves harvesting stem cells which already exist in the body. They are typically taken from adipose tissue, or fat cells, but can also be taken from blood cells or bone marrow. The stem cells are processed to become more concentrated and reinjected into the area where an injury or degeneration has occurred.
  • Platelet-Rich Plasma Therapy: this form of therapy begins with a blood draw. The blood is then placed into a centrifuge which separates platelets out from other components in the blood. Platelets are an aspect of blood which contain proteins and growth factors. Platelets are a crucial part of the healing process, from a paper cut to knee surgery. The concentrated platelets are then injected into the area where pain is occurring.

Both of these forms of therapy are taking the body’s own healing processes, amplifying them, and using them to heal more intensely.

Both procedures use an imaging technique such as ultrasound or MRI (Magnetic Resonance Imaging) to pinpoint the exact location they should be injected that will have the most benefit.

Both procedures are outpatient and typically don’t last more than two hours to complete. Patients may experience slight pain at the injection site for a couple of days following the procedure, but this typically goes away quickly. The injection site is sometimes numbed for greater comfort.

The goal of regenerative therapy is two-fold: it seeks to reduce pain and to aid the healing process, which in turn can prevent further damage in the long-term. Patients have reported feeling reduced pain in as little as a couple of hours, but most patients see results within a matter of days.

After a total knee replacement surgery, a patient may consider regenerative therapy for its healing properties. The replacement surgery is a drastic measure, and on its own can take a long time to fully recover. These therapies offer a sort of “boost” in the recovery process. These types of injections allow the muscles surrounding the surgery to repair faster, providing more stability to the joint. They also offer healing properties to the bones which are placed under immense stress from the surgery.

The amount of pain felt after a knee replacement surgery could be reduced using these therapies. The aforementioned recovery timeline may also be altered for the better. Recovering more quickly means a patient is able to return to their normal lives more quickly. This type of surgery can change daily activities from cooking to driving to sleeping. It also affects a patient’s ability to return to work – all jobs, from sedentary ones to active ones, are affected by this.

Knee replacement is a drastic and life-altering process during recovery. When faced with the option to undergo surgery, patients should consider all of the options available, especially those which offer hope for a speedier recovery such as regenerative therapy.

Conclusion

Knee pain can have many causes, but the most common culprits are products of degeneration over time or injury. The complex network of tendons, ligaments, bones, and cartilage can create an opportunity for pain to persist even when conventional treatments fail. If they do fail, there are still options for a patient who is experiencing pain. Total knee replacement surgery is seen as a last resort for knee pain but may be necessary for some to return to a normal life. The recovery process is long and impacts almost every aspect of daily life. When faced with this decision, patients should consult with doctors about all of the treatment options available to them. The field of regenerative therapy may offer a speedier recovery, meaning patients can return to the things they love more quickly.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni