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How To Relieve Pain After Knee Replacement Surgery

What Are Some Types Of Knee Surgery

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

The most common knee surgeries involve arthroscopy â a surgical technique used to repair many different types of knee problems â or knee replacement.

Arthroscopic surgery

Arthroscopy is a type of keyhole surgery used to diagnose and treat a wide range of knee problems. A keyhole surgery is one in which long, thin instruments are inserted into the patientâs body through small incisions.

For arthroscopic knee surgery, the surgeon inserts a probe with a small camera, called an arthroscope, into the knee joint. The scope displays pictures on a video monitor to help guide the surgeonâs work. Surgical instruments are inserted into the joint through a second incision.

The American Academy of Orthopaedic Surgeons describes the following as the most common arthroscopic procedures for the knee:

  • Removal or repair of a torn meniscus â a type of cartilage in your knee that cushions and stabilizes the joint
  • Reconstruction of a torn anterior cruciate ligament , which is a ligament that helps stabilize the knee joint
  • Removal of inflamed synovial tissue
  • Trimming of damaged articular cartilage
  • Removal of loose fragments of bone or cartilage
  • Treatment of patella problems
  • Treatment of knee sepsis

Knee replacement

In a knee replacement operation, the surgeon removes damaged parts of the knee joint and replaces them with new parts made of materials such as metal, ceramic, or plastic. Contrary to the name of the procedure, the surgeon does not replace the entire knee joint.

Immediately After The Operation

Doctors have made big advances in pain management after total knee replacement over the last 10 to 15 years due to advancements in using regional nerve blocks, spinal blocks, and other methods of pain control.

During knee surgery, your healthcare team might either use a general anesthetic, where you will be fully asleep, or a localized anesthetic, where youre numb from the waist down but still awake.

After the surgery anesthesia wears off, your healthcare team can provide pain medication either orally or through an intravenous tube.

These medications may include a strong opiate or opioid such as morphine, fentanyl, or oxycodone, and are intended only for short-term use. Its important to note that larger doses over time can lead to physical dependence and addiction. Follow your doctors instructions to avoid adverse effects.

The Patient Problems After Knee Replacement Surgery Are Many At Caring Medical We Can Address Many Of These Problems We Cannot Address All Especially When The Problem Of Knee Replacement Is Caused By Hardware Failure And Hardware Placement Failure

  • PROBLEM: The knee replacement hardware is wearing out and loosening or it was not placed in the knee correctly and stress is causing the device problems. This problem will need surgical consultation and possibly revision surgery.
  • PROBLEM: Infection. This is during the initial recovery period. On prosthetic devices, bacteria can form and colonize. This problem will need a consultation with the surgical group and possibly emergency medicine.
  • PROBLEM: The implant or the surgery caused fractures in the thigh or shin bone. This problem will need a consultation with the surgical group and possibly emergency medicine.
  • PROBLEM: Knee prosthesis instability and loss of range of motion , this can also lead to considerable pain.

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Variables In Pain Level

There arefactors that can increase or decrease your level of pain after surgery.

  • Activity Level: Movement of the joint and physical activity is encouraged after surgery and should be guided by your doctor and physical therapist. Activity level can increase swelling and lead to more pain. This is normal and can be managed through medications or hot/cold therapy.
  • Time of Day: Believe it or not, the time of day can play a factor in your pain level after hip or knee replacement. Pain at night is more common. There are several reasons for this, including being active during the day and increased swelling, as well as not having any distractions at night and focusing on your pain or discomfort.
  • Stress: Heightened stress levels can worsen both physical and perceived pain. If you are feeling stressed or anxious, tell your doctor and set aside dedicated time each day to meditate or relax. Journaling, talking with a friend or listening to calming music are ways to relax while recovering from surgery.

What Should I Expect After My Total Hip Or Total Knee Replacement

Managing Pain After Total Knee Replacement

NOTE: The following is a general guide to care following your procedure. Your healthcare provider may have somewhat different instructions for you. Please follow those.

After total knee or total hip replacement surgery you can expect gradual improvement over the coming months. You should gradually expect less pain, stiffness and swelling, and a more independent lifestyle. Returning to work depends on how quickly you heal and how demanding your job may be on a new joint.

After you are discharged from the hospital or rehabilitation facility, there will be a few weeks before you return for a follow-up visit with your surgeon. This period of time is critical in your rehabilitation and you may require outpatient therapy services for positive long-term results from your surgery.

In general, patients do very well after discharge. However, its important that you contact the surgeons office if any of these occur:

  • You have increasing pain in the operative site.
  • There is new or increased redness or warmth since discharge.
  • There is new or increased drainage from your incision.
  • The operative site is increasingly swollen.
  • Your calf becomes swollen, tender, warm or reddened.
  • You have a temperature above 101 degrees Fahrenheit for more than 24 hours.
  • For total knee replacement, your ability to flex has decreased or remains the same as when you were discharged from the hospital.

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Knee Replacement Pain After Three Months

Swelling and bruising can continue for three months or more following knee replacement surgery. However, it varies from patient to patient and depends on the condition you were in before surgery. Many patients are back to their activities without the pain they had before surgery by this stage of recovery.

If you find that any movement or activity is still exceedingly painful after three months, you may be experiencing chronic pain. Chronic pain is defined as pain persisting for three months or longer. Its a condition that affects roughly 20% of knee replacement surgery patients. It can develop and increase in intensity in the weeks and months following surgery. This can have a huge impact on your overall quality of life. Talk to your doctor for help.

How Exactly Does Knee Osteoarthritis Develop

As we age, our cartilage can wear away naturally. Also, damage can occur prematurely due to infection or trauma. When this occurs naturally, as part of the ageing process, it is known as osteoarthritis.

As this cushioning cartilage thins, the knee begins to receive less protection against shock, and the bone ends can become injured by day-to-day activities such as walking. The underlying bone can become inflamed, which in turn can produce aching pain and stiffness.

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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.

Strategies To Reduce Pain After Knee Surgery Without Opioids

Back Pain Relief Stretches After Knee Replacement Surgery

Hinich and others at U of U Health are working on multiple strategies to reduce opioid pain medication usage.

Creating better tools for measuring pain

Asking patients to quantify pain on the Numerical Rating Scale of 0 to 10 is not scientific, which makes it harder to create effective treatment plans and avoid overprescribing opioids. U of U Health developed a better way to measure pain. Providers discuss pain and how its impacting quality of life with the patient, then input that information into a Clinically Aligned Pain Assessment tool . The tool analyzes the data and offers recommendations for an effective treatment plan.

While developing the tool, researchers studied more than 12,000 pain assessments and found that nurses and patients all preferred CAPA over NRS. The tool accurately identified pain severity and offered effective treatment 81% of the time, compared to just 42% of the time with NRS.

Setting realistic expectations

Recovery after a knee replacement is difficult and long. Pain can last for several weeks, and swelling can continue for up to six months after the operation. But its normal to have some pain. When orthopedic surgeons set that expectation from the start, many patients understand they only need pain medications for a short time, immediately after surgery, when the pain is most intense.

Teaching mindfulness

Utilizing physical therapy

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Post Joint Replacement Surgery: Alternatives To Narcotics For Pain Relief

Pain relief forknee replacement surgery and other joint surgeries has been a hot-button topicover the past decade. With an epidemic of nearly 450,000 opioidoverdoses in America since 1999, physicians have been more mindful of therisks of narcotic prescription drugs and more dedicated to educating patientson alternative methods of pain relief.

Orthopedicsurgeons perform these procedures to help people who are in end-stagearthritis and living in chronic pain. As with any surgery, some discomfort andpain can be expected after a hip or knee replacement.

There is arange of pain management resources available for patients who have had surgery.From prescriptions to over-the-counter medications to drug-free alternatives,there are safe and effective options for all patients. Let’s explain thedifferent kinds of post-surgery pain relief in the following list.

How Long Does Pain Last After Knee Replacement Surgery What To Expect

Knee pain can appear in many forms. Arthritis, an injury, and gradual wear and tear as you age can all have an effect on your activities and comfort level. If youre unable to walk or climb a stairs because of your pain , knee replacement surgery may be the best way to get your life back. While the benefits of the procedure may significantly outweigh temporary discomfort, its important to have realistic expectations regarding your recovery timeline and knee replacement pain after surgery.

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Where Will I Feel Knee Replacement Pain

As mentioned above, knee replacement pain can come in many different forms depending on the cause. Knee pain is to be expected due to the surgical procedure itself, with swelling, bruising, and the introduction of prosthetic parts.

Beyond that, it is possible to feel pain in parts of the body other than your knee. This is known as referred pain.

Your hips, lower back, groin area, and calves may initially hurt due to the change in your stance and the way you walk. Of course, it is also typical to feel sore due to extended amounts of time in bed during your recovery.

Knee Supports & Braces

Knee Pain Meniscus Tear Treatment and Prevention

Knee supports are beneficial following acute injury and for simple degenerative conditions that have worsened over time. Knee supports can be helpful if the joints are painful when using stairs, walking or even when sitting or standing. They can help to relieve, alleviate or remove pain as well as control uncomfortable and unsightly swelling. Also degenerative osteoarthritis or meniscus problems can be treated with medi knee supports. Our medical grade compression provides a massaging effect to reduce knee swelling and stabilise the knee. Warmth and proprioceptive bio-feedback help you recover and strengthen each day.

Anterior knee pain is common amongst young female athletes and this can be due to patellar tracking issues during skeletal maturation. Our unique range of patella guiding knee supports can help to get you quickly back in shape.

Our knitted knee supports are breathable which therefore leave you perspiration-free. The incorporation of soft comfort zones behind your knee joint in the crease ensures your wearing comfort and freedom of movement. This helps with compliance which in turn helps with accelerated rehabilitation. Supports for the knee can relieve, alleviate or remove the pain . Swellings, osteoarthritis or meniscus problems can be dealt with in this way.

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Research Continued: After The Surgery The Researchers Found Patients Had To Alter Their Recovery And Post

  • The amount of pain and discomfort in recovery and post-op became the greatest impact of post-surgical patient non-satisfaction.
  • Compared with preoperative health problems, postsurgical health problems were associated were a bigger problem than anticipated.
  • Significant differences in thinking before surgery and surgical outcomes were observed including
  • Greater problems than anticipated in:
  • Mobility,
  • Not being able to perform usual activities,
  • anxiety/depression.
  • It is important to know that the purpose of this research was to assign a set of values to these patient problems in order to be able to come up with a formula that would better help the patient with their expectations before and after the surgery. The researchers had to conclude in the end that:

    Our systematic review highlights a lack of evidence about the effectiveness of prediction and management strategies for chronic postsurgical pain after total knee replacement.

    In the end, there is no way currently to predict who will benefit and who will get worse from knee replacement surgery and patients should be counseled that there is no guarantee that knee replacement will work for them.

    Advanced Exercises And Activities

    Once you have regained independence for short distances and a few steps, you may increase your activity. The pain of your knee problems before surgery and the pain and swelling after surgery have weakened your knee. A full recovery will take many months. The following exercises and activities will help you recover fully.

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    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 .

    In This Video Our Patient Jeannette Had Issues With Spinal Stenosis And Problems Post Knee Replacement

    Increase Knee Bend (Minimize Pain) After Knee Replacement/Surgery Using TENS
    • 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.

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    Studies Have Demonstrated That Poor Management Of Acute Pain After Total Knee Replacement Is Strongly Associated With The Development Of Chronic Pain

    In March 2017, researchers went further, writing in the medical journal Clinic in Orthopedic Surgery:

    • Study:postoperative pain is a major cause of dissatisfaction among patients after total knee replacement. Studies have demonstrated that poor management of acute pain after total knee replacement is strongly associated with the development of chronic pain, emphasizing the importance of appropriate control of acute pain after total knee replacement
    • Our Comment:
    • The patient has knee replacement
    • The patient suffers from acute pain after surgery
    • Painkillers and other medications are prescribed to control a patients pain. Acute pain turns into chronic pain as the joint continues to degenerate. Pain is an indication of tissue damage that needs repair.

    What Causes Sciatica Symptoms

    The Sciatic nerve is a large nerve that goes through your leg. It starts off as branches from the spinal cord, they come together from the low back near the hip and it goes down your leg and branches off to different parts of your leg. When any part of this nerve gets irritated, pinched or swollen it can cause the Sciatica symptoms.

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    How To Get Rid Of Unused Opioids

    Do not keep unused medicine “in case” you think you may need it. Having it in the house where other adults, children or pets could reach it is unsafe.

    • To get rid of unused opioids, bring them to a drop-off location or to an Allina Health Pharmacy. To find a location near you:
    • Minnesota: Go to pca.state.mn.us and type “household hazardous waste” in the search box.
    • Wisconsin: Go to dnr.wi.gov and type “health care waste” in the search box.
  • If you can’t get to a disposal site:
  • Scratch off your name, your provider’s name and the prescription number on the medicine label. Or, scribble the information out with a black marker.
  • Add a small amount of vinegar to dissolve most of the pills.
  • Take the cap of your medicine container shut with a strong tape.
  • Put the taped medicine container in a paper bag or other container you cannot see through .
  • Throw the contents in the garbage, not the recycling bin.
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