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Lateral Knee Pain After A Total Knee Replacement
Mar 23, 2022
Lateral knee pain after a total knee replacement is common and may be caused by pain at the fibular head. The new knee implant will change the stresses and loading through the tibia.
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0:00
Hey guys Tony here welcome to the total knee replacement support group YouTube
0:05
channel. I wanted to answer a question about lateral knee pain pain on the
0:10
outside of your knee after a total knee replacement. So there's lots of factors
0:15
that come into play when we're talking about pain. Pain you know it can't be
0:22
measured it can't be touched it can't be like manipulated. Pain is one of those
0:27
things that it's absolutely context dependent and influences and affects people differently. I know certainly there's people out there with high pain
0:39
thresholds, low pain thresholds, but it's one of those things where we do the best
0:45
we can to manage it, to try and understand it, to try and figure it out
0:49
And so from a mechanical perspective, and I think mechanical perspective is
0:55
probably the least effective way to talk about pain but I've got other videos
1:00
discussing other pain issues this one's gonna be biomechanics so a person in the
1:08
group posted a comment asking about pain on the outside of her knee after the
1:13
knee replacement what could be causing the pain why is it here so let's talk
1:17
about the knee replacement for a second if you look at imaging x-ray imaging of
1:22
of knee replacements you see the prosthetic implants right So you think of if I take a look here my leg you think of the tibia you see how they cut off the top of the tibial bone they put the implant in this
1:36
is the femur they cut off the bottom of the femur bone they put the implant in
1:40
but if you look really closely on the side of the tibia so the tibia is the
1:46
shin bone on the outside of the tibia there's a bone called the fibula it's a
1:52
long skinny bone it makes that little bump on the outside of your ankle but at the top of that
1:58
fibula it's the fibular head it is a bone that has cartilage just like your knee had cartilage
2:06
it sits up kind of nestles like if you think of this as the top of the tibia that fibula comes up
2:13
right underneath that overhang and so technically it it wasn't involved in the knee replacement
2:21
but in reality if you have arthritis in the knee you probably have some arthritis on the head of
2:29
the fibula you probably have some degenerative changes you probably have some issues there
2:34
so you know when somebody comes in and they have lateral pain on the outside of their knee we're
2:40
You're usually thinking iliotabial band, you're thinking lateral collateral ligament, or you're thinking the head of the fibula
2:48
And I don't hear people talk about that enough. So of course, the next question is
2:55
well what do I do about it How do I fix it How do I manage it First part is understand that when they put that prosthesis in on top of the tibia it changes the way the bone is loaded different from the way you
3:14
had the knee before. You know, oftentimes you'll see kind of that bow-legged or that valgus, that
3:19
knock-kneed position. They refit everything so that the knee is nice and straight. They're
3:25
completely different stresses going through the fibula and the tibia when they took a crooked leg and made it into a straight leg. Now we want it to be a
3:35
straight leg but just understand that we have to adapt to a new loading pattern
3:39
That could be part of the sensation you're feeling. The other part is if we
3:46
do have some arthritis on the top of that fibular head there are a couple
3:51
little maneuvers that your physical therapist is more than adequately trained to help you with. They could do some of what we call like AP glides or PA glides
4:01
There's some tibial rotation things that you can do within what the knee
4:07
replacement will allow, but that may also help the tibia itself. And I would say
4:14
that if you don't have full range yet, as the range continues to improve, we're
4:20
gonna start to see some improvement in potentially the pain coming from that
4:25
fibular head So let do this It been almost four and a half minutes I don want to take this video any longer Plus I got some patients getting ready to walk in the door Go on Google
4:37
Look or search for the term fibula. Look at images of knee replacements
4:44
See where the implant is and see where that bone on the outside of the lower leg goes
4:51
And you guys determine. And maybe you can even poke around and palpate, right
4:55
So if my pain is out here kind of just below the joint line of the knee, my pain is in this section and maybe it hurts when it's back
5:08
Maybe it hurts as it's moving into extension. This is where that fibula is
5:15
The fibular nerves, the peroneal nerves kind of wrap around the head of that bone and go down the leg
5:20
it's certainly reasonable that that could be part of what's driving the pain
5:26
Guys, let me know if you have any effective strategies to manage that outside leg pain
5:33
Let me know if you have more questions about this. I can record another video
5:38
And let me know how you guys are doing. I love all the stories and the engagement coming out of the group
5:43
We just added like 300 new members to the group. The group is growing like crazy
5:48
If you have questions, that's the best way to get a hold of me
5:54
Guys, I'll catch you on the next YouTube Live
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