Why Is My Knee Replacement Clicking And Popping
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Knee Replacement Pain: The Week Following Surgery
You should expect to stay in the hospital for several days following knee replacement surgery. This is often considered the most painful stage of the recovery process. Your doctor will prescribe medications to help you manage your pain level.
In addition to icing your knee, you may be encouraged to move your foot and ankle to increase blood flow and lower the risk of swelling and blood clots. Your doctor may also use blood thinners, support hose, and compression boots to prevent further complications.
Generally the day after surgery, a physical therapist will show you exercises that will help you recover your range of motion and continue to heal. You may even be asked to get up and take a few steps . Patients who get up and put a safe amount of weight on their new knee typically experience a quicker recovery.
After leaving the hospital, most patients continue to take some form of pain medication for two to six weeks. Your doctor will determine the best method of pain relief for your specific needs, whether it is over-the-counter medications or something stronger.
Weight Loss Exercise And Diet
Think about the extra pounds people carry every day due to their being overweight. This puts added pressure and strain on the back and stomach muscles, causing those muscles to stretch and weaken. Weak back and stomach muscles cannot support the back properly. Poor posture can shift your body out of balance. This forces only a few muscles and joints to do all the work. Without proper exercise, muscles become weak and tire easily. Exercise is necessary to keep the back strong and limber. A good conditioning exercise program led by a trained instructor can be particularly helpful. An effective program includes a warm-up period about 30 minutes of aerobic activity isolated muscle group work and a cool-down period. Over a period of time, the rewards of regular aerobic workouts can include a slimmer waistline and healthier back.
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You Have Bad Arthritis
Most people who undergo a knee replacement have either osteoarthritis, the wear-and-tear type of arthritis rheumatoid arthritis, an autoimmune condition that causes joint pain and damage or post-injury arthritis.
Osteoarthritis, rheumatoid arthritis and posttraumatic arthritis affect the knee through different mechanisms, however, these different conditions are similar in that they all result in loss of cartilage, which causes pain and loss of motion, says Nathanael Heckmann, MD, an orthopaedic surgeon at Keck Medicine of USC and an assistant professor of clinical orthopaedic surgery at the Keck School of Medicine of USC. When these symptoms become severe, knee replacement surgery may provide considerable symptom relief by replacing the worn-out surfaces of the knee.
Your Back Pain Impacts Your Kneeand Knee Replacement Outcomes
The new study looked at more than 1,000 knee replacements over two years. In almost 700, the patients were asked to fill out a spine-function questionnaire. Fifty-four percent of the knee replacement patients questioned had daily low-back pain. While patients without back pain demonstrated good results on their functional knee questionnaires , patients with low-back pain reported significantly poorer knee replacement outcomes. In addition, the study showed that patients with back pain also had more pain and lower knee function before the knee replacement.
Despite these findings, I can count on both hands the number of times that I have seen an orthopedic surgeon talk to a prospective knee replacement patient about his or her low-back issues or even ask whether the patient has back pain. Far fewer times has a surgeon imaged the low back as part of his or her work-up for the knee. Why does this happen? See above. In our managed-care, hyperspecialized world, the physician looking at the knee often doesnt really believe its his or her job to look at the low back.
Chris Centeno, MD
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Treatment Of Anterior Knee Pain After Tka
Therapy of anterior knee pain after TKA depends on the causes, pain intensity and functional impairment. One can distinguish between functional causes and mechanical causes. For functional causes non-operative treatment is the treatment of choice. For mechanical causes surgical treatment may be indicated. Therefore, mechanical causes should always be excluded before therapy planning. Figure shows an algorithm for the diagnostics to exclude mechanical causes of anterior knee pain after TKA.
Diagnostic and therapeutic algorithm for anterior knee pain after TKA
The Patients Still Had Knee Pain After Knee Replacement Because It Was Not Their Knee Generating The Knee Pain It Was The Hip And Spine
A 2017 study published in the journal Clinical Orthopedic Surgery, doctors found that in the patients they examined with pain after knee replacement
- 25.6% of the patients in the study were found to have nerve entrapment in the spine,
- 15.4% were found to have hip osteoarthritis or femoral head avascular necrosis.
Knee pain persisted after knee replacement because the problem was not the knee but the hip and spine.
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What The Surgical Site Should Look Like
You may see a little clear discharge tinged with blood for a few days after the surgery, but this is normal.
If the discharge changes color, there is redness around the site, or your notice a foul odor, your dog could have an infection. Its important to know that with quality care, this is a rare occurrence.
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Offset Errors Of The Femoral Component
The anterior offset of the femoral component has a major impact on the mechanics of the patellofemoral joint. An anterior overhang can be caused by selection of a femoral component that is too large or an overly minimal anterior resection . This can lead to increased pressure of the patella and its surrounding structures .
However, an increased anterior resection can also lead to patellofemoral problems. In this case, the passive quadriceps insufficiency may be a cause of anterior knee pain. Increased posterior offset can also lead to flexion deficit which might also influence the contact pressure in the femoropatellar joint.
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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.
Other Conditions That Cause Back Pain
Sometimes pain felt in the back actually originates elsewhere in the body. Such problems may include: prostate trouble in men problems with reproductive organs in women kidney diseases, such as an infection or kidney stone diseases of the intestines or pancreas, such as cancer or a blockage cancer that has spread to the spine multiple myeloma, a form of cancer of the bone and bone marrow curvature of the spine rarely, a tumor on the spinal cord
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How Far Should I Walk Immediately After Total Knee Replacement
A total knee replacement patient should be walking about 150 feet with a walker the day after the surgery.By three weeks after surgery most patients are able to walk about ¼ mile without any ambulatory aid such as a walker or cane.
Most surgeons have a post-surgery binder of specific instructions that are issued to the total knee replacement recipient upon their discharge from the hospital.
In this binder of instructions is usually a section that discusses how much the surgeon wants the patient to walk during the two to four weeks of home therapy before the patient initiates outpatient physical therapy.
In those instructions, they almost always say Walk 10 to 15 munites a day.Those instructions are unclear and too general for the average patient to understand.
First, the surgeon is telling the patient to walk 10 to 15 minutes a day as part of a home exercise rehabilitation program.Walking to and from the bathroom is not considered part of an exercise program, it is considered activities of daily living. And all walking done as part of the activities of living does not count as time toward the rehabilitation exercise program.
Secondly, the recommended 10 to 15 minutes of walking is all at one time. It is not broken into smaller segments of time that are then added together to achieve 10 to 15 minutes of walking.
Thirdly, the surgeon is not taking into consideration the patients speed or stride length when recommending walking 10 to 15 minutes daily.
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.
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Does Back Pain Cause Knee Pain
As one of the most complex joints in the body, the knee allows the entire leg to move, flex, and have a good range of motion. Meanwhile, with its vertebrae and shock-absorbing discs, the back has a myriad of responsibilities it holds you physically together and secures the high-speed conduit for your complex and delicate nervous system.
Together, the knees and the back provide flexibility, motion, and support. However, they also rely on each other to maintain balance and equilibrium. Therefore, when your back hurts, so might your knees.
What Patients Want From Their Knee Replacement:
In the November 2017 edition of the journal Medical Care, a combined research team from the University of Illinois at Chicago, China Medical University Hospital, and National Taiwan University Hospital published their findings on what concerned patients before knee replacement and the type of pre-existing conditions these patients had.
Before the surgery concerns about successful surgery circled around these factors:
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Calf Pain May Persist For Several Weeks Or Months After A Knee Replacement
Since there are so many possible causes of pain in the calf and ankle, it is impossible to determine how long the associated pain will last.
For most clients their symptoms will resolve in the first 6 to 12 weeks. If pain persists beyond that timeframe without a known cause it is recommended that you consult with your surgical team and physical therapist for further medical assessment.
My Hip Pain After Knee Replacement Surgery
After my surgery, I experienced slight pain in both of my hips during physical therapy. I chalked it up to relearning to walk and I understood that my body was getting comfortable with a new knee.
This was the only hip pain I experienced early on. However, a year and a half after my TKR I experienced more severe hip pain.
Before leaving on a vacation, I went on several 6-8 mile hikes within a week. I like to keep active but even this was a lot for me .
During the last hike, my right hip began to hurt and gradually got worse during the hike. Fortunately, the second half of the hike was downhill. Im not sure I would have been able to make it back to the car if it had been uphill.
Two days later, the pain was severe during my long plane flight.
I searched for hip pain information on the internet and talked with friends and was convinced I had bursitis.
I took ibuprofen regularly but the hip pain remained. I had planned several excursions during the first week of the trip including hiking and biking.
As the week went by, the pain increased in my hip. I had to lift my right knee to get in a car and I also had trouble sleeping.
I continued to take ibuprofen but my hip began to throb at night . The last few weeks were spent at my daughters home and I was still in severe pain.
I was unable to hike or even walk very far.
My daughter set up an appointment with a physical therapist who examined me. He said I did not have bursitis.
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Knee Replacement Complications In Former Athletes
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.
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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.
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When Can My Dog Start Running Jumping And Swimming Again
Your dog should be kept on light, short, and dry exercises for at least two to three weeks. Refrain from letting it do anything too vigorous for the first six weeks.
Not sure whether your dog really needs luxating patella surgery? Dr. Brian Loon from Amber Veterinary Practice .
to join our pack and find us on and .
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Allergies Increase Your Chance Of More Knee Pain After Knee Replacement
The obvious thought here is that there is a greater chance of pain if you are allergic to the materials in the artificial joint used to replace your knee, and while that is certainly known to be true, there is more. Having any kind of multiple allergies, not just metals, can be a sign that you will have more pain and poorer outcomes following a knee replacement.
If your reason for considering a knee replacement is to address your knee pain, you may not achieve the result you are hoping for as knee pain after knee replacement is the single most common complication to the surgery. Keep in mind that despite what youve been told, a surgical replacement of your knee may not necessarily be your last option. Before surgery and after conservative care, consider our knee replacement alternative, the Percutaneous Knee Arthroplasty , for knee OA.
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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.
Lower Back And Knee Pain
If you have acute or chronic knee pain, mentally and purposefully scan for other pains or discomforts that accompany it. These pains or discomforts may seem completely unrelated, but consider them anyway.
Back pain can be related to knee pain simply based on the phenomenon of referred pain. The nerves to the lower extremities branch directly off the lower spine. So its easy to see how a pinched nerve, perhaps due to a bulging lumbar disc in the lower back, could direct pain down that nerve branch and into the knee.
If you sit a lotmaybe you travel for a living and spend a lot of time on airplanes, or maybe you have a desk job and dont get up and move around like you shouldsitting reduces the disc height and increases the disc bulge by pushing water out of the disc. So if you sit a lot, and you have both back and knee pain, its possible the knee pain is due to your back.
You might not even consider your back discomfort to be pain. It may just be a little tense or tight. It could be very mild, but dont discount it. Before deciding on a major knee surgery, you owe it to yourself to have even the mildest back discomfort investigated to determine if its your back causing your knee pain.
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