Research: Doctors Are Looking For The Causes Of Pain After Knee Replacement And It Is Hard To Find
The confusion as to what may be the cause of chronic knee pain after knee replacement is a cause of great concern not only among doctors but obviously among patients. We often find patients to be confused between what is normal and what is not normal after knee replacement.
- Is some pain normal?
- Are the clunking sounds normal?
- Is the instability normal?
What You Can Expect:
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.
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What Are Different Types Of Surgery For Knee Pain
Many knee surgeries involve arthroscopy, which is a keyhole surgical technique that can be used to diagnose and treat various knee issues. The surgeon puts an arthroscope into the knee joint and then makes a second incision to insert surgical instruments into the joint. Types of knee surgeries include:
Other less common surgical techniques include:
- Plica removal
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What Are The Signs Of Knee Replacement Failure
The most common symptoms of a failed knee implant are pain, decrease in joint function, knee instability, and swelling or stiffness in the knee joint.
Persistent pain and swelling can indicate loosening, wear or infection, and the location of the pain can be all over the knee or in one particular area . A decline in knee function may result in a limp, stiffness or instability. Patients who demonstrate these symptoms and signs may require revision joint surgery.
Characteristics Of Severe Arthritis Of The Knee
Pain is the most noticeable symptom of knee arthritis. In most patients the knee pain gradually gets worse over time but sometimes has more sudden flares where the symptoms get acutely severe. The pain is almost always worsened by weight-bearing and activity. In some patients the knee pain becomes severe enough to limit even routine daily activities.
Morning stiffness is present in certain types of arthritis. Patients with morning stiffness of the knee may notice some improvement in knee flexibility over the course of the day. Rheumatoid arthritis patients may experience more frequent morning stiffness than patients with osteoarthritis.
Swelling and warmth
Patients with arthritis sometimes will notice swelling and warmth of the knee. If the swelling and warmth are excessive and are associated with severe pain, inability to bend the knee, and difficulty with weight-bearing, those signs might represent an infection. Such severe symptoms require immediate medical attention. Joint infection of the knee is discussed below.
The knee joint has three compartments that can be involved with arthritis . Most patients have both symptoms and findings on X-rays that suggest involvement of two or more of these compartments for example, pain on the lateral side and beneath the kneecap . Patients who have arthritis in two or all three compartments, and who decide to get surgery, most often will undergo total knee replacement .
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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,
What Should I Expect
Its important to note that everyone has different pain level tolerances, and no two cases are the same because our knees are complex joints. Knees are the second-largest joints in the body, after the hip joints. As such, a knee replacement is a complicated surgery that involves balancing ligaments, cutting into the bones of the knee joint, and replacing parts of the knee joint with artificial parts. The manipulation of the knee joint to place the parts leads to the pain after the procedure. Postoperative pain after knee replacement surgery is related to the healing, stretching, bending, and rotating that the knee must do after surgery.
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Is Knee Replacement Surgery Painful
Total knee replacement surgery is a painful procedure, and when you are approaching the doctor, he will help you understand it. On the day of surgery, the doctor will give you anesthesia before the surgery. This anesthesia is important because it will not let you experience any pain during the process, and no problems will take place throughout. Doctors will perform the surgery, make the cuts, and follow the procedure, and you will not even feel a bit of pain.
But when you come out of the impact of anesthesia, you will experience some pain that can be managed with the help of painkillers and other medications doctors are suggesting. Do know this pain is a result of a procedure and you cannot avoid it. With pain killers alone, it can be managed.
Complications After Knee Replacement Surgery
The possible complications a person experiences after knee replacement surgery include infection and blood clotting. If a patient is not paying attention to the cut, the chances of these conditions are quite common. Along with that, pain is very common and you have to deal with it.
Taking unnecessary painkillers or non-steroidal anti-inflammatory drugs will not help you. If a doctor is suggesting you take the painkillers again, then only take them. Otherwise, avoid taking them.
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An Artificial Meniscus May Soon Be Available
If you are suffering from knee pain following meniscus surgery or are without viable treatment options, the NUsurface®Meniscus Implant may provide an alternative option, once it has approval from the U.S. Food and Drug Administration. NUsurfaces design mimics the function of the natural meniscus and redistributes weight across the knee joint. The implant is made from medical grade plastic and, as a result of its unique materials, composite structure, and design, does not require fixation to bone or soft tissues.
NUsurface can potentially address the treatment gap of those who are too old for meniscus repair and too young for total knee arthroplasty. U.S. clinical trials completed enrollment in June 2018, and the company expects to file for U.S. Food and Drug Administration approval soon.
When Knee Surgery May Not Be For You
Infections. Make sure you get them treated before surgery. For instance, take care of gum infections. It will lower the chance of getting an infection in your new knee.
Other medical problems. Do you have heart or lung problems, diabetes, or blood clots? It may raise the chances of complications from your surgery. You’ll need to get these under control before you can make a decision about knee replacement.
Other reasons for your joint trouble. “Is your knee really causing your pain?” Lajam says. “Sometimes you get pain from the low back that causes your knee pain. Sometimes people with bad hip arthritis have pain in the knee.” Work with your doctor to make sure you’ve found the real reason you hurt. If you don’t, your knee may still bother you just as much months after surgery.
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Is Pain Normal 3 Months After A Knee Arthroscopy
Yes, knee pain can be normal for up to three months after knee surgery. This depends on how much work was done during surgery, however you may still have pain with running, jumping, and deep squatting. If youve had ACL surgery, then pain 3-months later is still quite expected.
Even though the meniscus and other tissues have been cleaned up, there may still be other issues in the joint that can cause swelling and weakness. Until the knee and surrounding muscles get stronger, there is a good chance that you can have pain and achiness with demanding activities.
What To Expect Post Knee Replacement
Although the procedure has its limitations, a dramatic reduction in knee pain and a significant improvement in performing everyday activities of daily living is seen in most cases however, total knee replacement does not allow movements more than before arthritis sets in. In addition, with regular use and activity, every knee replacement implant begins to wear its plastic spacer, which may speed up due to excessive movement or weight and cause a painful loosening of the prosthesis. Thus, most specialists advise against high-impact activities such as running, jogging, jumping, or other high-impact sports after surgery. Following a total knee replacement, unhindered activities include unlimited walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and other low-impact sports. With appropriate activity modification, knee replacements can last for many years.
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Research: Surgeons Warn Surgeons That Knee Pain After Knee Replacement Does Not Automatically Mean Revision Knee Surgery
One of the reasons that people are in our office with continued pain after knee replacement is that they are being told that eventually, or sooner, rather than later if the pain persists, they will have to have revision surgery to clean out tissue that may be causing pain, and to examine the components of the artificial knee.
A recent study from orthopedic surgeons in Italy was published in the Current Reviews in Musculoskeletal Medicine. Simply stated the surgeons warned:
Pain can be related to a lot of different clinical findings, and the surgeon has to be aware of the various etiologies that can lead to failure. Pain does not always mean revision, and the patient has to be fully evaluated to have a correct diagnosis if surgery is performed for the wrong reason, this will surely lead to a failure.
When Knee Replacement Surgery Is Recommended:
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Opioid Benefits And Risks
- The medicine works quickly.
- You will feel less pain.
- You will be able to be active to speed your recovery. For every day you stay in bed, you need 3 days to regain your strength.
- You will be able to sleep or rest better.
Potential risks are:
- Taking an opioid can lead to addiction.
- On average, more than 130 people die each day in the U.S. from an overdose of opioids, according to the Centers for Disease Control and Prevention.
What Are The Risks And Complications Of Revision Knee Replacement
Any surgery can have potential complications. The complexity of revision joint surgery increases the chance of surgical complications, which include but are not limited to:
- wound drainage
- damage to nerves or blood vessels
- intra-operative fractures
- pulmonary embolism
Infection, bleeding, damage to nerves or blood vessels, and intra-operative fractures can be minimized by using antibiotics before and after surgery, employing sterile surgical techniques and utilizing well-planned surgical exposures. Patients who are obese are particularly at increased risk of infection and wound drainage issues post operatively.
Similar to primary knee replacement, some mild swelling of the knee or ankle may be present after surgery for as long as three to six months. Swelling can be treated by elevating the leg, applying an ice pack, and wearing compression stockings.
Prior medical conditions, such as heart and lung complications or stroke conditions, can be aggravated by a revision procedure. These conditions may also develop in patients after revision surgery. Very rarely, death can occur. The decision to perform revision joint surgery is made when the benefits of pain relief and functional improvement outweigh the risk of potential complications.
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Why Is There Pain Behind My Knee With A Knee Scope
This is knee swelling and it typically goes away within a few weeks after knee surgery. If you still experience this behind your knee even up to six months, try wearing a knee compression sleeve because it will help reduce the amount of fluid build-up in the knee joint.
This can also be due to tight hamstring muscles in the back of knee that are pulling on the knee joint and causing pain behind knee. This is a common problem after knee surgery because this muscle group often overcompensates after surgery.
Surgery Treatments For Knee Pain And Injuries
Knee surgery is often used for the treatment of different conditions that can causeknee pain. While non-surgical methods are often attempted for initial treatment, there are situations where knee surgery becomes the recommended or necessary treatment. Learn about different types of knee surgery and the conditions that are best treated with each.
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What Is Knee Replacement Surgery
A knee replacement is also called knee arthroplasty. It might be more accurately termed a knee “resurfacing” because only the surface of the bone requires replacement.
Knee replacement surgery consists of the following steps as enumerated below
Bone Preparation: The damaged cartilage surfaces at the ends of the femur and tibia are removed.
Positioning the Metal Implants: The joint surface is recreated by replacing the cartilage and bone with metal components that may be cemented or uncemented.
Resurfacing the Patella: The surface beneath the kneecap is resurfaced with a plastic button which may not be required in all cases.
Spacer Insertion: A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.
Knee Replacement Surgery Shouldnt Be Your First Line Of Treatment
Even if your knee pain is significant, most doctors will recommend non-operative treatment options before recommending knee replacement surgery. This might include weight loss, an exercise regimen, medications, cortisone or other injection therapies, a minimally invasive surgical procedure, such as a meniscectomy, or bracing.
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Looking After Your Knee Replacement
Your new knee will continue to improve for as much as two years after your operation as the scar tissue heals and you exercise your muscles. You’ll need to look after yourself and pay attention to any of the following problems:
Stiffness Sometimes the knee can become very stiff in the weeks after the operation for no obvious reason. Try placing your foot on the first or second step of the stairs, hold on to the banister and lean into your knee. This should help to improve movement and flexibility in your knee. Its very important to continue with the exercises you were working on in the hospital.If the stiffness doesnt improve after about six weeks your surgeon may need to move or manipulate your knee. This will be done under anaesthetic.
Pain Pain caused by bruising from the operation is normal in the first two months, and you’ll probably still need to take painkillers at six weeks to help you sleep through the night. You may still have some pain for as long as six months. If you still have pain after this, speak to your physiotherapist or GP.
Infection You should speak to your GP or hospital if you notice any signs of infection, for example:
- breakdown of the wound with oozing/pus or sores
- increased pain
- redness and the affected area feeling warmer than usual or smelling unpleasant.
You should also look after your feet see a doctor or podiatrist if you notice any problems such as ingrown toenails that could become infected.
Catastrophizing Thoughts And Central Sensitization = Catastrophic Results And Opioid Dependence After Knee Replacement
Researchers in Canada writing in the Journal of Pain Research found pain catastrophizing reflects a patients anxious preoccupation with pain, inability to inhibit pain-related fears, amplification of the significance of pain, and a sense of helplessness regarding pain.
Catastrophizing thoughts are unrealistic beliefs that only the worst can happen. A person who goes into any medical treatments believing it will not work is at a significant disadvantage. A patient should relay these thoughts to his/her doctor so that appropriate action can be taken. For some patients, counseling will be effective, for some therapy, for some prayer. The patients must be made aware of options that will help them move from hopelessness to cautious optimism.
A significant problem with catastrophizing thoughts that needs to be addressed is a greater risk for opioid dependence.
Doctors in Belgium write in the Bone and Joint Journal that pre-operative pain in the knee predisposes to central sensitization . Pain due to osteoarthritis of the knee may also trigger neuropathic pain and may be associated with chronic medication like opioids, leading to a state of nociceptive sensitization called opioid-induced hyperalgesiapainkillers increase chronic pain.
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