KNEE PAIN – Why Does My Total Knee Replacement Still Hurt So Much
Persistent Knee Pain After Total Knee Replacement Surgery
Pain is a highly complex human experience that cannot be easily explained by mechanical problems.
It is possible to have scar tissue without pain. It is possible to have limited range of motion without pain. It is even possible to have redness and swelling without pain.
But many of the patients I work with in my physical therapy clinic who are experiencing persistent pain after total knee replacement are experiencing all of these impairments AND pain.
What percent of total knee replacements are successful?
By several accounts nearly 20% of patients are not happy with the outcome of their total knee replacement. [1]
Why does my total knee replacement still hurt?
One of my favorite clinical studies reviewing different aspects of pain following a total knee replacement is The painful knee after total knee arthroplasty: evaluation and management. [2]
A list of the most common causes of pain:
- Infection
- Mechanical Instability
- Loosening of the component
- Periprosthetic fracture
- Anterior knee pain
- Overhang
- Non-Joint Causes:
- Soft tissue irritation
- Neuropathic pain
- Complex regional pain syndrome
In future updates to this article, I will be providing more details on the above conditions.
What is considered normal knee pain?
Many of the patients I work with in my physical therapy clinic will ask “Is this normal?”
There is something calming about knowing the pain you feel is normal or common.
Normal Knee Pain After Joint Replacement Surgery
Normal knee pain would be characterized by soreness throughout the knee, thigh, and calf. It is often described as a 4 out of 10 increasing to a 7 out of 10 at the most.
Patients will report the first 24 hours after surgery feeling lower pain levels than compared to the next 48 to 72-hour. After 72 hours the pain levels should reduce to a more comfortable level.
Normal pain may increase with activity and normalize with rest. Normal pain often responds well to pain medication, icing, or moist heat.
What are Abnormal Pain Levels
Abnormal pain would be characterized by pain that increases throughout the day and doesn’t relent with pain medication, icing, or moist heat. High pain levels cause increased respiration rates, sweating, and signs of stress.
Abnormal pain may cause loss of appetite, nausea, and anxiety.
In these cases, it is important that the patient contact the surgical team for a possible change in pain medication or further medical assessment.
Infection After Total Knee Replacement
While it is true that an infection may also cause pain after a total knee replacement, an infection may also be present without pain. Some classic warning signs to watch for infection include:
- Excessive and worsening redness
- Seepage, drainage, or oozing
- Redness that progressively extends away from the knee
- Increased warmth at the knee
- Increased body temperature
If you or your therapist have reasons to suspect a possible infection, it is important that you contact your surgical team or go to your local emergency room for further medical assessment.
Mechanical Instability
There have been reported cases in which the prosthesis implanted during a total knee replacement surgery becomes unstable or the ligaments surrounding the knee become ruptured.
Mechanically instability is often associated with an unsafe feeling while walking to stepping on the surgical leg, but it isn’t often associated with pain in the knee joint.
A knee that has become mechanically unstable is loose and therefore patients do not feel the pain associated with knee stiffness.
Citations and Reference:
More Blog Posts …
Best Knee Massager for Arthritis in 2022
Choosing the Best Knee Massager for Arthritis In order for you to choose the best knee massager for arthritis, it is important you understand the different types of knee massagers and the different types of arthritis. Osteoarthritis Osteoarthritis (OA) is one of the...
Buying an Ebike After Total Knee Replacement 2022 [VIDEO]
2022 Ebike After Total Knee Replacement Surgery Buying an ebike after total knee replacement surgery can be an amazing way for anyone who loves cycling to resume riding a bike outdoors sooner than expected.Can you ride an ebike after total knee replacement? Yes,...
Best Handmade Crutch Bags on Etsy
Best Handmade Crutch Bags on Etsy These are the coolest handmade crutch bags on Etsy because they are handmade and more importantly made by a patient of mine. * Disclosure: I am not paid to promote this product. I just think it is super cool when someone creates...
Why do people hate physical therapy so much?
Do people REALLY hate physical therapy? A recent Quora post I saw asked the question "Why do people hate physical therapy so much?" I think it boils down to a loss of control and the following three aspects: not knowing what to expect, not knowing how much it will...
What is a Heel Prop for Knee Extension [Video]
Heel Prop for Knee Extension Heel prop for knee extension is a great exercise to perform following a total knee replacement and ACL reconstruction surgery. The exercise may be performed while in a sitting or supine position.https://youtu.be/_Ql-TrBFRQE1. Passive Heel...
What Do I Need at Home After Total Knee Replacement: Day 1 to Week 12
What do I need at home after total knee replacement surgery? (Day of Surgery) Your surgical team should have provided you with a comprehensive checklist of required items you will need for home after your total knee replacement surgery. They will also provide you with...
Total Knee Replacement Exercises Week 1 – Ask Doctor Jo [VIDEO]
https://youtu.be/yL5maSn3M-gOriginal Reference: YouTube Channel Ask Dr. Jo Publish Date: Apr 11, 2016No Pain No Gain Unlike most of the other advice you will find on this website, Dr. Jo says a total knee replacement exercise is a time for punching into the pain. The...
Stool Scoots Exercise aka Chair Scoot Exercise | AMAZING Knee ROM 2022
What is the Chair Scoot Exercise? The chair scoot exercise is a great exercise for anyone who has had arthroscopic knee surgery or a total knee replacement. It is a great option for people who have had a partial knee replacement as well. It is a simple exercise to...
3 BEST Ways to get up from a Fall After Knee Replacement Surgery
How Common Do People Fall After Knee Replacement Surgery? A fall after knee replacement surgery is fairly common. One study found that "the number of falls reported following TKA ranges between 14.1 and 38.3%." Link What can cause a Fall After Knee Replacement Early...
Who Orders the Antibiotics After Knee Replacement Before Dental Work
Are Antibiotics Required Before Dental Work After Total Knee Replacement The topic of prophylactically using antibiotics after knee replacement before dental work remains controversial. Link This 2016 publication in Arthroplasty Today, suggests "Current international...