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.