How Long Does Knee Pain Last After Knee Replacement Surgery?

One of the most common questions we hear is, “How long does pain last after knee replacement?”

Traditional total knee replacement will typically require one to three months of recovery with the use of a walker or a cane; while partial knee replacement surgery requires significantly less time. But there is more to consider when trying to figure out how long pain will last after surgery.

How long the pain lasts after knee replacement surgery depends on a wide range of factors, before and after the surgery.

What Happens During Surgery?

Prior to surgery, your physician and surgeon will consider things like weight, the condition of existing bone and cartilage, and other medical factors, and will have a plan in place post-surgery for optimal healing.

During knee replacement surgery, your doctor will make an incision, moving your knee cap, and cutting away any damaged bone, cartilage, and joint surfaces. This is then followed by the attachment of artificial joints, which are tested by rotating and bending the new knee replacement, before the incision is closed up with stitches and/or surgical staples.

Factors during the surgery, including blood loss, and unforeseen medical issues involving the condition of the bone, cartilage and underlying muscle can have an impact on recovery time and post-op pain following a knee replacement surgery.

Pain after knee replacement surgery is sometimes caused by biological factors present before the surgery, while others may be caused by complications and conditions during the surgery itself.

Arthritis is an example of a biological factor that may be present before the surgery, which can flare up after knee replacement surgery. Similarly, patients with pre-existing concerns about fibromyalgia may find their pain response heightened after knee replacement surgery for as much as six months.

The body’s inflammatory response post-op is another biological factor, which could contribute to an increased pain level after knee replacement surgery. Inflammation could also lead to secondary imbalances, from the body trying to compensate for knee pain, and redistribute weight load, etc.

Even under the best of conditions, your surgeon will be on-guard for a number of rare, but reasonable concerns that could impact recovery time and pain after knee replacement surgery. While your doctor will take steps to prevent problems, it’s still possible for these to rare issues to occur:

• Infection
• Nerve injury
• Prosthetic loosening
• Poor alignment or rotation
• Incorrect sizing
• Instability
• Stiffness

Addressing inflammation in the body. You can help.

Inflammation is a natural response within the body, and lets us know when things are out of balance. It’s a natural part of the healing process, following knee replacement surgery, for the area around the replacement to be inflammed.

There are steps that can be taken to ensure the body’s inflammation response is healthy and normal, and these include eating a diet lower in inflammation-causing foods, and allowing a specialist in the field of using movement and tension release exercises to reduce secondary inflammation that might come from compensatory body mechanics.

Set Realistic Expectations

Despite a good outcome for many patients, approximately 20% of patients experience chronic pain after total knee replacement, according to a study published in a journal of the National Institute for Health Research (NIHR). Pain and stiffness are frequently cited as the reason for a less than optimal result after knee replacement surgery.

Unfortunately, some of these patients will not find a reason for the source of their ongoing symptoms. However, if a patient has these problems then it is important for the surgeon to evaluate for both direct and indirect causes of the pain.

Sometimes, indirect causes of knee pain following knee replacement may be confused as being related to the knee replacement surgery. These include hip arthritis, sciatica, knee bursitis or systemic diseases such as fibromyalgia. Pain from arthritis in the hip usually occurs in the groin, but can also manifest in the thigh or the inside of the knee.

If a patient’s knee pain primarily occurs when the hip is rotating, it is important to have an x-ray of the hip to rule out arthritis as the cause of the knee pain.

Sciatica commonly presents as pain traveling from the buttock down to the knee, the shin, and possibly the foot. Radiating pain through the knee can be caused by a herniated disc in the lower back.

If there continues to be significant pain six months to one year after surgery then the patient needs to be further evaluated by an orthopaedic surgeon.

The initial work-up for pain will likely include lab studies and x-rays. The labs will focus on evaluating for subtle signs of infection by looking at the white blood cell count and looking at markers for inflammation. X-rays will be used to ensure proper alignment of the knee replacement prosthesis, and to confirm that there are no indications of loosening or change of position compared to previous x-rays. A bone scan can be helpful to look for signs of loosening as well.

What You Can Do?

Rest

Knee replacement surgery takes a toll on the body. So it’s probably a good idea to ensure that your realistic expectations include an expectation for allowing time for rest and healing to occur.

Pain, swelling, and over-activity are all related. The antidote to all three is rest. Being on your feet causes both pain and swelling. The knee is the biggest, most complex, nerve-rich joint in the body. When overused, the knee will react sharply, causing discomfort and pain.

After the first week of your recovery, rest for longer periods of time, concentrating your movement to short spurts of activity, increasing gradually over time. Don’t expect to be able to do housework or other daily activities for at least 2-4 weeks depending how quickly you recover.

Ice

 Ice can reduce pain in combination with medication, and with less severe pain, it can be used on its own. For knee replacement patients, we recommend an ice machine with special wrap-around compression bags. You fill these bags with iced water and gently wrap them around your knee. Consult your surgeon to discuss if this makes sense for you.

Medicate

It’s critical to pay careful attention to the pain medication and anti-inflammatory medications your surgeon prescribes for you after surgery.

Elevate

Elevating the knee according to your surgeon’s recommendations can also help with reducing excess fluid build-up and inflammation. Be sure to follow your doctor’s recommendations in this regard.

Reach Out for Help

As your knee replacement heals and you begin to increase activity, it’s often a good idea to talk to knee pain recovery specialists, who can help you find the right exercises and support to ensure a pain-free experience going forward.