Pain after Knee and Hip replacement

Knee and hip replacement surgery can provide effective long-term pain relief and improve function at the joint [1]. However, you should expect to experience some pain in the weeks immediately following your surgery. After your surgery, your joint pain will no longer stem from degenerative changes from arthritis, but instead will be the result of acute inflammation and sensitivity around the surgery site [2]. The majority of your surgical pain should resolve within 2 weeks of your procedure. However, you will most likely experience some degree of post-operative pain for up 6 weeks to 3 months after a knee replacement surgery [3]. It is not unusual for some patient to take a rush or Tylenol a day for up to six months especially after knee replacement. In general, knee replacements tend to hurt slightly more than hip replacements.


Physical therapy will help you to restart normal physical activity after your procedure. You will be encouraged to start bearing weight on your leg within a day of your surgery. You should be able to carry out activities such as sitting up from a lying position, standing up from a sitting position, walking short distances (with or without an assistive device), and walking up a short flight of stairs (with or without an assistive device) without severe pain [4]. Activities such as chores or driving can be resumed within 7-10 days or 3-4 weeks, respectively, after your joint replacement.


Your doctor will utilize multimodal pain control to help alleviate your post-operative pain. Multimodal pain control involves the non-pharmacologic and prescription of different types of pain medication to target multiple sources of your pain [5]:

  1. 1- Ice and elevation

  2. 2- Opioids: these medications work to relieve pain within the central nervous system; examples of opioids include morphine, codeine, and oxycodone

  3. 3- Anti-inflammatories: these medications inhibit inflammation in the tissues around your new implant; examples of anti-inflammatories include ibuprofen, aspirin, acetaminophen, and naproxen

  4. 4- Gabapentinoids: these medications work to relieve pain in the nerves; one example is Neurontin

When dealing with pain, first thing to do is to use ice and elevation of your leg. Icing your leg for about 15-30 minutes every hour is extremely helpful non-pharmaceutical way to relieve your pain [2]. You should try combination of Tylenol and anti-inflammatories unless you have any contraindications for anti-inflammatories like mild to moderate kidney failure or history of bleeding from gastric ulcers.


When it comes to narcotic medications like Hydrocodone or Oxycodone, it is best to start with lower dose. You should use at least one medication from each of these three categories. This will give you better pain control with fewer side effects.


You may experience other symptoms including swelling, bruising, numbness, or tingling around the surgery site after your procedure. These symptoms are normal and are expected to improve within a few weeks post-surgery. Bruising like seen in the picture could be normal. They tend to resolve by 3-4 weeks. You should continue to use ice and elevate your leg.



If you experience progressively uncontrolled pain or worsening swelling, bruising and tingling/numbness beyond two weeks after surgery, you should contact your surgeon.

References:

  1. 1. Lespasio, M., Guarino, A., Sodhi, N., Mont, M. Pain Management Associated with Total Joint Arthroplasty: A Primer. Permanente Journal. 2019; 23: 18-169.

  2. 2. Ekman, E., Koman, A. Acute pain following musculoskeletal injuries and orthopaedic surgery: mechanisms and management. Instr Course Lect. 2005; 54: 21-33.

  3. 3. Fitzgerald, J., Orav, E., Lee, T., Marcantonio, E., Poss, R., Goldman, L., Mangione, C. Patient quality of life during the 12 months following joint replacement surgery. Arthritis Care & Research. 2004; 51 (1): 100-109.

  4. 4. Zavadak, K., Gibson, K., Whitley, D., Britz, P., Kwoh C. Variability in the attainment of functional milestones during the acute care admission after total joint replacement. The Journal of Rheumatology. 1995; 22 (3): 482-487.

  5. 5. Elmallah, R., Chughtai, M., Khlopas, A., Newman, J., Stearns, K., Roche, M., Kelly, M., Harwin, S., Mont, M. Pain Control in Total Knee Arthroplasty. Journal of Knee Surgery. 2018; 31 (6): 504-513.

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