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 …
Do Toe Spacers Help Bunions
Yes, toe spacers help bunions by mechanically realigning the great toe with the natural structure of the medial foot and arch. Toe spacers should initially be used for short periods of time, up to 20-minutes a day during the first week before increasing to several...
Heel Slides After Knee Surgery
"I would like to know when we can officially give up the darn heel slides and other stretch exercises, or do we need to continue forever?" Heel slides after knee surgery are just one of many exercises available to increase range of motion, reduce swelling, and regain...
Does RockTape Kinesiology Tape Help Recovery After Total Knee Replacement
Yes, kinesiology tape has been studied and may be effective for patients following total knee replacement surgery. Here is a quote from a recent study concluding: "KT technique appeared to be beneficial for reducing postoperative pain, edema, improving knee extension...
5 Best Wedge Pillows for Total Knee Replacement
What is a wedge pillow? A wedge pillow is literally what it sounds like, a pillow shaped like a wedge. Wedge pillows are commonly used for people who have sleep apnea or breathing issues at night. They are also used for any condition in which a person needs to keep...
Best walking shoes after knee replacement surgery in 2022
Best Shoes After Knee Replacement: What should I wear immediately after knee replacement surgery? What are the best shoes to wear at home? At Physical Therapy?
Scheduling A Massage After Knee Replacement Surgery
Massage therapy is an effective treatment in post-surgical care to reduce pain, improve swelling, and help return patients to daily activities. Several studies have investigated the benefits of massage therapy as soon as 2 days after total knee replacement surgery....
When Can I Drive After Total Knee Replacement Surgery?
You may typically resume driving 6 weeks after total knee replacement surgery. In the US, some surgeons will allow people who had their left knee replacement resume driving sooner. The most important factor to getting clearance to drive is your ability to walk...
Shin Pain After Knee Replacement
Shin pain after a knee replacement is often due to bone strain. The knee is experiencing new loading patterns and will take up to 12-months to remodel.
What causes sciatica after knee replacement?
Occasionally after a total knee replacement, my patients reports signs and symptoms consistent with sciatica. My patients describe a sharp, burning hot poker stabbing them in the buttock with searing pain that runs down the lateral back of the leg to the knee and...
Top 3 Devices To Help Get An Elderly Person Up From The Floor
3 Best Devices in 2021 To Help An Elderly Person UP from the Floor After a Fall. Under $100, Under $1,000, and Over $2,000