Total knee-replacement surgery usually means the end of chronic pain from degenerative changes (osteoarthritis) in the knee. The trauma of major surgery causes pain that is usually managed postsurgically with opiates (pain killers) and analgesics, nonprescription drugs like ibuprofen.
But complications from surgery also can cause severe pain. These include infection, dislocation of the knee joint, and fracture. These situations also can be managed effectively if the patient promptly reports them to the orthopedic surgeon. In some cases, these complications may require a visit to the emergency room.
Surgical Pain
Postsurgical pain is inevitable and natural with a total knee replacement (arthroplasty). In this procedure, the patient exchanges chronic pain in the knee joint for short-term pain following surgery, with the prospect of up to 20 years with a smoothly functioning replacement joint (prosthesis).
During surgery, pain is eliminated by anesthesia. While the patient is usually given a choice of different types of anesthesia, many orthopedic surgeons prefer the spinal block technique. In this procedure, a short-acting anesthetic is injected into the spinal column between vertebrae in the lower spine.
The patient is also given tranquilizing or sedative drugs before and during surgery by an intravenous (IV) drip, and is aware of no pain. With this type of anesthesia, the patient is awake but sleepy and is not aroused or alarmed by sounds of surgery.
Postsurgical Pain
After surgery, patients will take a chemical analgesic until the pain of surgery subsides. These are often opiates such as hydrocodone and oxycodone. These are powerful narcotics that, if taken appropriately, promote faster healing than would take place without them.
Because of the addictive properties of these drugs, it is important to be honest with your doctor about your pain and your history, if any, of drug abuse.
Some of the side effects of these drugs include constipation, nausea and vomiting. Taking over-the-counter analgesics like ibuprofen with the pain killers reduce side effects and allow a more comfortable recovery.
Other Sources of Pain
Besides routine postsurgical pain, there are other types of pain that can occur. These include pain caused by wear and slipping of the new joint. This kind of pain increases gradually until bony surfaces begin to rub together. The pain grows more intense with more movement---and decreases with sitting.
Infection in the knee joint is a medical emergency and causes pain with redness and swelling. Fluid may accumulate in the knee joint that does not go away even when you are immobile.
Dislocation of the knee joint will cause both sharp pain and a deformity of the joint.
Dislocation, Deformity
Deformity of your knee joint can damage blood vessels, muscles and nerves and compromise their functionality. You may lose the entire blood supply to your lower leg, with the result that your lower leg becomes numb, weak, or even paralyzed. In addition, a deformity can partly or completely block arteries in the lower leg, which causes pain, swelling, paleness and cold.
Blood clots are most likely to occur during the postoperative phase when your movement of the joint is temporarily stopped. More pain, swelling or redness in the lower leg accompanies formation of a clot. The greatest danger is that the clot might become dislodged and travel to the lungs, where it can shut down the blood supply (pulmonary embolism).
Get Help
If you should experience incremental pain from what feels like a slipping of the new joint in your knee, call your surgeon. Although this is not a medical emergency, it is an urgent situation that needs an urgent response. If you have increased swelling, warmth or excessive drainage from the surgical site, call your doctor.
You should go directly to the hospital emergency room if you experience new pain while resting, new swelling, have a fracture or dislocation, redness or warmth that may accompany infection, or swelling, redness, and pain below your knee that would be a sign of a blood clot (deep vein thrombosis).
Tags: knee joint, causes pain, your knee, blood supply, call your, chronic pain, emergency room