From the Guidelines
Pain in a replaced knee joint after 10 years is not normal and should be evaluated by a healthcare provider. While occasional mild discomfort might occur with weather changes or increased activity, persistent or new pain could indicate complications such as implant loosening, wear, infection, or instability 1. If you're experiencing pain in your knee replacement, schedule an appointment with your orthopedic surgeon for evaluation. They may order X-rays or other imaging to assess the implant position and integrity. Blood tests might be needed to rule out infection, with tests such as C-reactive protein (CRP) and erythrocyte sedimentation rates (ESRs) being useful in diagnosing infection 1.
Some key points to consider in the evaluation of pain in a replaced knee joint include:
- Infection is a serious complication of joint arthroplasty and should be excluded, with a reported frequency of 0.8% to 1.9% of TKAs 1
- Aseptic loosening is a common cause of TKA failure, particularly in late-stage revisions 1
- Osteolysis, or particle disease, can occur due to macrophage phagocytosis of particle debris and is a leading cause of late TKA revision 1
- Instability refers to abnormal and excessive displacement of the articular surfaces of the prosthesis and can result in revision surgery 1
Treatment depends on the cause and could range from conservative measures like physical therapy and anti-inflammatory medications (such as naproxen 500mg twice daily or ibuprofen 600mg three times daily with food) to revision surgery in severe cases 1. Most knee replacements last 15-20 years, but wear and tear can occur over time as the plastic components degrade or the implant loosens from the bone. Regular follow-up appointments every few years are recommended even for well-functioning knee replacements to monitor for potential issues before they become symptomatic 1.
From the Research
Knee Pain After Replacement
- Knee pain can be caused by various factors, including osteoarthritis, internal derangement injuries, and other conditions 2, 3.
- After a knee replacement, some patients may still experience pain, which can be due to several reasons such as loosening of the implant, infection, or wear and tear of the artificial joint.
- Studies have shown that osteoarthritis is a common cause of chronic knee pain, and therapeutic options include physical therapy, oral pharmacologic therapy, intra-articular injections, and surgery 3.
- Magnetic resonance imaging (MRI) can be used to evaluate the knee joint and detect any abnormalities that may be causing pain 2, 4.
Management of Knee Pain
- Interventional radiology techniques, such as intra-articular injections and neurotomy, can be used to reduce pain and improve mobility in patients with knee osteoarthritis 3.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to be effective in managing perioperative pain following total joint arthroplasty, with oral selective cyclooxygenase (COX)-2 and non-selective NSAIDs and intravenous ketorolac being safe and effective options 5.
- Patient safety is a major concern, and guidelines have been developed to manage severe treatment complications and burdensome courses, including the prevention of the "second victim" syndrome 6.
Long-Term Outcomes
- The long-term outcomes of knee replacement surgery can vary, and some patients may experience pain or other complications after 10 years or more.
- Regular follow-up appointments with an orthopedic surgeon can help to monitor the condition of the artificial joint and address any issues that may arise.
- Further research is needed to determine the optimal management strategies for patients with knee pain after replacement surgery.