Signs and Symptoms
It is common to have swelling, warmth and aching for several months after a knee replacement. Pain is worth a closer look when:
- Pain has not steadily improved by about 3 to 6 months after surgery, or it comes back after a period of feeling good
- The knee is stiff and will not bend or straighten as far as it should
- The knee feels wobbly, gives way or is hard to trust on stairs
- You have pain around the kneecap, clicking or catching
- You have burning, tingling or very sensitive skin around the incision
- Swelling, warmth or redness keeps coming back, with or without fever
What Causes It?
There are many possible reasons a knee replacement stays painful, and more than one can be present:
- Loosening, where the bond between the implant and the bone breaks down over time
- Infection around the implant, which can appear soon after surgery or years later
- Instability, when the ligaments and implant balance do not hold the knee steady
- Stiffness from excess scar tissue inside the joint (called arthrofibrosis)
- Kneecap problems, such as poor tracking or irritation of the tissues around it
- Nerve pain from small skin nerves near the incision
- Pain referred from somewhere else, most often an arthritic hip or a pinched nerve in the lower back
How We Diagnose It at POPB
Finding the cause is the most important step. Your evaluation includes a detailed history of your surgery and recovery, an exam of motion, stability and the kneecap, and a check of your hip and spine. X-rays are taken on site and compared with earlier films when available.
Depending on what the exam shows, next steps may include blood tests for infection, drawing fluid from the knee (aspiration) to test it, or further imaging. Painful knee replacements are evaluated by Dr. Martin, who has special expertise in complex revision hip and knee replacement, and Dr. Kerr, an adult reconstruction surgeon. Dr. Baskin, a physiatrist, treats pain after total knee replacement without surgery.
Non-Surgical Treatment Options
When there is no loose implant or infection, many causes of ongoing pain can be treated without another operation:
- Targeted physical therapy in our office for stiffness, strength or kneecap mechanics, with your therapist and physician sharing the same chart
- Non-surgical pain treatment with Dr. Baskin, including evaluation of nerve-related pain and procedures performed in our in-office procedure room when appropriate
- Treatment of the true source when pain is coming from the hip or lower back
- Medication adjustments, activity changes or bracing
Surgical Options
Revision knee replacement means replacing some or all of the original implant parts. It may be recommended for loosening, infection, instability, implant wear or some cases of severe stiffness. Revision is more complex than a first knee replacement and often requires special implants and planning.
Dr. Martin has special expertise in complex revision knee replacement, and Dr. Kerr also performs revision surgery. Infections sometimes require more than one operation. For severe stiffness, a manipulation under anesthesia or a procedure to release scar tissue may be considered first, depending on timing.
Recovery
Recovery depends on the cause and the treatment. Physical therapy for stiffness or weakness usually takes several weeks to a few months. Recovery after revision surgery is often longer than after the first replacement, and full improvement can take up to a year or more. Timelines vary.
Therapy after revision is usually done in our office, so your therapist and surgeon can adjust your plan together.
Insurance and Cost
Medicare and most commercial PPO plans generally cover the evaluation, X-rays, lab tests, physical therapy, pain management procedures and medically necessary revision surgery, subject to your co-pay, co-insurance and deductible. Some procedures require prior authorization.
HMO and managed-care plans require a referral from your primary care physician before your visit. Our staff verify your benefits when you call. You do not need to have had your first surgery at POPB to be evaluated.
When to Be Seen
Call our office if your knee replacement is still painful, stiff or unstable several months after surgery, or if pain returns after the knee had been doing well. If you have fever, spreading redness or drainage from the incision, go to the emergency room or call 911, because these can be signs of infection.
