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When Your Knee Is Still Hurting, Months After Total Knee Replacement

A Small Percentage of Patients Continue to Have Chronic Knee Pain After Knee Replacement Surgery - Options to Consider

August 2021

If you suffer from knee pain, you know firsthand how it can impact the quality of your life. That dull, achy, throbbing, and deep pain that you feel when walking. Or the pain at night when you try to sleep. It can make everyday life miserable.

Although these problems are more common as we get older, they can also be an issue for younger adults.

Knee joint problems along with accompanying pain may be the results of a sports injury or accident. Or it can be attributed to osteoarthritis, also known as “wear and tear” arthritis. Rheumatoid arthritis can also affect the knees by causing the joint to become inflamed and by destroying knee cartilage.

Three comparative knee joint illustrations: normal knee – with inflammation – with degeneration
Three comparative knee joint illustrations: normal knee – with inflammation – with degeneration

Non-Surgical Treatments – and When to Consider Surgery

There is a broad range of non-surgical treatments that can help provide knee pain relief and maintain your mobility.

From cortisone injections to viscosupplementation, to regenerative biotherapeutics, physical therapy and a variety of other minimally invasive techniques, there are many options available.

For some patients however, non-surgical options just aren’t enough – and an evaluation for total knee replacement might be appropriate. This procedure is more formally known as a total knee arthroplasty. During a total knee arthroplasty, your surgeon replaces your knee joint with an artificial one.

Post-Knee Replacement Nerve Pain

Which brings us to the situation where you may have had a total knee replacement, and continue to suffer with pain long after the procedure.

Large nerves and nerve branches that serve the ankle, foot, toes, and other parts of the lower leg pass through the knee. Some of these nerves and branches are in the back of the knee, and others are in the front and side. The skin and tissue around the knee is also dense with nerve endings.

Knee replacement surgical technique has evolved considerably over the years. However, when surgical incisions are made, some of the nerves, skin, and tissue around the knee are cut. Although surgeons take care not to inadvertently damage large nerves when possible, studies have shown that this can occassionally occur.

Nerve recovery after knee replacement surgery is a slow process. This may involve feelings of tingling, burning, pins and needles, and other pain symptoms around the knee and in the leg. This is usually a sign that nerves are awakening and healing. However, some patients continue to have chronic, lasting pain months after an extended post-surgery period.

Treatment Options for Chronic Post-Knee Replacement Nerve Pain

Your first step at that point is to make an appointment to see the surgeon who performed your knee replacement. He or she can evaluate your knee and check for possible complications from the surgery, such as an infection or a problem with the artificial joint.

However, there are occasions when surgeons are unable to uncover the cause of ongoing pain after knee replacement surgery. Many clinical studies attribute this chronic pain to swelling (inflammation), damage to one or more peripheral nerves around the knee, or other non-specific issues.

In the past, when this chronic pain occurred, patients were left with few treatment options other than taking pain medication. Over recent years, however, a variety of new options have been developed to treat chronic pain after knee replacement surgery. One of the more promising approaches to alleviate this pain is the utilization of Peripheral Nerve Stimulation.

Peripheral Nerve Stimulation (PNS)

Peripheral nerve stimulation is an FDA-cleared non-opioid pain management system used to treat chronic and acute pain. This approach involves placing an extremely small lead wire near the peripheral nerve that is causing you pain in your knee. Ultrasound imaging is used to guide placement of the lead during an outpatient procedure.

The lead is connected to a very small stimulator. Patients can adjust stimulation and customize its output using a small remote controller. When the stimulator is turned on, patients generally feel a comfortable tingling sensation over the targeted nerve. That stimulation masks or prevents pain signals from reaching your brain.

Peripheral nerve stimulation technology has been advancing at a rapid pace in recent years. Configurations of different systems vary widely. Some are intended for long term use, and others are designed to be used for short periods before removal. In fact, there are some systems that are used for only up to 60 days, and after removal of the device, significant and sustained relief continues.

If you have continuing pain after a knee replacement, you should discuss with your medical provider if peripheral nerve stimulation might be an appropriate therapy for you.

Related Article: Relieving Chronic Knee Pain After Knee Replacement or ACL Surgery

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