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What Causes Pain Behind Knee After Total Knee Replacement

The One Constant: X10

Knee Pain After Total Knee Arthroplasty

I think in my mind the X10 was the one constant that I knew that was safe. It was a safety net. I could get on that machine, and I know the machine would go and move my knee to the degree that was on the screen. It wasnt going to do it any more or any less. It wasnt going to apply more pressure or less pressure. Every day before I started the machine, I was thinking to myself, how in the world am I going to bend it one degree more today than I did yesterday because it hurt to get to where I was? The process of being on the machine for 40 minutes, it was like that machine just gently moved my leg over that 40 minutes every day, and it would loosen up over that 40 minutes every session, three times a day. Eventually, Id get there, and Id get to that last two minutes where I would go one degree farther than I did the previous workout.

I cant explain how the machine did it, but it worked, and I got one degree farther. Over a period of time, that confidence that the machine was not going to hurt my leg and that I could do it was invaluable. There was a great deal of comfort and of security knowing that I was getting better. The machine was taking care of my leg and my knee and I was improving. I was now managing extreme pain after total knee replacement surgery.

Pathophysiology And Etiology Of Pain

Pain is a normal manifestation of everyday life and serves as a protective mechanism for the body, causing the individual to react to try to eliminate the pain stimulus. However, excessive pain after a TKA can diminish or hinder quality of life. This form of pain typically originates in the peripheral nervous system .

The PNS consists of all the nerves outside of the brain and the spinal cord. It is made up of bundles of axons which are enclosed by connective tissue to maintain the continuity, nourish and protect the axon. Each axon in the PNS can be surrounded by a myelin sheath, called a Schwann cell sheath, and these two together form a nerve fibre. An axon can be myelinated once it reaches a thickness of one or two micro metre. The difference between a myelinated and non-myelinated nerve fibre is the conduction velocity . Nerve fibres can therefore be classified into different types depending on their diameter and conducting velocity.

The problem with pain receptors is that, unlike smell or taste for example, they adapt very little and sometimes not at all. The continuous excitation of nociceptors, therefore, tends to lead to a chronic aching pain. This increase in sensitivity of the nociceptors is called hyperalgesia.

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

  • 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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Symptoms Of Knee Pain

Suffering from knee pain is never fun. Before diving into some of the common causes of knee pain, lets explore the common symptoms. The severity of the pain can vary depending on the cause of the problem and the location.

Some common signs and symptoms of knee pain include swelling and stiffness, as well as redness, in the knee. Your knee may even feel warm to the touch. Other common symptoms include not being able to fully straighten the knee, weakness or instability, and popping or crunching noises.

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  • Here Are A Few Things You Can Expect After Knee Replacement Surgery:

    How to Manage Pain Swelling and Bruising After Total Knee ...
    • Rest and Ice: The knee will be swollen and tender, which is why you need to follow doctor suggestions for keeping the leg elevated and icing the joint.
    • Medications: Not only does medication help with pain management, but it is also vital to reduce inflammation. Sometimes antibiotics are needed for preventing infection.
    • Follow Up: You will have follow-up appointments to talk to your sports medicine doctor about recovery. Surgical staples or stitches will be removed during the office visit. Reach out to your doctor if you notice unusual symptoms, such as redness, fever, incision drainage, or increased pain.
    • Home Modifications: You might need certain modifications to help you navigate your home. Since the knee needs to heal, you must use crutches. Some patients transition to a cane or walker as the recovery progresses. Consider using other modifications, such as handrails, a shower bench, a reaching stick, and removing loose cords and rugs that could cause a fall.

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    Similar Conditions That Affect The Knee

    Meniscus tear

    Sometimes patients with knee pain don’t have arthritis at all. Each knee has two rings of cartilage called “menisci” . The menisci work similarly to shock absorbers in a car.

    Menisci may be torn acutely in a fall or as the result of other trauma or they may develop degenerative tears from wear-and-tear over many years. Patients with meniscus tears experience pain along the inside or outside of the knee. Sometimes the pain is worse with deep squatting or twisting. Popping and locking of the knee are also occasional symptoms of meniscus tears.

    Since some of these symptoms may be present with arthritis and the treatment of arthritis is different from that of meniscus tears, it is important to make the correct diagnosis. A good orthopedic surgeon can distinguish the two conditions by taking a thorough history, performing a careful physical examination, and by obtaining imaging tests. X-rays and Magnetic Resonance Imaging scans may be helpful in distinguishing these two conditions.

    Knee Joint Infections

    Also called infectious arthritis or septic arthritis, a joint infection is a severe problem that requires emergent medical attention. If not treated promptly knee infections can cause rapid destruction of the joint. In the worst cases they can become life-threatening.Symptoms of a knee joint infection include:

    • severe pain
    • fevers and

    Again, a joint infection is a serious condition that requires immediate medical attention.

    Calf And Ankle Pain After A Knee Replacement

    Since a new knee changes the alignment of the whole leg it is common to experience ankle and calf pain during your recovery.

    If the knee curved inward before surgery Genu Valgum then the new, straight knee will increase medical ankle compression and may cause pain on the inside of the ankle.

    * Recommendation: Your physical therapist may prescribe several exercises that increase ankle eversion to improve the mobility of the inside ankle.

    Conversely, if the knee curved out Genu Varum before surgery then pain at the outside of the ankle may be more commonly experienced after surgery.

    * Recommendation: Your physical therapist may prescribe several exercises that increase ankle inversion to improve the mobility of the outside ankle.

    These are normal symptoms and should improve in a few weeks of walking and joint specific exercises.

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    Loosening Of The Implant

    This is most often the cause of pain years or decades after a knee replacement. However, it is seldom the cause of persistent pain right after surgery. In order for a total knee replacement to function properly, an implant must remain firmly attached to the bone. During the initial surgery, it was either cemented into position or bone was expected to grow into the surface of the implant. In either case, the implant was firmly fixed. Over time, however, an implant may loosen from the underlying bone, causing the knee to become painful.

    The cause of implant loosening is not always clear, but high-impact activities, excessive body weight, and wear-and-tear of the plastic spacer between the two metal components of the implant are all factors that may contribute. Also, patients who are younger when they undergo the initial knee replacement may “outlive” the life expectancy of their artificial knee. For these patients, there is a higher long-term risk that revision surgery will be needed due to loosening or wear-and-tear.

    In some cases, tiny particles that wear off the plastic spacer accumulate around the joint and are attacked by the body’s immune system. This immune response also attacks the healthy bone around the implant, leading to a condition called osteolysis. In osteolysis, the bone around the implant deteriorates, making the implant loose or unstable.

    How Does A Meniscal Cyst Develop

    Pain in Back of Knee After Knee Replacement

    Usually, a tear forms in the meniscal cartilage from degeneration or an acute injury. Fluid from the knee joint then leaks out of the tear forming a cyst. So, a meniscal cyst is not a true cyst but an outpouching of displaced knee fluid. Also, the cartilage tear can form a one-way valve preventing the fluid from going back into the knee. The fluid then collects as a cyst below knee cap.

    Often, meniscal cysts form in people with a past history of a knee injury, cartilage damage, or contact or twisting sports. Also, the presence of arthritis predisposes to the formation of a cyst on side of knee.

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    What Are The Risk Factors For A Failed Knee Replacement

    Age, activity level, surgical history and a persons weight can contribute to implant failure. Younger, active patients, people who are obese, and those who have had prior knee surgeries all have a higher increased risk of a failed implant.

    Younger, more active patients have a higher rate of revision than older, less active patients because they place more stress on their prosthesis over more time. Obese patients have a higher incidence of wear and loosening because of the increased force of their weight, and they are more prone to infections because of their increased risk of wound healing. Patients with previous knee surgeries are at higher risk for infection and implant failure.

    What Helps Pain After Total Knee Replacement

    Its vital to note that pain is often inevitable right after knee replacement surgery. However, you should also know that the success rate of such procedures is 90% to 95%. Successful implant placement also lasts for over a decade.

    With that said, there are many ways to manage and ease pain following knee replacement. Here is a general guideline, including a timeline, of what you can do to reduce knee surgery pain.

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    Characteristics Of Severe Arthritis Of The Knee

    Pain

    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.

    Stiffness

    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.

    Location

    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 .

    Knee Pain Treatment In Boynton Beach Fl

    Pain After Knee Replacement Surgery

    Other issues that can cause persistent pain include bursitis, complex regional pain syndrome, and pinched nerves.

    No matter the cause of your knee pain we can help you get rid of it, once and for all. Contact the post-op knee pain specialists at Personalized Painful Knee Replacement Institute in Boynton Beach, Florida, by calling 903-7448. You may also request your appointment now.

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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.

    Can Rehabilitation Be Done At Home

    All patients are given a set of home exercises to do between supervised physical therapy sessions and the home exercises make up an important part of the recovery process. However, supervised therapy–which is best done in an outpatient physical therapy studio–is extremely helpful and those patients who are able to attend outpatient therapy are encouraged to do so.

    For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.

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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.

    Q: I Had Knee Replacement Surgery Four Months Ago Why Do I Still Have Pain

    Knee Tendon / Ligament Pain After Knee Replacement

    A: Recovery from surgery can take several months, so its not unusual to still have soreness in the knee that was replaced. As the intensity of rehabilitation exercises increases, more strain is put on the muscles and joints that have not been used in a period of time. Stick with the routine of exercises that were prescribed by a physical therapist. Though bending and stretching the knee may hurt at first, re-training the body to move normally will help with recovery in the long run.

    Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.Policy

    In addition, postoperative swelling is often a major source of pain for patients. Pain in the knee following the operation can last from six months to as long as one year, but dont get discouraged. Once fully healed, knee replacement surgery will help provide pain relief and improved function long-term.

    This article is adapted from Cleveland Clinic Arthritis Advisor.

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    Mild Knee Replacement Complications

    All of us will experience some mild knee replacement complications after surgery. Your recovery will be a time of adjustment and each persons body adjusts to their new knee differently.

    Complications can include bruising, swelling, tenderness and pain during the healing process. In most cases, these minor complications will last only a short time .

    Knee stiffness may develop after surgery, especially if you remain sedentary. Physical therapy will help with many of these mild complications.

    Some mild complications may persist and need further attention from your physician. Ill mention the more serious complications below.

    Always follow your doctors instructions to reduce your risk of developing complications.

    A Realistic Assessment Of What We Can Do To Help With Your Pain After Knee Replacement

    In our clinic, we try to provide information on helping people explore other treatment options before joint replacement. One of those options is simple dextrose Prolotherapy. This regenerative injection technique helps rebuild damaged ligaments and tendons.

    When the patients have already had a joint replacement, we will do a physical examination of the knee to assess how we may be able to help.

    • Prolotherapy fixes soft tissue, it cannot fix hardware failure,
    • Prolotherapy works by stabilizes the knee by strengthening the natural muscle and bone attachments, ligaments, and tendons.

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