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Good morning, guys. Tony Maritato here. Welcome to the Knee Replacement Support Group YouTube channel
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In this video, I want to answer the question about shin pain following a total knee replacement
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Now, I'm going to use some research behind me to help you understand kind of where this hypothesis comes from
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And please know it's just a hypothesis, just a thought. It's just a basic kind of educated guess on why we think you experienced that shin pain
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or the pain at the top of the tibia around the tibial plateau
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The main thing is the alignment. When you had your osteoarthritis in the knee prior to the knee replacement, most patients
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at least most patients that I've seen, pre-surgical have malalignment, meaning the knee either
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doesn't fully extend or it hyper extends or it's bowed in or it's bowed out, the knee typically is
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not a neutral straight knee. And so when you have the knee replaced, all of a sudden now the
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orthopedic surgeon has done an amazing job straightening everything up, but it's going to
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take time for the bone to get used to the new alignment. We've got new stress going through
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that So the study behind me looks at partial knee replacements and essentially what they saying here So unexplained pain is an important complication of both total knee replacements
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Unicompartmental is a partial knee replacement. They're usually replacing either the medial aspect or the lateral aspect
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After unicompartmental, I can't speak this morning, knee replacement, the most common
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side of pain, anterior, medial. So front inside part of the knee over the proximal tibia
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Tibia is the shin bone, essentially. And so the reason's not clear
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However, it may be due to high bone strain. And that's what we're talking about right now
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So essentially, just to paraphrase, we're not going to go through the whole study. This is a PubMed journal article
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the study found that different loading occurs through the knee in different areas through the
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bones of the knee the bones of the knee are the tibia the fibula is running along the outside
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and the femur above and my thought is and my experience would suggest that when you have
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kind of a crooked knee to begin with you can imagine your body has adapted over time there more compression on this side and there more stretch more tension on that side Well if all of a sudden I cut the ends of those bones and I go totally straight
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now this side is going to have a lot more compression than it used to. And this side
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is going to have a lot more tension than it used to. It will get better. Patients typically describe
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it as like a compressive, like an elastic strap that's squeezing the top of the shin bone
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Uh, lots of patients will experience pain along the shin bone itself
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And the other part is, remember many of the patients that I see in the clinic, they don't
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come out with full zero extension. There's usually a little bit of flexion left in the knee that they're working on
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But what that means is that for the next two, four, six weeks, eight weeks, while they're
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working on getting to zero, the knee stays flexed while they're standing
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That means that there's going to be more posterior compression, more anterior tension
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There's still different loading forces going through the bone. And we can see here in the article, it says
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As the bone remodels over time this strain will decrease Probably explains why the pain usually settles within 12 months Sorry guys I know 12 months feels like a lifetime but this is typically what we see Now I tell you practically in the
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clinic, most of my patients are resolving the shin pain, anterior knee pain, somewhere around the
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three-month mark but certainly 12 months is a reasonable time frame so hopefully i can kind of
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that helps to explain a part of why you might be having some of that bone pain in the shin the bone
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pain around the tibia because we're loading the bone differently the alignment is totally different
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but just like anything with time the body will adapt the body will customize to it
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and that discomfort should go away. If you guys have other questions, let me know
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I'm going to try and pull some more of the clinical research for you guys so you can see where some of these answers are coming from
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Certainly, just like this article, we don't know. We're still guessing. We're trying to make the best possible educated guess we can
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But with your help, with you posting your questions in the comments below these videos
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I can help provide better answers for you. as always thank you so much like the video subscribe to the channel and I'll catch you on the next one
