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Can Knee Replacement Cause Neuropathy

How Common Is Numbness In The Knee After Acl Surgery Or Knee Replacement Surgery

Neuropathy and Knee Replacement, and a Quick Recovery

The symptoms of numbness post knee surgery are surprisingly common! Lets jump in and see exactly how many people end up with numbness after surgery.

The below picture graphs percentages of knee numbness after surgery. This is taken according to available literature on how many people will have numbness after ACL surgery or a total knee replacement.

You can see that 85% of patients experience numbness after arthroscopic ACL repairs, compared to 50% of patients who experience numbnessafter a total knee replacement.

This is probably due to what was previously discussed about the surgeon not being able to visualize structures within keyhole surgery.

Translation Into Practice: Practice Pearls/performance Improvement In Practice /changes In Clinical Practice Behaviors And Skills

  • Injury to nerves may occur due to intrinsic factors or extrinsic factors following knee surgery, leg fractures, and in the setting of vascular disease or inflammatory conditions.
  • Early evaluation and treatment of nerve injuries can avoid long-term impairments and irreversible nerve damage.
  • Injections may be useful for both diagnostic and potentially therapeutic purposes. Imaging with radiographs, ultrasound, and MRI can evaluate for structural signs of nerve pathology.
  • EMG can help localize nerve lesion and determine severity/prognosis.
  • Treatment may include both conservative measures and surgical intervention, depending on nature of injury.
  • Peroneal Nerve Injury Treatment

    Pro Tip

    Most people expect the diagnosis to be straightforward. While the history and physical exam can be helpful, more studies are often needed. These can include MRI, ultrasound, electromyography, and/or a nerve conduction study. Dr. Walcott

    Seeing a doctor as soon as possible can help prevent long-term damage. Treating it will also;help minimize your pain and increase your mobility.

    Treatment depends on the severity of the nerve damage. This may include letting the nerve heal on its own or may require surgery to repair or replace the nerve, or to remove a tumor or growth causing nerve injury. Medications can help control symptoms.

    Non surgical treatments include:

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    Problem: Neuropathic Knee Pain After Surgery Nerve Damage Caused By The Surgery

    Above we discussed neuropathy, nerve damage, as occurring in a small portion of knee replacement patients. A study from doctors in the United Kingdom published in the Bone and Joint Journal; suggests that while a small percentage of patients suffer from neuropathic pain caused by knee replacement, it is still an underestimated problem in patients with pain after total knee replacement.

    The same research team had more to say in a 2017 study that will be discussed below.

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    Can Knee Replacement Cause Neuropathy ? Know Here!

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    Despite A Good Outcome For Many Patients Approximately 20% Of Patients Experience Chronic Pain After Total Knee Arthroplasty

    When we discuss the problems of joint replacement, we always bring in the joint replacement specialists for their opinion. This is a recent research sampling of doctors who specialize in knee replacement.

    In the medical journal;EFORT Open Reviews, published by;the British Editorial Society of Bone & Joint Surgery, doctors wrote in August 2018:

    • Despite a good outcome for many patients, approximately 20% of patients experience chronic pain after total knee arthroplasty.
    • Chronic pain after total knee replacement;can affect all dimensions of health-related quality of life, and is associated with:
    • functional limitations,
  • Assessment of the cause of pain after total knee replacement has been inadequate
  • Finally: Treatment of chronic pain after total knee replacement is challenging, and evaluation of combined treatments and individually targeted treatments matched to patient characteristics is advocated.
  • How Does Peripheral Neuropathy Start

    Peripheral nerve damage can be caused by various conditions, such as accidental injury, autoimmune diseases, bacterial and viral infections, kidney and liver disease , and cancerous tumors that press on the nerves or develop in the bone marrow.

    However, the most common culprit of peripheral neuropathy is diabetes. It is also called diabetic neuropathy.

    What happens in diabetic neuropathy is that the high blood sugar levels can damage the nerves, particularly those in the legs and feet. The first symptoms typically begin the feet.

    Peripheral neuropathy due to diabetes can be slowed down by controlling blood sugar levels and making lifestyle changes as explained by your doctor. If it is not effectively managed, diabetic neuropathy can lead to complications such as limb loss , hypoglycemic unawareness, drops in blood pressure, and joint damage.

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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.

    How Long Does Neuropathy Last

    Pain After Knee Replacement: Fixed Patient’s Nerve Pain After Knee Surgery

    Neuropathy caused after surgery is typically a temporary condition. If total knee replacement does cause neuropathy, it will likely go away within 1 year.

    The severity of the neuropathy depends on how long the nerve was compressed or how badly it was damaged.

    Prior nerve health also plays an important role in how fast neuropathy will go away. If someone is diabetic or has a history of a nerve injury then the neuropathy can last longer. The less the nerve was hurt the faster the recovery.

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    Numbness In Knee Or Leg After Knee Surgery Causes Treatment And More

    Knee numbness after surgery is very common with up to 85% of surgical candidates experiencing some form of numbness post operation.

    Even with this high prevalence, the causes and long-term outcomes of knee numbness after surgery are not always explained.

    Prefer to skip ahead?

    This article will cover knee numbness in detail to give the best understanding of what actually causes numbness, and what the longer term outcome of your knee numbness.

    Prefer to watch the video? Check this blog in video format here:

    Patients May Still Be Undergoing Knee Replacement For Degenerative Lumbar Spine And Hip Osteoarthritis

    Patients may still be undergoing knee arthroplasty for degenerative lumbar spine and hip osteoarthritis. . . We suggest heightened awareness at pre-and post-operative assessment and thorough history and examination with the use of diagnostic injections to identify the cause of pain if there is doubt.

    In other words, patients received a knee replacement when the cause of pain came from the hip and spine.

    In the journal Modern Rheumatology, Japanese doctors wrote:

    We suggest that rheumatologists be aware of hip disease masquerading as;knee;pain;or low back;pain.

    In the case of chronic joint pain, a thorough examination is imperative in identifying the correct diagnosis. That sounds like common sense, but the sad truth is that the source of pain is often missed because of misinterpretation of MRI and other imaging scans. Please see our article on MRI accuracy.

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    How Is Pain After Total Knee Arthroplasty Treated

    The doctors at US Neuropathy Centers offer customized treatment plans to alleviate nerve pain. They may recommend peripheral nerve stimulation.;

    Peripheral nerve stimulation involves a minimally invasive procedure to implant a lead wire near your pinched or damaged nerve. A small implanted generator powers the electrode wire and allows it to release electrical pulses to disrupt or block the nerve signals.;

    Your doctor may also recommend surgery to release the nerve. The physicians at US Neuropathy Centers perform minimally invasive procedures to release the common peroneal nerve that takes less than 20 minutes to complete. In most cases, your pain disappears almost immediately, and you can walk around on the same day.;

    If youre troubled by knee pain after total knee arthroscopy, call US Neuropathy Centers or make an appointment online today for expert assessment and treatment.;

    What Are Symptoms Of Peroneal Nerve Damage

    How to Properly Prepare for a Total Knee Replacement

    Dr. Rx

    Nerves arent only involved in the sense of touch. Nerves are the highways that electrical activity travels on. Muscles are activated and fueled by this electrical activity. If there is any damage or disturbance to the highway , muscles may not work properly since electrical signals cannot be delivered to them. Dr. Brian Walcott

    The first sign of injury may be tingling on the outer edge of the leg and thigh, the area between the big toe and second toe, and the top of your foot. Next youll feel numbness, which means that the injury has progressed, or is more severe.

    If the injury is severe, you may have difficulty moving your foot in different directions. One hallmark symptom of a peroneal nerve injury is the inability to point your toes or your foot up toward the ceiling or point it outward.

    You may also notice your foot is pointing to the floor when you stand, a condition known as foot drop. This can make it difficult to walk, and you may find yourself stumbling over roots, curbs, and steps.

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    Causes Of Peripheral Neuropathy

    Peripheral neuropathy is a condition that is marked by damage to the peripheral nervous system, which generally comprises the nerves in the limbs. The peripheral nervous system sends sensory information to the central nervous system , such as pain and cold signals. Nerve damage can therefore negatively impact pain and temperature perception, balance, the ability to grasp things, and even speech function, depending on which nerves are affected.

    Picture a wire that transmits signals. With peripheral neuropathy, the wire is broken or badly damaged, so the signals do not reach the recipient. The damage could also lead to garbled, distorted, or incorrect signals. That is why in peripheral neuropathy, you may have a tiny injury in a toe that turns into a large infection because you couldnt feel pain in the toe, to begin with.

    There are many types of nerve damage, but lets talk about the particular causes and symptoms associated with peripheral neuropathy.

    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 .

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    How Common Is Numbness

    As stated, sensory skin nerves are invariably cut at the time of knee replacement surgery. About 50%;of people notice symptoms of numbness around the area of the skin incision one year after their surgical procedure. That said, less than 10% of these people are bothered by this symptom.

    The three factors which are most notably associated with being bothered by numbness are:

    • Length of the Incision: The strongest association with numbness was the length of the surgical incision.;Longer surgical incisions are more likely to cut nerves underneath the skin.
    • Female Gender: Women seemed to be more commonly affected by abnormal sensations around her incisions, and more than three-quarters of the patients to report discomfort as a result were women.
    • Age of the Patient: People;older than 70 years of age had fewer complaints about being bothered by abnormal sensations around their incisions.

    In addition to these factors, the nerve that provides sensation to the front of the knee starts on the inner side of the joint and progress over the front of the joint extending towards the outer side of the knee joint. When the skin incision is based more towards the inner side of the knee joint, it is more likely to cut the larger portion of the nerve whereas incisions based more towards the outer side of the joint tend to involve the smaller branches. When only the smaller branches are cut, the effect on the perception of sensation is reduced.

    Causes Of A Peroneal Nerve Injury

    Nerve Pain after Knee Replacement Surgery. WHY and HOW to Manage Effectively

    The common peroneal nerve runs very close to the surface of your skin just below the knee, which is why it is so easy to injure. It can become injured in the following ways:

    • A cut through the nerve .
    • A broken bone or dislocated knee puts pressure on the nerve.
    • Too much pressure is placed on the nerve by you crossing your legs or laying on the nerve for too long.
    • A tumor or cyst is pushing on the nerve.

    Pro Tip

    Injury to the peroneal nerve can occur in any activity and sport where the knee is stressed. Snow skiers and snowboarders are particularly susceptible. Falling and landing directly on the knee puts it at risk for soft tissue injury and dislocation. Since the nerve is so close to the knee joint, it can be injured as well. Dr. Walcott

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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 Long Do Damaged Nerves Take To Heal

    Regeneration time depends on how seriously your nerve was injured and the type of injury that you sustained. If your nerve is bruised or traumatized but is not cut, it should recover over 6-12 weeks. A nerve that is cut will grow at 1mm per day, after about a 4 week period of rest following your injury.

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    Harvard Medical Schools Findings Surrounding The Phenomena Of Continued Pain Following Total Knee Replacement

    Here are some more quick facts surrounding the phenomena of continued pain following total knee replacement from researchers at;Brigham and Womens Hospital, Harvard Medical School.

    In this 2017 study published in the medical journal;Osteoarthritis Cartilage, the doctors found:

    • Approximately 20% of total knee replacement;recipients have suboptimal pain relief. .
    • Pre-operative widespread pain was associated with greater pain at 12-months and failure to reach a clinically meaningful difference in pain, pre and post replacement
    • Patients with widespread pain along with the pain catastrophizing problems may help identify persons with suboptimal total knee replacement outcomes.

    What Is The Most Commonly Reported Problem After Knee Replacement Surgery

    Peripheral Neuropathy After Total Knee Replacement (With ...

    Knee replacement surgery can result in physical complications ranging from pain and swelling to implant rejection, infection and bone fractures. Pain may be the most common complication following knee replacement. Its normal for patients to experience some degree of pain up to six months after surgery.

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    Numbness Foot After Knee Surgery

    In many physiotherapy works, numbness in the knee or leg after surgery is extremely normal. Knee numbness is a common side effect of surgery. Up to 85% of surgical applicants will experience numbness foot after knee surgery.

    However, with numbness, another such common side effect is a burning sensation in foot after knee surgery. Cutting tissue open to reveal the sections that need to be fixed or removed is a standard procedure in surgery. Any time you cut into tissue, theres a chance youll cut nerves as well.


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