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Knee Replacement: Continued Knee Pain Post-Operation

By Last updated on January 13th, 2022January 13th, 2022No Comments

Knee replacement surgery is one of the most prevalent types of orthopedic surgery. When the knee joint wears out, most commonly due to wear-and-tear arthritis, a knee replacement is performed.

After a knee replacement and rehabilitation, more than 90 percent of patients consider their results as good or exceptional. However, not everyone who undergoes the operation has a pain-free knee. People who are in agony following knee replacement surgery may feel hopeless and believe there is nothing else they can do.

According to a new study, 1 in 5 people experience persistent pain following knee replacement surgery, yet many do not seek treatment.

Anatomy of the Knee

One of the most important joints in our body is the knee joint because it bears most of the weight of the body during any given activity. Due to its prominence, knee pain or injury can become debilitating quickly. When mobility is affected or pain becomes unbearable, it is time to see a doctor.

The knee joint is formed predominantly by three bones:

  • The tibia (shin bone)
  • The femur (thigh bone)
  • The patella (kneecap)

There is articular cartilage between the bones that acts as a cushion to prevent them from rubbing against one another and causing injury. The cartilage also allows the joint to glide smoothly during activity.

Another major piece of cartilage in the knee is the meniscus. This tough piece of cartilage acts as a shock absorber for the joint as a whole, which is an important function since the knee can bear so much weight. People who force their knees to endure a lot of shocks, such as a runner, are more prone to meniscus injury – but it can happen to anyone at any time.

Other important structures that help the knee function include tendons, muscles, and ligaments that hold the joint in place. These soft tissues also provide support and strength to the joint. Some particularly important ligaments in the knee include:

  • ACL (Anterior Cruciate Ligament)
  • PCL (Posterior Cruciate Ligament)

Injury to these ligaments can significantly impact daily life.

Any of the major structures in the knee can become injured, and injury can have a variety of causes. Some knee injuries occur suddenly, as in a sports injury or car accident. Other forms of injury can develop slowly over time as the joint is misused or in the process of natural degeneration of soft tissue.

Recovery from knee replacement surgery can take up to three months for you to resume most activities, and it could take up to a year to fully recover your maximum strength and endurance. The recovery process involves a lot of physical therapy, hard work, and dedication to recovery.

Who should get Knee Replacement Surgery?

Knee replacement surgery is an option for individuals who have long suffered knee pain and seen little to no improvement from conventional treatment methods. It is considered major surgery and making the decision should not be taken lightly.

There are many conditions and injuries that can lead to total knee replacement surgery, though the most common is arthritis. Other conditions include prolonged injury to the meniscus that results in bone-on-bone contact, abnormalities of the joint that may have occurred from an injury or long-term misuse, or conditions that cause abnormal bone growth like bone spurs.

As it is major surgery, the operation is only offered to individuals who have tried other less invasive treatments first. Some common, minimally invasive treatments for knee pain include:

  • Physical Therapy: individuals who experience knee pain may benefit from certain exercises. Patients work with a physiotherapist to strengthen the muscles that support the knee and improve the range of motion associated with the knee. Many patients have great success from physical therapy, and injuries that are not caused by degeneration can be improved by physical therapy and even stop the further progression of an injury.
  • Pain Relief: over-the-counter anti-inflammatory drugs like Ibuprofen can reduce symptoms and make it easier to get through the day. Intense pain may be treated with prescription pain medication – discuss with your doctor the risks and side effects.
  • Corticosteroid Injections: injecting a large dose of synthetic cortisol can reduce inflammation, which can relieve pain. These injections are not likely to be used on the arthritic or senior populations, as they can further degenerate soft tissue over time.
  • Brace or Assistive Devices: wearing a knee brace can help the joint heal in the correct position, and the compression can help reduce swelling. Some doctors may also suggest assistive devices such as a cane or walker to reduce the amount of weight being placed on the joint.

Knee replacement surgery involves removing the end of the shin and thigh bone, and the entire kneecap. A replacement joint, made of plastic and metal, is then cemented to the end of the bones. A synthetic kneecap may be placed in its normal location. Before closing the incision, doctors will bend the knee to ensure that the synthetic joint functions properly.

Patients who are younger and more active may consider a partial knee replacement surgery as a form of treatment as well. This surgery only replaces part of the joint, such as the tip of the shin or thigh bone, but not both. Partial knee replacement surgery often requires another surgery ten years later but can be a good option for those who are still active and whose lifestyles may require less invasive surgery.

Patients who are above 60 years of age and who have been experiencing a form of arthritis (most likely Osteoarthritis or Rheumatoid Arthritis) for a long time may consider total knee replacement as a last resort for treatment. Arthritis is a degenerative condition that can be managed, but unfortunately never stops progressing, leading to a complete overhaul of the joint system – a total knee replacement.

Potential Risks and Complications

Every surgical procedure comes with a set of risks or complications that may occur during surgery. These include infection, stroke, pneumonia, and a reaction to anesthesia.

Knee replacement is generally considered safe and rarely do the operations fail.

What if Pain Persists After Surgery?

An important complication that may occur post-operation is that the surgery does not provide the intended results. Many doctors now agree that there are too many knee replacements being done, and they may be performed on patients who don’t necessarily need them, particularly patients under the age of 60.

According to a 2014 study published in Arthritis & Rheumatology, one-third of patients who have had knee replacement surgery may not be good candidates for the treatment since their arthritis symptoms aren’t severe enough to warrant surgical intervention.

The knee replacement materials, the metal, and plastic that are cemented to the bone have a limited lifespan. Patients who receive a partial knee replacement in their 50s and 60s are more likely to need corrective surgery after approximately 10-15 years.

Patients who are obese are more likely to require corrective surgery, as the joint is bearing more weight which causes it to wear down more quickly. This may also occur if the joint heals incorrectly, which can occur if physical therapy is not practiced as suggested by a medical professional.

When the artificial joint begins to lose its supportive structure, it can cause great discomfort and pain. It can be difficult to do surgery on these artificial joints, as they have been cemented to the bone. Scar tissue can complicate the procedure as well. Skilled surgeons can do what they can to improve the joint, but it can be a difficult surgery.

Causes of Persistent Knee Pain

Causes of Persistent Knee Pain

So, what exactly is causing pain after surgery? In addition to the replacement joint wearing down, there are several other causes to look out for:

  • Poorly Aligned Implant: if the implant is loose or not aligned correctly, it will not function correctly.
  • Kneecap Misalignment: issues with the kneecap placement are a common source of pain after surgery, as stress is added due to the change in muscle structure.
  • Avascular Necrosis: a condition that causes bone tissue to die, caused by poor circulation. Patients with avascular necrosis, also called osteonecrosis, may experience more pain near the knee as the supportive bones degenerate.
  • Infection: an infection can cause increased swelling around the knee, as well as pain on the surface of the skin.

To determine the cause, doctors order a series of tests. This may include blood tests, X-Rays, MRIs, or other imaging or physiological tests. Once they know what is causing pain, they can begin to develop a revised recovery plan. Many of the same techniques are attempted as the first attempt – physical therapy, assistive devices, and corticosteroid shots might be considered as options. If pain persists through these, doctors and surgeons may consider revision surgery.

The recovery time after a revision surgery can be long and difficult, though many patients have successful results. Others, however, are turning to alternative treatment methods to get out of the surgery cycle.

Regenerative Medicine’s Role in Preventing the Need for Surgery

Regenerative therapy is a solution for patients seeking relief from pain after surgery, but it offers other benefits, too – it could prevent the need for it altogether. Treatments like Stem Cell Therapy and Platelet-Rich Plasma (PRP) Therapy use the body’s own regenerative cells to heal injuries and repair damaged tissue.

There are specific criteria that may make these types of patients good candidates.

It’s no surprise that patients suffering from prolonged knee pain are seeking out other treatment options. Surgery can have negative consequences and it may seem overwhelming to go through revision surgery and the recovery process all over again. Using cells that are sent to an injury site naturally, but in increased amounts, could be the solution to healing damaged tissue.

Dr. Matthew HC Otten

Director of Regenerative Orthopedic and Sports Medicine
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan State University Alumni

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