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Limitations of Knee Replacement Surgery

Knowing what to expect after surgery can help reduce the risk of dissatisfaction with the procedure. In this article, Dr. Lawrie discusses common causes of dissatisfaction after knee replacement.

Total knee replacement is a successful treatment for end-stage degenerative disease of the knee. While most patients experience significant improvement in their pain and function after the procedure, some can remain dissatisfied for a variety of reasons. Knowing what to expect after surgery can help reduce the risk of dissatisfaction with the procedure. In this article, we will discuss common causes of dissatisfaction after knee replacement.

“My knee feels numb”

Some patients will have a numb patch of skin on the outside of the knee after surgery. This is due to a skin nerve, called the infrapatellar branch of the saphenous nerve, that starts on the inside of the knee and crosses the front of the knee to the outside of the knee. During surgery, small branches of this nerve are cut to get to the joint to perform the procedure. The nerves do slowly regenerate over time, however, they may never fully recover to their preoperative status.1 This is normal and, in most patients, does not cause any long-term discomfort.

“My knee feels hot, swollen and tight”

Most patients expect the knee to be swollen and warm immediately after the knee replacement procedure. However, it is common that patients experience intermittent warmth and swelling in the knee throughout the first year after surgery.2 The swelling in the joint can cause the knee to feel “tight.” Usually, these symptoms are activity related and get better with rest, ice and elevation. Swelling that is persistent or associated with pain should be brought to your surgeon’s attention for evaluation as it may be a sign of a more serious problem with the joint replacement.

“My replaced knee looks different than my other knee”

Early on after surgery, swelling can cause the knee to appear larger than normal. As the swelling subsides, most patients expect the knee to return to normal appearance. However, due to the surgical dissection and formation of scar tissue after surgery, the knee may never appear the same as the other non-operated knee. It is very uncommon for the implant to be seen or felt through the skin. The appearance of the knee is not due to inappropriate implant size.

“My knee clicks and clunks”

All knees have some “wobble” due to the stretchy nature of ligaments, which are like rubber bands that help keep the knee from moving too far in either direction. When the knee wobbles, one side of the joint can lift off the other then the ligaments snap them back together. We do not feel this wobble in our natural knees because the surfaces of the knee are coated with soft cartilage and provides some give and shock absorption properties. Knee replacements, however, are metal on one side and polyethylene on the other. Therefore, when the knee wobbles from side to side, and the ligaments snap the knee back into position, the metal on polyethylene hitting is sometimes felt as a clunk or click. These noises are common. Over the first year, these sensations decrease, but may remain present in patients with certain movements.3

“I can’t kneel”

Most patients can’t kneel comfortably after knee replacement. While the true cause of this discomfort is unknown, it is likely a combination of the location of the incision and surgical dissection that occurs during the surgery. For patients that kneel for their work or leisure activities, kneeling programs are available through physical therapists that can help desensitize the knee. Heavy knee pads or soft pads can also help reduce the discomfort.

Patients who understand the reality that knee replacements will make them better, but not perfect, will overall be more satisfied after surgery. It is important for patients to talk to their surgeons about what to expect throughout their postoperative recovery and for their long-term outcome.

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  1. Xiang, Y. et al. Neuroma of the Infrapatellar branch of the saphenous nerve following Total knee Arthroplasty: a case report. BMC Musculoskelet Disord 20, 536 (2019).
  2. Greengard, S. (2021, January 5). How to Manage Pain, Swelling, and Bruising After a Total Knee Replacement. Healthline. Retrieved August 1, 2022, from https://www.healthline.com/health/total-knee-replacement-surgery/managing-postoperative-pain
  3. Turner, T. (2022, May 16). Knee replacement complications: Problems after knee surgery. Drugwatch.com. Retrieved August 1, 2022, from https://www.drugwatch.com/knee-replacement/complications/

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