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Is Knee Replacement Surgery Painful

Why Is My Knee So Tight After Surgery

New Procedure Takes Pain Out Of Knee Replacement Surgery

Arthrofibrosis is also known as stiff knee syndrome. The condition sometimes occurs in a knee joint that has recently been injured. It can also occur after surgery on the knee, such as a knee replacement. Over time, scar tissue builds up inside the knee, causing the knee joint to shrink and tighten.

When Knee Replacement Surgery Is Recommended:

  • Severe knee pain or stiffness that limits everyday activities, including walking, climbing stairs, and getting in and out of chairs. It may be hard to walk more than a few blocks without significant pain and it may be necessary to use a cane or walker
  • Moderate or severe knee pain while resting, either day or night
  • Chronic knee inflammation and swelling that does not improve with rest or medications
  • Knee deformity a bowing in or out of the knee
  • Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries
  • The Ligament Problem Is A Clue That For Some Patients Post Knee Replacement Pain May Be A Problem Of Overdoing It Even While In The Hospital Or Nursing Home

    In a study from October 2018, doctors writing in the Journal of Pain Research, looking at why some people had excessive pain after knee replacement surgery asked if this was a problem of overdoing it in the hospital following the surgery? The research measured the results of making patients progressively walk more steps in the hospital or nursing home up to 10 days after the surgery.

    These are surgeons and pain management specialists from leading hospitals and universities in Japan talking about patients soon after knee replacement during the surgery recovery.

    • Poor pacing during physical activity is associated with severe pain in postoperative patients
    • Over-activity results in a number of potential injuries to muscle fibers, nerves, bones, and ligaments. These injuries, as well as the repetitive experience of pain, will prolong pain and contribute to neurobiological mechanisms of peripheral and central sensitization.

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    What Can I Do To Help Ease The Pain

    Once the knee replacement surgery is completed, its imperative that the patient gets up and walking on the new knee as soon as possible to prevent blood clots. Putting pressure on the newly operated joint, as well as bending the knee will cause initial pain but will fade as the healing continues. Fortunately, knee replacement surgery technology and pain management have come a long way since the first days of the procedure, so today knee replacement surgeries involve less pain and patients are able to heal faster than ever before.

    Pain Associated With The Incision

    Total Knee Replacement: Vanguard cruciate retaining knee replacement ...

    As your incision heals there will be different sensations coming from the skin and incision site. There will be itching, redness, and soreness. As the body heals the skin, there is an immune response that causes chemical changes in the skin and as a result inflammation and pain.

    Being able to differentiate between normal healing of the skin and possible complications or infection might help reduce the actual pain associated with this process.

    Signs of infection include:

    If you experience one of more of these symptoms then contact your surgical team.

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    What Can Cause Knee Pain Years After A Knee Replacement

    Knee replacements dont last forever. Most knee replacements perform well and cause no issues to patients for 10 to 20 years after the operation. When pain occurs years after knee replacement, its typically due to one of these four knee replacement problems after 10 years or more.

    • Soft tissue irritation around the knee The most common pain patients experience that occurs years after a knee replacement will be the soft tissue around the knee. Patients still have multiple tendons, ligaments, and muscles around the knee that may become irritated with varying activities.
    • The implant becomes loose A loosening implant is a cause of pain that can occur years after knee replacement surgery. A loosening implant is typically caused by wear and tear over time, though it can be exacerbated by high-impact sports or obesity. A loosening implant can cause pain as well as instability in the knee and a change in the alignment of the knee joint.
    • Infection The infection rate after knee surgery is very low, around 1 percent. If an infection does set in around the components of the knee replacement, it can be difficult to treat with antibiotics. Revision surgery may be necessary to get the infection under control.

    Knee Replacement Pain A Year And Beyond

    The goal of knee replacement surgery is to help you get back to the activities you love. Your doctor will encourage you to stay fit through activities like swimming, cycling, and even golf. This type of exercise will help you stay limber and pain-free.

    On the contrary, there are certain activities that could negatively affect the prosthetic joint materials in place. Even normal use will begin to wear out the implants, but excessive weight or activity can cause your knee replacement to loosen and become painful. You may need to avoid running, jogging, high-impact exercises, and contact sports for the rest of your life following surgery.

    The good news is that studies show more than 90% of total knee replacements are still functioning properly 15 years after surgery. Staying healthy and following the advice of your doctor will help you achieve these long-term benefits.

    While its possible for pain to persist for a year and beyond, it shouldnt be debilitating. Scar tissue can continue to heal, as well as the muscles in your knee, but if youre suffering from ongoing pain after a year, always talk to your doctor.

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    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.

    Preparation For Total Knee Replacement Surgery

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    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.


    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?

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    Knee Replacement Surgery Procedure:

  • Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
  • Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or “press-fit” into the bone.
  • Resurface the patella. The undersurface of the patella is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.
  • Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.
  • Heres What We Know About Post

    • Typically, knee replacement surgery hurts more than hip replacement surgery .
    • After surgery, pain is no longer achy and arthritic but stems from wound healing, swelling and inflammation.
    • Hip replacement patients often report little to no pain around the 2-6 week mark.
    • A large percentage of knee replacement patients report little pain around the 3 month mark.
    • Pain, swelling, and bruising are part of the natural recovery process.
    • PreHab in the weeks leading up to surgery can help reduce recovery pain. This is due to better preparing the body and muscles that support the affected joint and learning tips and tricks to manage joint pain.
    • Fear and anxiety about pain and holding onto old pain after surgery can slow down your recovery.

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    My Tips To Ease Pain The Week After Tkr Surgery

    Take my advice dont try to tough it out.

    • Stick to the medication plan developed with your hospital team.
    • As time goes by and the pain decreases wean yourself off the Percocet. Dont make an arbitrary decision to stop cold turkey.
    • You will be sitting or lying down initially so elevate your knee. Icing doesnt always feel good but it dramatically reduced my swelling and pain after therapy.
    • If you can, stay busy, read, watch TV, do puzzles anything to keep your mind off the pain.

    Knee Replacement Pain After 1 Week

    Causes of Pain After Knee Replacement Surgery

    Everything I read and heard from others convinced me that the physical therapy was important and that it would hurt. I was not disappointed.

    The range of motion exercises were tough and they take a lot of self-discipline when nobody is watching over you. There were many times I had to talk myself out of cheating.

    I am glad that I persevered. I was surprised that I was up and walking so fast in the hospital. I was also surprised that I had two physical therapy sessions in the hospital.

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    After only two days home the home therapist made her first visit and the work began. I saw her twice the first week and each time she added exercises and they became harder and harder to do.

    During my first home physical therapy session the therapist measured my range of motion from 180 degrees flat to 70 degrees bent. By the end of the first week I had improved to 78 degrees.

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    Reasons For The Procedure

    Knee replacement surgery is a treatment for pain and disability in theknee. The most common condition that results in the need for kneereplacement surgery is osteoarthritis.

    Osteoarthritis is characterized by the breakdown of joint cartilage.Damage to the cartilage and bones limits movement and may cause pain.People with severe degenerative joint disease may be unable to donormal activities that involve bending at the knee, such as walking orclimbing stairs, because they are painful. The knee may swell or”give-way” because the joint is not stable.

    Other forms of arthritis, such as rheumatoid arthritis and arthritis thatresults from a knee injury, may also lead to degeneration of the kneejoint. In addition, fractures, torn cartilage, and/or torn ligaments maylead to irreversible damage to the knee joint.

    If medical treatments are not satisfactory, knee replacement surgery may bean effective treatment. Some medical treatments for degenerative jointdisease may include, but are not limited to, the following:

    • Anti-inflammatory medications

    • Cortisone injections into the knee joint

    • Viscosupplementation injections

    • Weight loss

    There may be other reasons for your doctor to recommend a knee replacementsurgery.

    Pain Above Or Below The Surgery Site

    Some surgeons use a tourniquet to reduce blood loss during surgery. This results in major soft tissue damage to the thigh musculature.

    Alternatively, many patients experience significant pain in the calf and shin below the knee. This may be attributed to the new leg alignment or new walking patterns.

    Both the upper leg pain and lower leg pain are frustrating and sometimes said to be worse than the knee pain.

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    Pain After Knee Replacement Surgery The First Night

    After dinner, I prepared for my first nights sleep knowing I would be woken up every 4 hours for vitals and medication.

    It would have been nice if my roommate and I could have had the same nurse because they never arrived at the same time. I woke up every time his nurse appeared too, however I was able to sleep off and on.

    The pain was not an issue for me as the pain medication kept the pain quite manageable. The frequent urination, the nurse visits and the traffic in the hall were my biggest interruptions.

    I believe the air cuffs that stimulated my legs helped relieve the pain also. The icing seemed to help with the pain, but it was probably more effective with the swelling. I had severe swelling above my knee, around my knee and down to my ankle.

    I had a fitful nights sleep but not necessarily due to pain.

    Knee Replacement Complications In Former Athletes

    Persistent Pain After Knee Replacement Surgery

    In a recent paper, doctors from NYU Langone Medical Center, Hospital for Joint Diseases suggest that total knee arthroplasty is often the best answer for end-stage, post-traumatic osteoarthritis after intra-articular and periarticular osteoarthritic fractures the knee.

    However, total knee replacement in the setting of post-traumatic osteoarthritis is often considered more technically demanding surgery and the surgical outcomes are typically worse for these patients. The goal of the NYU paper was to create a new classification label for post-traumatic osteoarthritis patients and improve medical documentation and improve patient care.

    • The researchers looked at post-traumatic osteoarthritis patients who suffered from osteoarthritis as a result of high demand or athletic activity. These were on average were younger and healthier than the primary total knee replacement population .
    • The healthier post-traumatic total knee replacement group had the following complications:
    • higher rates of superficial surgical site infections,
    • bleeding requiring transfusion,
    • increased length of hospital stay,
    • and 30-day hospital readmission.

    In a similar study, doctors at Duke University also recognized that Total Knee Arthroplasty as an important treatment for post-traumatic arthritis. However, these researchers also found complications that should not be expected in a mostly healthy patient population.

    This included:

    • knee wound complications
    • need for revision surgery.

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    Things No One Ever Tells You About Getting A Knee Replacement

    Heres what you need to know thats not in the brochure: 1. You might not be a good candidate.A study published last year by researchers from Virginia Commonwealth University in Richmond questioned the value of knee replacement for some of the people rushing to get it. After analyzing data from a large study of men and women who had the operation, the researchers found that fully one-third of them were not actually good candidates for the surgery, which is why they got only a very modest benefita 2-point improvement on a common measure of knee function, compared with a 20-point improvement for people who started out with really bad knees.

    “Pain that doesnt go away and moderate to severe arthritis are necessary for a knee replacement to do its job,” Lajam says. “If you have the surgery, but its actually a problem of nerve pain, hip pain, or circulation, its not going to help you.” The advice here is not to wait until your knees are completely destroyed before seeking surgery, but to make sure that youve tried other measures first and that you meet both criteriaconsistent pain and advanced arthritis.

    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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    When To See A Doctor

    People should speak with a doctor as soon as possible if they think that they have developed a blood clot or infection.

    Signs of blood clots include new or worsening pain or swelling in the calf, ankle, or foot and redness, swelling, or tenderness above or below the knee.

    Part of a blood clot can break loose and travel to the lungs, where it can get stuck and cause a blockage. This condition is called pulmonary embolism, and it is a very serious and sometimes life threatening emergency.

    Signs of pulmonary embolism include:

    • shortness of breath
    • sudden chest pain
    • coughing with chest pain

    Blood, or systemic, infections require immediate treatment to prevent further serious complications. Signs of infection may include:

    • high fever, typically higher than 100.4ºF orally
    • worsening pain, swelling, flushing, or tenderness of the knee or the area around the surgical incision
    • leakage from the surgical incision
    • worsening pain during rest and activity


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