Persistent Knee Pain After Replacement: Causes and Solutions

Q: Persistent Knee Pain After Replacement: Causes and Solutions

Hello： I would like to clarify your question first. <br>Generally, artificial joints do not have specific steel pins; are you sure the doctor mentioned steel pins? Do you have any images for reference? Before I respond, I must fully understand the issue. <br>1： The term "guarante

Knee replacement surgery has been performed, but there is still pain?

Hello Doctor, I am inquiring on behalf of my brother-in-law.
He underwent knee replacement surgery in May 2020, and he has been experiencing pain for the past year, which has recently worsened significantly.
He consulted the original surgeon, who mentioned that the steel rod placed during the last surgery was too short to support his leg, causing it to become misaligned.
He needs to undergo another surgery to replace it with a longer rod.

1.
Will replacing the steel rod and adjusting its length guarantee an improvement in his pain?
2.
Is the cause of the pain due to insufficient precision in measuring the rod length during last year's surgery, or can the rod shift position post-operatively?
Thank you very much for your assistance, Doctor.

Ina, 40~49 year old female. Ask Date: 2021/04/10

Dr. You Dianqi reply Orthopedics

Hello: I would like to clarify your question first.
Generally, artificial joints do not have specific steel pins; are you sure the doctor mentioned steel pins? Do you have any images for reference? Before I respond, I must fully understand the issue.
1: The term "guarantee" does not exist in the medical or surgical field.
2: I only have text and cannot determine what you are asking about; I hope you understand.
I look forward to further information so I can provide you with a thoughtful response and advice.
Thank you.

Reply Date: 2021/04/10

More Info

Persistent knee pain after a total knee replacement can be a significant concern for many patients. In your sister-in-law's case, the pain persisting for over a year after surgery, coupled with the recent diagnosis of inadequate support from the previously implanted hardware, raises several important considerations.

1. Causes of Persistent Pain: There are multiple potential causes for ongoing knee pain after a knee replacement. These can include:
- Infection: One of the most serious complications post-surgery, even if it occurs months later.

- Implant Loosening: This can happen if the bone does not integrate well with the implant, leading to instability and pain.

- Malalignment: If the components of the knee are not properly aligned during surgery, it can lead to uneven wear and pain.

- Soft Tissue Issues: Scar tissue formation or issues with ligaments and tendons around the knee can also contribute to pain.

- Neuromas or Nerve Damage: Sometimes, nerves can be affected during surgery, leading to chronic pain.

2. Reoperation and Pain Relief: Regarding the need for reoperation to replace the screws with longer ones, it is essential to understand that while this procedure may address the mechanical issue of support, it does not guarantee pain relief. The success of such a surgery depends on various factors, including:
- The underlying cause of the pain.

- The overall health of the surrounding tissues and bone.

- The patient's rehabilitation process post-surgery.

3. Measurement and Positioning of Hardware: The pain could stem from several factors related to the initial surgery:
- Measurement Accuracy: If the length of the screws was not measured accurately, it could lead to improper support and alignment. However, this is typically a rare occurrence as orthopedic surgeons use specific protocols and imaging to ensure proper sizing.

- Postoperative Movement: It is also possible for hardware to shift slightly after surgery due to factors such as weight-bearing activities, leading to discomfort or pain. This is more common in cases where the bone quality is poor or if the patient has not adhered to postoperative guidelines.

4. Next Steps: It is crucial for your sister-in-law to have a thorough evaluation by her orthopedic surgeon. This may include:
- Imaging studies (like X-rays or MRI) to assess the position of the hardware and the condition of the surrounding bone and soft tissues.

- A discussion about the risks and benefits of reoperation, including the potential for pain relief versus the risks associated with another surgery.

5. Rehabilitation: Regardless of the decision made regarding surgery, a comprehensive rehabilitation program is essential. This may involve physical therapy focused on strengthening the muscles around the knee, improving range of motion, and addressing any gait abnormalities.

In conclusion, while reoperation to adjust the hardware may provide a solution to the mechanical issues, it is not a guaranteed fix for pain. A thorough assessment by a qualified orthopedic surgeon, along with a tailored rehabilitation plan, will be critical in addressing the ongoing pain and improving your sister-in-law's quality of life.

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