Revisiting Knee Replacement: Addressing Pain from Short Pins After Surgery - Orthopedics

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One year after total knee arthroplasty, the screws are too short and require another surgery?


Hello, doctor.
I underwent knee arthroplasty in May 2020, and I have been experiencing pain for about a year post-surgery, which has recently worsened.
I consulted the original surgeon, who mentioned that the steel rod placed during the last surgery was too short and could not support my leg properly, resulting in misalignment.
He suggested that I need a revision surgery to replace it with a longer rod.
I have a couple of questions:
1.
Will replacing the rod to adjust its length guarantee an improvement in my pain, or are there other methods to address this issue without undergoing another surgery?
2.
Was the inaccuracy in measuring the rod length prior to the first surgery the reason for this issue? If I undergo a second surgery, is there a risk of encountering the same problem again?
Thank you very much for your answers.

ina, 40~49 year old female. Ask Date: 2021/04/16

Dr. Shi Guozheng reply Orthopedics


What you are describing as misalignment may be due to the tilting of the tibial stem, which is referred to as prosthetic loosening.
The term "replacing the steel pin to adjust the length" pertains to surgery and is not related to length but rather to the fixation of the bone cement used during the procedure.
After the second surgery, it does not necessarily mean that the same issue will occur again.

Reply Date: 2021/04/16

More Info


Knee replacement surgery, also known as total knee arthroplasty, is a common procedure aimed at relieving pain and restoring function in patients with severe knee arthritis or injury. However, persistent pain after surgery can be a significant concern for many patients, as you've described in your situation.
1. Will replacing the pins guarantee pain relief?
In the medical field, it is important to understand that no surgical procedure can guarantee complete relief from pain. While replacing the pins with longer ones may address the structural issues that are contributing to your pain, there are no absolute assurances that this will resolve all discomfort. Pain after knee replacement can arise from various factors, including but not limited to improper alignment of the components, soft tissue irritation, or even psychological factors such as anxiety about the surgery or recovery process.
Before proceeding with another surgery, it may be beneficial to explore non-surgical options. Physical therapy can often help strengthen the muscles around the knee, improve range of motion, and alleviate pain. Additionally, pain management strategies such as medications (NSAIDs, acetaminophen), corticosteroid injections, or even alternative therapies like acupuncture may provide relief. Consulting with a pain management specialist could also be a valuable step.

2. Was the initial measurement of the pins inaccurate?
The issue of pin length and placement is critical in knee replacement surgery. If the pins were indeed too short, it could lead to instability and misalignment, which may explain the pain you are experiencing. However, it is also possible that other factors contributed to the current situation, such as changes in bone structure or soft tissue healing post-surgery.
When considering a second surgery, it is essential to ensure that the surgical team is thorough in their pre-operative assessments. Advanced imaging techniques, such as MRI or CT scans, can provide better insights into the current state of your knee and help in planning the surgery more accurately. The surgical team should also review the previous surgery's details to identify any potential pitfalls that could be avoided in the second procedure.

In summary, while replacing the pins may help address the pain, it is crucial to have a comprehensive evaluation of all contributing factors. Engaging in a multidisciplinary approach that includes orthopedic surgeons, physical therapists, and pain management specialists can provide a more holistic treatment plan. Always remember that open communication with your healthcare providers is key to navigating your recovery effectively.

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