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How Painful Is Knee Replacement Surgery

What You Can Expect:

How painful is a total knee replacement

Pain will fluctuate based on time, medication, activity, and more.

On a 0 to 10 pain scale with 0 being no pain and 10 being the most intense pain possible the first 48 to 72-hours after surgery are often described as a 7/10.

7/10 Pain is Cant be ignored for any length of time, but you can still go to work and participate in social activities.

The pain will often vary between 3/10 Annoying enough to be distracting at the low end up to an 8/10 Physical activity severely limited. You can read and converse with effort. Nausea and dizziness set in as factors of pain.

Open Surgery On The Heel Bone

If a person fractures their heel bone, they may need surgery. An operation is not always necessary if the bone has not moved too far out of place.

To repair the fracture, a surgeon must cut into the skin to get to the broken bone. They can then fix the bone back together, using plates or screws.

The skin around the heel is thin, and this area does not have a lot of soft tissue. It is easy to damage the nerves around the heel bone during surgery. Along with the attachment of screws to the bone, this can make the operation and recovery painful.

Extending The Life Of Your Knee Implant

Currently, more than 90% of modern total knee replacements are still functioning well 15 years after the surgery. Following your orthopaedic surgeon’s instructions after surgery and taking care to protect your knee replacement and your general health are important ways you can contribute to the final success of your surgery.

To assist doctors in the surgical management of osteoarthritis of the knee, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case. For more information: Surgical Management of Osteoarthritis of the Knee – Clinical Practice Guideline | American Academy of Orthopaedic Surgeons

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Pain After Knee Replacement

During the knee replacement surgery, the diseased ends of the knee joint are removed. Prosthetic metal parts are placed at the bone ends that reduplicate the function of the knee joint. A plastic polyethylene insert is placed in between the two opposing metal surfaces.

X-ray showing a total knee replacement.

General pain in the knee after replacement surgery is part of the recovery process. The pain may be associated with swelling and generally goes down in the initial 2-3 weeks. The pain is typically managed with medications such as non steroidal anti-inflammatory medications or short term opioid medications. The swelling is generally managed using an ice pack.

While the general knee pain slowly goes away in the initial few days, some patients may need oral pain medications for several weeks after the surgery. Physical therapy and home exercises help to decrease the pain.

For diagnosis of the cause of the pain, the physician will note the characteristics of the knee pain. The quality, location, onset, radiation, relieving and aggravating factors all help the physician to find the cause is pain. The physician conducts a thorough physical examination and may request radiological studies in the form of an X-ray, CT scan or an MRI. Blood investigations may be done to look for signs of infection.

Intraoperative image showing closure of a total knee replacement.

Dr. Suhirad Khokhar

Up To A Third Of Knee Replacements Pack Pain And Regret

Total Knee Replacement Rehabilitation

Danette Lake thought surgery would relieve the pain in her knees.

The arthritis pain began as a dull ache in her early 40s, brought on largely by the pressure of unwanted weight. Lake managed to lose 200 pounds through dieting and exercise, but the pain in her knees persisted.

A sexual assault two years ago left Lake with physical and psychological trauma. She damaged her knees while fighting off her attacker, who had broken into her home. Although she managed to escape, her knees never recovered. At times, the sharp pain drove her to the emergency room. Lakes job, which involved loading luggage onto airplanes, often left her in misery.

When a doctor said that knee replacement would reduce her arthritis pain by 75 percent, Lake was overjoyed.

I thought the knee replacement was going to be a cure, said Lake, now 52 and living in rural Iowa. I got all excited, thinking, Finally, the pain is going to end and I will have some quality of life.

But one year after surgery on her right knee, Lake said shes still suffering.

Im in constant pain, 24/7, said Lake, who is too disabled to work. There are times when I cant even sleep.

Most knee replacements are considered successful, and the procedure is known for being safe and cost-effective. Rates of the surgery doubled from 1999 to 2008, with 3.5 million procedures a year expected by 2030.

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The National Joint Registry

The National Joint Registry collects details of knee replacements done in England, Wales, Northern Ireland and the Isle of Man. Although it’s voluntary, it’s worth registering. This enables the NJR to monitor knee replacements, so you can be identified if any problems emerge in the future.

The registry also gives you the chance to participate in a patient feedback survey.

It’s confidential and you have a right under the Data Protection Act to see what details are kept about you.

Common Symptoms That Indicate You Might Need Knee Replacement Surgery

  • Persistent knee pain that limits your movement
  • A change in the appearance of your knee
  • Knee pain when bending down
  • Knee pain while exercising
  • An inability to support your body weight on one leg
  • Limited relief from other forms of treatment you’ve tried

Living with persistent knee pain can dramatically impact your quality of life. If you’re living with any of the above symptoms, its important to find out more about the possibility of knee replacement surgery.

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What Happens During Surgery

During a total knee replacement operation, your orthopaedic surgeon will first create an incision in your knee to access your patella . This is moved aside to provide access to your joint. Your surgeon will then remove the damaged ends of your femur and tibia . The ends of these bones are measured and shaped to fit your prosthesis. But before this is fitted, your orthopaedic surgeon will test your joint with a trial prosthesis.

Once the prosthesis is ready to be fitted, your surgeon will replace the end of your femur with a curved metal piece, while a metal plate will replace the end of your tibia. They will position a plastic spacer between these two metal parts to minimise friction. Total knee replacement surgery could also include replacing the back of your patella , but this will depend on the extent of damage to your knee.

If you are having partial knee replacement surgery to remove and replace a specific damaged part, surgery can be performed using a smaller incision.

After your partial or total knee replacement surgery, your incision will be closed with stitches or clips and covered with a dressing.

Total Knee Replacement Surgery

A Less Painful Approach to Knee Replacement

Also known as total knee arthroplasty, this procedure involves replacing two or three compartments of your knee joint.

During a total knee replacement operation, your orthopaedic surgeon will remove and replace both sides of your knee joint and replace each with a prosthesis. The back of your kneecap might also be replaced, though only if necessary.

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How Your New Knee Is Different

Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery can be predicted by the range of motion you have in your knee before surgery. Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Kneeling is sometimes uncomfortable, but it is not harmful.

Most people feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities.

Most people also feel or hear some clicking of the metal and plastic with knee bending or walking. This is a normal. These differences often diminish with time and most patients find them to be tolerable when compared with the pain and limited function they experienced prior to surgery.

Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.

Knee Replacement Recovery Tips

Here’s some top tips for four common questions about total knee replacement recovery time:

  • How Long Does The Pain Last? Many people find they have less pain after their knee replacement as the arthritis pain is no longer there. The post-op pain usually settles down within 6-12 weeks although their may be some residual pain and swelling for up to a year.
  • How Do I Sleep After A Knee Replacement? Typically people find it most comfy to sleep on a firm mattress, either lying on their back or on their side with a pillow between their legs.
  • Can I Kneel Down With My Knee Replacement? Yes you can although it may be uncomfortable in which case use a cushion or knee pad. Kneeling won’t cause any damage to the knee replacement and certainly won’t delay your knee replacement recovery time.
  • How Do I Make the Best Recovery? In order to make the best knee replacement recovery, follow all the advice from your doctor and physical therapist. Start exercises prior to surgery, get up and about as soon as possible, stick to your rehab program, take medications regularly when advised and keep going. There may be ups and downs along the way, but stay focused and positive
  • You can find the answers to loads more similar questions in the total knee replacement recovery questions section.

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    What Can Be Expected In Recovery And Rehabilitation After A Knee Replacement Surgery

    Recovery after knee replacement may depend on factors like your underlying medical condition or the type of knee replacement surgery performed. Some people may go home soon after surgery, while others may need to stay back longer. However, in normal conditions, a patient may expect to stay in the hospital for 3-5 days after the surgery. Physical therapy is advised to increase knee strength and mobility gradually. It is very important to follow the physiotherapists advice to avoid any complications. Post discharge, it may require about 12-14 weeks to recover and resume normal functioning even though the knee tissues continue to heal. While you are back home, you should take care of the following:

    • Continue with your medication and therapy as advised
    • Try and reduce the usage of walking aids gradually
    • Continue your exercises but do not force your knee
    • Do not sit cross legged for at least six weeks after the surgery
    • Do not place any object like a pillow under your knee while sleeping
    • Avoid any kind of twisting motion of the knee
    • Wear comfortable and supportive shoes
    • Do not bend excessively or kneel on the operated knee till full recovery

    What Are The Risks Of Total Knee Replacement

    Physio Knowledge : Total Knee Replacement Rehabilitation

    Most people do very well with their minimally invasive total knee replacement. But as with any surgery, the procedure does carry some fairly rare risks. Possible complications of the surgery include:

    • Infection

    • Loosening of the components of the knee

    • Limited motion of the knee

    There is also a very slight risk that the procedure might not relieve your pain. Your own risk of complications may vary according to your age and your other medical conditions. Ask your provider about the risks that most apply to you.

    Pre-Operative Education

    Johns Hopkins offers in-person educational sessions to help you prepare for knee replacement surgery. During your class, we’ll review important aspects of your care and what to expect before and after surgery. You will be able to ask questions and meet many of the staff who will be caring for you in the hospital.

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    Preparation For Total Knee Replacement Surgery

    Patients undergoing total knee replacement surgery usually will undergo a pre-operative surgical risk assessment. When necessary, further evaluation will be performed by an internal medicine physician who specializes in pre-operative evaluation and risk-factor modification. Some patients will also be evaluated by an anesthesiologist in advance of the surgery.

    Routine blood tests are performed on all pre-operative patients. Chest X-rays and electrocardiograms are obtained in patients who meet certain age and health criteria as well.

    Surgeons will often spend time with the patient in advance of the surgery, making certain that all the patient’s questions and concerns, as well as those of the family, are answered.

    Costs

    The surgeon’s office should provide a reasonable estimate of:

    • the surgeon’s fee
    • the degree to which these should be covered by the patient’s insurance.

    Total Knee Replacement Surgical Team

    The total knee requires an experienced orthopedic surgeon and the resources of a large medical center. Some patients have complex medical needs and around surgery often require immediate access to multiple medical and surgical specialties and in-house medical, physical therapy, and social support services.

    Finding an experienced surgeon to perform your total knee replacement

    Some questions to consider asking your knee surgeon:

    • Are you board certified in orthopedic surgery?
    • Have you done a fellowship in joint replacement surgery?
    • How many knee replacements do you do each year?

    Knee Replacement Surgery: Your Recovery Timeline

    • How active you were before having knee replacement surgery
    • Your usual everyday activities
    • The nature of your job
    • Your age

    A total knee replacement recovery timeline will look slightly different to a partial knee replacement recovery timeline. Your orthopaedic surgeon will understand your personal circumstances and health better and be able to advise what your personal knee surgery recovery timeline looks like.

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    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.

    Expected Range Of Motion

    Persistent Pain After Knee Replacement Surgery

    After knee replacement surgery, it is important to work with a physical therapist to restore as much range of motion as possible. Typically, the range of motion will progress quickly during the first three months. It can continue to increase for up to two years following surgery.

    Normal motion after knee replacement is defined as the ability to get within 5 degrees of a straight knee and the ability to bend the knee back to 90 degrees. Most knee replacements have movement ranging from zero degrees to 110 degrees or more.

    The range of motion of the replaced knee can be improved with a combination of stretches, exercises, and gradual resumption of normal activities. Some surgeons will recommend the use of a machine to bend the knee, called a CPM .

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    Five Reasons Why Knee Replacements Fail

    Wear and loosening

    Properly functioning implants depend on their appropriate fixation to the bone. Fixation is usually achieved by cementing the implant onto the bone. Some surgeons prefer instead to use biologic fixation, meaning no cement placed between the implant and the bone.

    Although implants are firmly fixed at the initial knee replacement surgery, they may become loose over time. The cause of loosening may not always be clear but high impact activities, excessive body weight and wear of the polyethylene component may all act as contributing factors. Friction caused by the joint surfaces rubbing against each other wears away the surfaces of the implant, creating tiny particles that accumulate around the joint. In a process called aseptic loosening, the bond of the implant to the bone is destroyed by the body’s attempt to digest these wear particles. During this process, normal, healthy bone is also digested , which can weaken or even fracture the bone.

    When the prosthesis becomes loose, the patient may experience pain, change in alignment, or instability.

    Infection

    Revision surgery of the infected knee can take several forms. Depending on the degree of infection and damage, the surgeon will determine one of two basic courses of action:

  • perform a simple washout of the knee while keeping the original prosthetic components in place
  • completely exchange the implants with new ones in a full knee revision operation
  • Instability

    Leg fractures

    Stiffness

    Knee Replacement Recovery Time Guide

    Here we will look at total knee replacement recovery time, including what happens at what stage post-op and how long it typically takes to get back to your usual activity.

    If are having or have had only one side of your knee replaced, visit the partial knee replacement recovery time section instead to found out how it will be for you.

    Knee replacement recovery time will vary from person to person, and may be affected by:

    • Severity of arthritis
    • Compliance with exercises pre and post-op

    Let’s have a look at a typical knee replacement recovery time process.

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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.

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