Knee Replacement: Continued Knee Pain Post-Operation

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

More than 90% of patients felt their knee replacement and rehabilitation results were excellent and exceptional. However, not everyone who undergoes the operation can walk out pain-free. There are a few people in severe pain after knee replacement surgery and often feel hopeless.

According to a study, 1 in 5 people experience persistent pain following knee replacement surgery, yet many still 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 body’s weight. 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)

Articular cartilage between the bones cushions the bones 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 challenging 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 runners, are more prone to a 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 vital 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 natural degeneration of soft tissue.

Recovery from knee replacement surgery can take up to three months 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.

Understanding Continued Knee Pain

Continued knee pain after knee replacement surgery can be frustrating and impact quality of life. Understanding why it occurs, the symptoms, and when to call your doctor is very important for pain management.

Continued knee pain is discomfort that extends beyond the expected recovery time after knee replacement. It can last from a few weeks to a few months. While initial pain is expected as the healing process begins, if it doesn’t stop or lessen with time, it could indicate that some issues need medical attention.

Acute Pain vs. Chronic Pain

Acute pain, lasting 1-3 days, occurs immediately after surgery and is usually managed in the hospital. It starts decreasing after a few weeks as healing begins.

Chronic pain lasts for around six months post-surgery, and the intensity requires medication and other pain management strategies.

The pain you feel may be located at the incision point, around it, or in another area. Knowing where it hurts is very important for managing the pain correctly. For instance, if it’s around the incision site, it may be due to scar tissue formation or inflammation.

Discomfort in the surrounding area indicates muscle tightness, which can be due to compensation movements the joint or knee has to make during recovery of the side muscles.

Pain Levels

Immediately following the operation, the pain is most intense and is managed with medication and treatment within the hospital. Three months afterward, the pain significantly reduces and is still managed by medicines as prescribed by the doctor and physical therapy.

Beyond six months and above, you may feel chronic pain, which requires assessment and pain management by medical practitioners.

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.

Many conditions and injuries 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, joint abnormalities that may have occurred from an injury or long-term misuse, or situations that cause abnormal bone growth, like bone spurs.

As it is a 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: Certain exercises may benefit individuals who experience knee pain. Patients work with a physiotherapist to strengthen the muscles that support the knee and improve the associated range of motion. Many patients have great success with physical therapy and injuries that are not caused by degeneration can be improved by physical therapy and even stopped from progressing further.
• 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 the risks and side effects with your doctor.
• Corticosteroid Injections: A large dose of synthetic cortisol can reduce inflammation and 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 placed on the joint.

Knee replacement surgery involves removing the end of the shin, 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 usual location. Before closing the incision, doctors will bend the knee to ensure the artificial joint functions properly.

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

Patients over 60 years of age 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, it never stops progressing, leading to a complete overhaul of the joint system—a total knee replacement.

Potential Risks and Complications

Every surgical procedure has 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 operations rarely fail.

What if Pain Persists After Surgery?

A significant 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, metal and plastic, 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 is healed incorrectly, which can occur if physical therapy is not practiced, as a medical professional suggests.

When the artificial joint loses its supportive structure, it can cause discomfort and pain. As they have been cemented to the bone, surgery on these artificial joints can be complex. Scar tissue can also complicate the procedure. Skilled surgeons can do what they can to improve the joint, but it can be a complex surgery.

Factors Contributing to Continued Knee Pain

Furthermore, if there is continued knee pain, there could be specific causes for it.

• Sometimes, the Sometimes could be misaligned or loose, which can cause pain.
• There could be an infection, blood clot, or damage to the surrounding tissue, causing persistent pain.
• Older patients or those with underlying health issues may have longer recovery times.
• Then, being overweight or indulging in strenuous activities can increase or worsen the pain.
• If the patient has arthritis or has had subsequent knee injuries, there could be chronic pain after the surgery that lasts.
• Anxiety and depression can also increase the pain perception, making recovery more challenging for the patient.

Symptoms and Warning Signs

Some symptoms and warning signs to watch out for are as follows. Do not delay and talk to your doctor as soon as you witness any of these warning signs:

• Pain gets intense or worsens over time, extending beyond the expected recovery timeline.
• If there is swelling and redness around the joint.
• If you still face difficulty walking, bending, or straightening your knee
• If you have a fever or pain and there is drainage from the incision site.
• If you feel there is no significant improvement after physical therapy and pain medication.

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 and pain on the skin’s surface.

To determine the cause, doctors order a series of tests. These may include blood tests, X-rays, MRIs, or other imaging or physiological tests. Once they know what is causing pain, they can 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 options. If pain persists through these, doctors and surgeons may consider revision surgery.

Recovery time after revision surgery can be long and arduous, 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 surgery altogether. Treatments like Stem Cell Therapy and Platelet-Rich Plasma (PRP) Therapy use the body’s 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. Sending cells to an injury site naturally but in increased amounts could be the solution to healing damaged tissue.