Something Is Wrong With My Knee Replacement: What Should I Do
Please Note: CSS Firm is no longer accepting or investigating new knee implant claims at this time. This article is for educational purposes only.
Knee replacement surgeries are intended to give patients a new knee that is projected to last them decades. Research has concluded that 96 percent of all knee implants are still functional after 10 years, and 80 85 percent will last 20 years. However, despite the fact that knee replacement implants are built for long life, some can fail or wear out.
Knee replacements can fail for many different reasons, such as:
- Incorrect placement of the knee replacement implant.
- Physical factors such as stiffness or weakness in the soft tissue surrounding the knee.
- Infection.
- Fractures due to an injury.
- Wear and tear.
- Unusual degree of friction that leads to bone loss and causes the implant to loosen.
If your knee replacement fails, your body will most certainly let you know, and you will exhibit a variety of symptoms, including pain, swelling, a loss of range of motion in your knee, and stiffness in part of all of the knee.
What to Do if You Suspect Knee Implant Failure:
- Dont hesitate to contact your surgeon immediately.
- You might also obtain a second opinion from another surgeon.
- You will likely be required to undergo a series of tests X-rays, an MRI, potentially a CT scan, and laboratory tests to diagnose the problem.
If you need revision surgery, your old knee replacement will have to be removed.
What Causes A Knee Replacement To Become Loose
Loosening is one of the most common complications of total knee replacement surgery. Patients usually need revision surgery to fix it. What that means is another surgery is required to address the loose knee replacement. There are many causes for a knee replacement to become loose. The 6 most common are:
Excessive Wear
Knee replacements do not last forever. The longevity of knee replacement depends upon many factors including the type of implant, age, and gender of the patient, diagnosis, and type of fixation . The majority of knee replacements last approximately 20-25 years . The actual implant can become worn out.
Infection
Infection can occur immediately after surgery or years later. The infection can affect the skin, muscles, and the artificial joint. This can compromise the cement that glues the artificial joint to the bone. When this occurs the knee replacement can become loose.
Fractures
Fracture on the thigh bone
During knee replacement surgery, the end of the thigh bone is amputated. A hole is then drilled into the end of the thigh bone. A metal stud is then hammered into the thigh to which the new knee joint is attached. If the bone is weak such is the case with patients with osteoporosis or if too aggressive, a fracture can occur. The end result can be a loose knee replacement.
Poor Alignment
Technical Failure
Rejection
Surgeons Say One In Four Patients With Pain After Knee Replacement Had No Clear Reasoning For Their Pain It Wasnt The Hardware It Wasnt Anything Obvious That They Could See
In the research above, surgeons have a road map of where to look for pain after knee replacement. Returning to the findings released in the British Pain Journal , the doctors suggest looking for pain in other places that are usually not explored:
- Our main findings are that some patients have severe pain that interferes significantly with their lives and that a large number of them have pain sensitization problems , many of which can be classified as neuropathic pain , rather than any local, nociceptive cause .
- A heightened sense of pain following knee replacement will be discussed throughout this article.
What is the research saying?
In November 2018 a study was published in the Journal of Knee Surgery. The doctors also were looking at nerve pain after surgery.
- The study had 154 patients with 222 knee replacements
- The goal of the study was to define the prevalence of pain persisting after total knee replacement and determine the impact of neuropathic pain.
- The ratio of patients with
- moderate-to-severe pain was 28% .
- Thirteen patients experienced unclear pain.
- A significant number of patients experienced moderate-to-severe and unclear pain after total knee replacement.
It looked like neuropathy but it wasnt neuropathy.
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What Are The Symptoms Of A Knee Replacement Failure
Certain signs and symptoms, such as increased pain or limited knee function, may indicate that youre experiencing a joint failure. Other symptoms of a failed knee replacement include:
- Pain in the knee
- Instability in the joint
- Redness and warmth
The redness and warmth associated with a joint replacement failure are due to inflammation and can be significant.
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With Nowhere Else To Go Doctors Suggest Another Knee Replacement
- Study: Early diagnosis is very important for the treatment of intractable pain following total knee replacement. A reoperation conducted without identification of a specific reason carries a high risk of failure.
- With nowhere else to go, doctors suggest another knee replacement.
- Second knee replacement operation with a high rate of failure.
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Technical Details Of Total Knee Replacement
Total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection. This is followed by inflation of a tourniquet to prevent blood loss during the operation.
Next, a well-positioned skin incision–typically 6-7 in length though this varies with the patients size and the complexity of the knee problem–is made down the front of the knee and the knee joint is inspected.
Next, specialized alignment rods and cutting jigs are used to remove enough bone from the end of the femur , the top of the tibia , and the underside of the patella to allow placement of the joint replacement implants. Proper sizing and alignment of the implants, as well as balancing of the knee ligaments, all are critical for normal post-operative function and good pain relief. Again, these steps are complex and considerable experience in total knee replacement is required in order to make sure they are done reliably, case after case. Provisional implant components are placed without bone cement to make sure they fit well against the bones and are well aligned. At this time, good function–including full flexion , extension , and ligament balance–is verified.
Finally, the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement. The surgical incision is closed using stitches and staples.
Anesthetic
Length of total knee replacement surgery
Pain and pain management
Up To A Third Of Knee Replacements Pack Pain And Regret
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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When Surgery Is Recommended
There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement often have:
- 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
Total knee replacement may be recommended for patients with bowed knee deformity, like that shown in this clinical photo.
What Does The Doctor Do Prior To Revision Surgery
When the decision for revision knee replacement is made, the surgeon will do a thorough clinical exam and order and laboratory tests. If infection is suspected, aspiration of the knee may be required. The aspirated fluid will then be sent to a laboratory for analysis to identify the specific type of infection.
In addition to X-rays, other imaging modalities may be helpful, such as bone scans, or . These advanced imaging technologies can demonstrate changes in the position or condition of the prosthetic components as well help to pinpoint the cause, location and the amount of bone loss to help plan for the surgery.
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Think That Walking And Moving Around Is The Major Achievement
Patients mistakenly think that walking is a major achievement after surgery and that walking without a walker is even better. Other healthcare professionals can misguidedly feed into that misconception making the problem even worse. The truth is that getting up and moving around after surgery is encouraged but for the first two weeks you should be protecting the joint from full weight bearing forces by using the walker. This allows you to carry a percentage of your body weight through your arms instead of on your surgical knee.
During your knee replacement surgery, the ends of your long bones have been cut and a prothesis placed over the top. Bone that has been cut can be very painful, just ask someone who has had a small piece of bone taken from their iliac crest for use in a back surgery. That bone removal site can ache for months.
If you walk around without any protection for your new knee you will likely inflame and aggravate the bones. This can cause a person to have a real problem controlling their pain. All things considered you dont want to be dealing with more pain than is already associated with the post surgical period. So use your walker.this means actually putting weight through your arms. A 4 wheeled walker is a horrible choice for this. Get the regular 2 wheeled walker and slow down a bit. Your knee will thank you and your recovery will go much faster.
What Is Partial Knee Replacement
A partial knee replacement is an alternative to total knee replacement for some people with osteoarthritis of the knee. This surgery can be done when the damage is confined to a particular compartment of the knee. In a partial knee replacement, only the damaged part of the knee cartilage is replaced with a prosthesis.
Once partial knee replacement was reserved for older patients who were involved in few activities. Now partial knee replacement is often done in younger people as their recovery is quicker and usually less painful. About 5% to 6% of people with arthritic knees are estimated to be eligible for partial knee replacement.
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Are There Any Reasons Why I Cant Have A Knee Replacement
Unfortunately, some people may not be able to have a knee replacement even though their arthritis is very bad. This may be because:
- your thigh muscles are very weak and may not be able to support your new knee joint
- there are deep or long-lasting open sores in the skin below your knee, increasing your risk of infection.
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.
- Neuropathic pain peaks at between six weeks and three months postoperatively. Currently, doctors believe the best choice of recommendations for neuropathic knee pain is pharmacologic management. For a discussion on Prolotherapy and nerve damage see our article on Neurofascial Prolotherapy.
The same research team had more to say in a 2017 study that will be discussed below.
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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.
What If My Knee Replacement Was Installed On The Wrong Knee
In some instances, the wrong sided implant may be used for your knee replacement e.g. a left knee replacement being used on your right knee. This can happen because: the hospital where the surgery was performed does not have protocols for confirming procedure sidedness before the surgery begins similar procedures at this hospital are used for confirming hip components to confirm knee components operating room personnel did not follow a standardized process to confirm knee implant sidedness the operating room staff focused on sizing of the knee replacement and not side.
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Looking For Alternatives To Total Knee Replacements
We’re also funding research which is investigating alternative approaches to total knee replacement. For example, total knee replacement is not recommended for many young people. This study aims to develop a new method called ToKa®, which uses images of the patient’s joint and specially designed software to design a patient specific implant that will be made via 3D printing. If successful, this technique could prevent osteoarthritis patients from needing total joint replacement.
What Is A Knee Replacement Surgery
Knee replacement, also called knee arthroplasty or total knee replacement, is a surgical procedure toresurface a knee damaged by arthritis. Metal and plastic parts are used tocap the ends of the bones that form the knee joint, along with the kneecap.This surgery may be considered for someone who has severe arthritis or asevere knee injury.
Various types of arthritis may affect the knee joint. Osteoarthritis, adegenerative joint disease that affects mostly middle-aged and olderadults, may cause the breakdown of joint cartilage and adjacent bone in theknees. Rheumatoid arthritis, which causes inflammation of the synovialmembrane and results in excessive synovial fluid, can lead to pain andstiffness. Traumatic arthritis, arthritis due to injury, may cause damageto the cartilage of the knee.
The goal of knee replacement surgery is to resurface the parts of the kneejoint that have been damaged and to relieve knee pain that cannot becontrolled by other treatments.
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When To See A Lawyer
As you’ve probably gathered by now, medical malpractice is a complicated legal field with a lot of hurdles and uncertainties. If you think that the harm you suffered after a knee replacement surgery is out of the ordinary and the result of your surgeon or other health care provider’s negligence, then you should consult with an experience plaintiff’s medical malpractice attorney.How Much is My Knee Replacement Malpractice Case Worth?
If you win your case, how much you recover will all depend on your medical expenses, lost wages and other concrete losses as well as the dollar amount the jury puts on your pain and suffering. Keep in mind, however, that some states put limits on how much a medical malpractice plaintiff can recover, regardless of what the jury awards.
What Is Hip Replacement Surgery
Hip replacement, also called total hip arthroplasty is surgery to replace a worn-out or damaged hip joint with an artificial joint called a prosthesis. Once the injured joint is surgically removed the prosthesis is cemented into the thigh bone and pelvis. Prosthesis composites include metal, ceramic and hard plastic. Hip replacement is an increasingly common surgery. A recent Blue Cross Blue Shield report revealed that hip replacements between 2010 and 2017 increased by 33% . Often times viewed as a safe and long-lasting, hip replacement is not foolproof.
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