Approximately 90% of people who undergo a total hip or knee replacement have a satisfactory outcome. Approximately 10% of patients will not be satisfied with their outcome. This 10% is composed of patients who have had a postoperative complication and require further treatment and/or surgery, patients with pain that was not alleviated by the procedure, and a percentage of patients who, due to psychosocial issues, are persistently unhappy after surgery.
When patients present with a painful total joint, it is important for the orthopedic surgeon to evaluate and diagnose the cause of that pain. Pain that begins after a period of pain-free function can point to loosening of the implant, mechanical problems, or instability of the joint. Pain that is persistent after surgery can be an indication of infection and/or an alternate source of pain such as the spine or peripheral vascular disease. It is important to share the chronology of your symptoms to make use of certain diagnostic tools to make the proper diagnosis. Often, the patient’s history and physical examination will lead to a diagnosis. The use of x-rays and laboratory tests can also be extremely helpful. Occasionally, special tests such as a bone scan or other type of imaging modalities will be utilized to help assist in the diagnosis. If the cause of pain cannot be determined, more surgery is rarely, if ever, indicated.
Fortunately, the overwhelming majority of people do quite well after joint replacement surgery but if significant pain persists, follow-up evaluation by an orthopedic surgeon is important.
William P. Barrett, M.D.
WPB/mf
My husband had total knee replacement (both knees) this past August. At almost 5 months post-op he continues to have pain from the lower part of his knee down both legs. At the time of the surgery, the surgeon chose to “let the bone grow into the plate” rather than cement it. Also, with a second opinion, we were told that if the bone has not grown in by now, it never will. We have also been told that the knock kneed positioning is 3-5 degrees off causing difficulty for my husband to walk. We were also told that the plate could be just a bit too large for his knee and that could also be a problem. Do you have any comments of suggestions for him? He continues to take strong pain medication on a regular basis and has been told to wait a few more months to no need to wait, just have the surgery and get it over with. I thank you in advance for your thoughts.
Dear Sharon,
Press fit fixation is less reliable than cemented fixation, If problems are present now they probably need to be addressed.
Regards,
Bill Barrett
I had a total knee replacement almost 12 weeks ago to alleviate problems brought on by bone on bone & resulting spurs. As a comparatively young replacement patient (52) I expected pain, but a fairly smooth recovery compared with older patients. The first 2 weeks were relatively smooth, other than the fact that I woke up unable to use my foot properly due to quadrants of extreme pain and others that were completely numb (my surgeon casually suggested that upon leaving his office I google RSD , which I did, to my shock). During the 3rd week I suddenly ‘crashed’ with extreme nausea, unable to eat anything or tolerate any noise, light, or movement. I could not do my exercises, but I did stay on the CMR (?) machine as much as possible. The nausea and diarrhea persisted for almost 2 1/2 weeks, during which time I lost 10 lbs. My ‘regular’ physician, whom I saw on recommendation of my surgeon, put me on a bland diet with gatorade, as well as doing blood tests and stool samples. She eventually decided that it was probably the reaction of my body to the pain meds (I don’t tolerate them well at all) and the scope patch I had worn for the past couple of weeks to enable me to take them. My stomach was possibly also irritated by the extra antibiotics (I had broken blisters that formed under the steri strips so went on an antibiotic 4x/day) and subsequent oral nystatin when I developed yeast/thrush. I’ll back up in saying that as soon as the nausea hit (which came on very suddenly while a visiting nurse was here) I went off all meds but the warfarin and took the scope patch off a day later. I could not take ibuprofen, as I was still on warfarin…thus the pain greatly limited progress.
To make a long story shorter. Once I got past the stomach issues, I started my PT. Not surprisingly, I was far behind where I should have been, especially in getting my quads to fire and knee to bend. I am still only BARELY at 100 with GREAT pain. I have a lot of swelling, whcih the PT said is not so unusual for some, and I treat it with ice and elevation at intervals. Also started taking ibuprofen…3 at a time, usually 3X a day. My foot is improving, for which I am very grateful, though there are still both some numb and some painful areas. I’m hopeful towards a full recovery of these nerves.
The surgeon who performed my replacement uses only 1 post-op visit, total. This seemed a bit unusual to me, after such a major surgery (I’ve had cartilage surgeries on this same knee with a couple of post-op visits…different surgeons in different areas), especially when I had experienced a rather difficult recovery thus far. My PT asked when I would have my next post-op visit and was also surprised that, after my initial 5-week visit, I was told that I was “done”. In fact, I was told that if I had any problems I could call and they would eventually get back to me, thought it might not be right away.
I’m now thinking that I would like to get another surgeon’s opinion on my knee and what I should be doing, which my PT has also encouraged me to do. She is wondering if I might need to have it manipulated under anesthesia at this point to be able to get past this low range of motion. I’m not sure of what to call this (a re-check by a different surgeon??) for insurance purposes, but I am quite sure that I do not want to return to the original surgeon. Any suggestions?
Thanks for reading to the end of this!