Will Your Bones Even Allow For A Revision Knee Replacement
An August 2019 study in the Journal of Orthopaedic Surgery and Research offered this warning to surgeons concerning the problems of identifying whether a patients bones were strong and dense enough to withstand another knee replacement procedure.
Revision total knee arthroplasty is a demanding procedure, with a high complication and failure rate and a high rate of bone losses and poor bone quality. Different classifications for bone losses have been proposed, but they do not consider bone quality, which may affect implant fixation.
Look at the study findings:
- Fifty-one patients were included .
- The most frequent cause of failure was:
- aseptic loosening of the implant .
- 18.9% of the cases demonstrated poor bone quality.
What the researchers of this study were seeking to point out is that if revision knee replacement is required, a plan to address and repair the possibility of bone loss, bone weakening, a loss of bone density should be undertaken. This would significantly increase the success of the replacement.
What Causes Pain After Knee Replacement Surgery
Researchers continue to study the many causes of pain after knee replacement surgery. Some are biological and due to conditions present before surgery, while others are due to complications that arise during surgery.
On the biological side, patients suffering from arthritis may experience increased sensitivity because of the ongoing pain that was present before surgery. As well explain below, inflammatory responses and allergy-related problems can also contribute to persistent pain. Another source of pain is referred pain originating from the hip due to a change in alignment.
If you are experiencing ongoing pain after knee replacement surgery, but do not have a medical history of arthritis or the previously mentioned issues, you may be dealing with surgical complications. While your doctor will take steps to prevent problems, its still possible for these to rare issues to occur:
- Infection
- Instability
- Stiffness
Remember to stay open and honest with your doctors. This will help them properly diagnose and treat the problem to get you the pain relief youre looking for.
Problems Associated With The Nervous System
After surgery, it is common to experience some damage to the branching sensory nerves that detect sensation around the knee joint. This damage is rarely noticed by most patients, but some may be bothered by a loss of sensation around the area of the incision. The situation is not serious, and often the area affected shrinks over time and there may be some recovery of sensation.Complex Regional Pain Syndrome. This is a poorly understood chronic condition lasting more than 6 months brought about by injury which could include surgery. It is a very rare condition thought to be caused by damage to the nerves around the knee. Symptoms include excessive pain, stiffness, changes in skin colour, fluctuation in skin temperature with possibly swelling to the affected area. Many cases of CRPS improve to some extent over time. Only your doctor can give an accurate diagnosis of CRPS and you may need the help of a specialist pain doctor if you have CRPS.
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Who Is Offered Knee Replacement Surgery
A knee replacement is major surgery, so is normally only recommended if other treatments, such as physiotherapy or steroid injections, have not reduced pain or improved mobility.
You may be offered knee replacement surgery if:
- you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced
- your knee pain is so severe that it interferes with your quality of life and sleep
- everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
- youre feeling depressed because of the pain and lack of mobility
- you cannot work or have a social life
Youll also need to be well enough to cope with both a major operation and the rehabilitation afterwards.
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Does A Knee Scope Hurt
Yes, a knee scope can be painful but it is typically rated as mild-to-moderate. This all depends on what surgery was performed. Most people tend to have surgical pain for 2-3 days and then the pain levels improve gradually from then on.
A knee scope is an outpatient surgery, but that doesnt mean its pain-free. In general, knee pain after a knee scope can range from mild to severe and it typically depends on the type of surgery you had done as well as what part of your knee was worked on. Common knee scope surgeries include a partial meniscectomy, a cartilage debridement, removal of a loose fragment, and even an ACL reconstruction.
Patients who experience low levels of pain typically have less performed on their knee such as a Meniscectomy, have a lower BMI, and a previously active lifestyle.
The level of discomfort also varies depending on how active you are in your daily life. The more active and stronger someone is before surgery then they are less likely to have high levels of pain after surgery.
People who experience higher levels of pain typically have more arthritis built up in the joint, are overweight or obese, and may have multiple things wrong in the knee joint.
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Pain After Tkr Surgery Checking Out Of The Hospital And Driving Home
The first time and only time I experienced nausea while in the hospital was during the discharge process. I let my nurse know and she said that a side effect of Percocet is nausea and that she would get me something to remedy the nausea.
She also suggested an over the counter drug Meclizine that could help me with any future nausea at home. Because of nausea I was unable to eat much during my last meal.
After discharge a volunteer brought a wheel chair and took me to my sons car. Even though the leg was down low, I did not experience any pain.
Getting into his small car was a bit difficult. At first I tried to get in the back seat in order to elevate my leg. That was not so easy so I opted for the passenger front seat.
With some help I was seated and on my way home. I suggest you bring the biggest most comfortable car you can find for the ride home. I only had a 20-minute ride home during which the pain was not bothersome.
Getting out of the car took some time. I was in the garage so I only had a short walk with my walker to my living room where I plopped down in my reclining chair.
I was happy to be home and I only felt moderate pain at that time. My wife went directly to the pharmacy to fill my pain medication prescription.
My Knee Still Hurts After Knee Replacement Surgery Is This Normal
by Ben Lankester – April 12, 2021
Most patients having a knee replacement will have had a total knee replacement effectively a complete resurfacing of the knee joint. It is an invasive operation that results in a lot of soft tissue inflammation, swelling and pain which takes a quite long time to settle down so it is normal for patients to have some pain for 4 6 months after the operation is done.
Some pain is normal for a few months after surgery.
A successful knee replacement operation:
- Resurfaces the damaged ends of the bone where the cartilage surface has worn away so that these no longer rub together.
- Re-aligns the leg if there has been deformity.
- Recreates the normal tension in the main knee ligaments which guide smooth bending movement.
- Gains a strong fixation of the metal and plastic components onto the bone.
If all these aims are achieved with a good degree of accuracy, then most patients will have a well-functioning settled knee. But there are many studies that show that about 15% of patients will be dissatisfied after surgery. Sometimes this will be due to persisting discomfort or pain, sometimes tightness or limited range of bend, sometimes instability or lack of confidence and often a combination of those features.
An arthritic left knee with deformity, and a resurfaced, realigned left knee with a total knee replacement.
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Will I Have Severe Pain After Knee Replacement Surgery
Pain is to be expected after the initial knee replacement, but it should not be severe. The first few days after surgery should include the highest level of pain, but your doctor will send you home with pain medication adequate for your pain level.
Most people fully recover from knee replacement surgery in about six months. There may be a small amount of pain and soreness for the duration of the healing process, but this is normal. If you find yourself in severe pain after knee replacement surgery, call your doctor. You could be experiencing complications that require additional treatment.
Diagnosis Of Knee Replacement Problems
If you follow the medical advice you are given after your return home from the hospital your implant should settle down without any problems. You should be able to return to normal activities about 6 weeks after the operation. Expect the pain and swelling to last for about 3 months, and it may take a year for all the swelling to disappear. The vast majority of knee replacement procedures are successful, and problems are unusual, but if you are experiencing pain or are worried about other issues concerning your knee replacement you should contact your doctor or surgeon as soon as possible, no matter how long after the implant procedure. An examination by your doctor or surgeon will be able to get to the source of the problem and they will have access to imaging techniques and laboratory tests which will exactly identify what the problem may be.
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Ligament Instability Was The Primary Reason For Repair Surgery
Doctors writing in the German medical journal, Der Orthopäde said:
- In 32.6 % of all cases , ligament instability was the primary reason for revision.
- In another 21.6%, ligament instability was identified as a secondary reason for revision.
- Analysis of the different instability forms showed combined instability in extension and flexion as the most common cause, followed by isolated instability in flexion and isolated instability in extension .
The summary statement of this research is extraordinary in its simplicity
Correct anatomical positioning of the components and balanced ligaments in the different extension and flexion positions are important for good clinical results, a stable joint, good function, and longevity.
In other words, put the ligaments back where you found them.
What Can Be Done To Help
If the Xrays are satisfactory, and there is no infection or abnormal nerve response, and no alternative source of referred pain, then the symptoms are likely to be due to subtle imbalances in the soft tissue sleeve around the knee, coupled with inadequate muscular control. Many patients can improve with a targeted programme of exercises guided by an experienced physiotherapist, and this should be the first course of action if no other problem has been identified.
If a problem is identified with the replacement, then it is important that you are seen by a knee specialist who has experience with re-do knee replacement surgery in order to fully understand what the likely outcome of further surgery would be, and the risks.
Repeat surgery may be an option, but is not as predictable as primary surgery. It is crucial that the source of problems is correctly identified before making this decision if not, you are at risk of undergoing another big operation and getting the same poor outcome.
Malaligned knee on left, with tibial component which has loosened and tilted, treated with revision total knee replacement , using more complex stemmed components to regain proper alignment and obtain fixation over a wider area of bone.
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Ongoing Pain After Knee Replacement: People Need Support And Encouragement To Seek Help
This is a plain English summary of an original research article
People with ongoing pain after knee replacement surgery may experience a sense of futility and believe nothing more can be done. A new study found that that one in five people report ongoing pain after knee replacement surgery, but many do not seek help in dealing with their pain.
The researchers say that improvements in the information given before surgery could help. And it is important that clinicians acknowledge pain at follow-up appointments. This may encourage people to seek help to manage their pain through services such as physiotherapy, surgery, or medication.
In this new study, researchers found that some patients did not want to undergo further treatment because they thought it would not work or be risky, or because they had other health problems to deal with. People were uncertain about what to do about their pain even after consulting their surgeon or GP.
Research: Doctors Are Looking For The Causes Of Pain After Knee Replacement And It Is Hard To Find
The confusion as to what may be the cause of chronic knee pain after knee replacement is a cause of great concern not only among doctors but obviously among patients. We often find patients to be confused between what is normal and what is not normal after knee replacement.
- Is some pain normal?
- Are the clunking sounds normal?
- Is the instability normal?
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Research Continued: After The Surgery The Researchers Found Patients Had To Alter Their Recovery And Post
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.
Risks Of Knee Replacement Surgery
Knee replacement surgery is a common operation and most people do not have complications. However, as with any operation, there are risks as well as benefits.
Complications are rare but can include:
- stiffness of the knee
- infection of the joint replacement, needing further surgery
- unexpected bleeding into the knee joint
- ligament, artery or nerve damage in the area around the knee joint
- persistent pain in the knee
- a break in the bone around the knee replacement during or after the operation
In some cases, the new knee joint may not be completely stable and further surgery may be needed to correct it.
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What Can I Do To Help Ease The Pain
Once the knee replacement surgery is completed, itâs 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.
Debilitating Pain After Knee Replacement
My husband had knee replacement surgery six months ago. The knee is still swollen, hard, and very warm. He still has chronic pain. He’s at a constant 3-4 level most of the time, with episodes that shoot the pain up to 9 -10 range every day every damned day! that bring him to tears. And this is a man who’s had broken bones, suffered concussion, and had a total hip replacement and was back on the golf course in six weeks. He’s had every blood test you can think of to rule out infection. He’s been X-rayed and scanned to rule out anything else. And we’re told everything with the new joint looks fine, so keep doing what you’re doing and it will get better. He does PT. He elevates, He ices. He does deep breathing. We’ve been to a pain management specialist who’s fiddled with his meds and done laser therapy. And nothing works to bring the pain down. it’s not getting better. Any ideas or recommendations?
THAT SOUNDS LIKE ME, BUT IT HAS BEEN YEARS! DON’T GIVE UP IT MIGHT NOT EITHER
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The Knee Cap Was Floating Because The Mcl Was Released Patellar Maltracking After Total Knee Replacement The Concern Of Catastrophic Laxity
Lets look at two studies surrounding the medial collateral ligament.
The first is from 2015, the second is from 2021
In June 2015 in the journal Knee Surgery, Sports Traumatology, Arthroscopy researchers wrote: Medial collateral ligament release is one of the essential steps toward the achievement of ligament balancing during the total knee arthroplasty in patients with varus deformity . When the varus deformity is severe, complete release of the MCL until balanced is often required. However, it is believed that a complete MCL release may lead to catastrophic laxity.
In March 2021, a study published in the journal Knee Surgery and Related Research continued that Medial collateral ligament release during knee replacement could lead to the surviving knee cap floating around the knee. Here are the studys observations: Patellar maltracking after total knee arthroplasty can lead to significant patellofemoral complications such as anterior knee pain, increased component wear, and a higher risk of component loosening, patellar fracture, and instability. . . A complete release of the MCL during surgery was associated with patellar maltracking. Surgeons should attend to patellar tracking during surgery in medially tight knees.