Pain After a Hip or Knee Replacement: When Recovery Stalls
Most people do well after a hip or knee replacement, but a real share still have pain months later. When recovery stalls, your surgeon checks the new joint first. If the implant and healing look right, guarded muscles, a tight scar and irritated small nerves are often part of what is left, and they can be treated alongside your physical therapy.
Learn moreHow Dr. Gordon helps recovery after surgerySome pain is expected, for a while
Recovery takes time. The American Academy of Orthopaedic Surgeons notes that some pain with activity and at night is common for several weeks after a knee replacement, and that most people feel some numbness in the skin around the incision.
What counts as "stalled" differs from person to person and from one surgery to the next. Your surgeon is the right person to judge your timeline.
How often pain lingers
A 2012 review of studies that followed patients over time found that 7 to 23 percent of people had an unfavorable long-term pain outcome after hip replacement, and 10 to 34 percent after knee replacement. In the best quality studies, the figures were 9 percent or more after hip replacement and about 20 percent after knee replacement.
The authors called for better awareness that this can happen. If you are in that group, it does not mean you did your rehab wrong.
Your surgeon looks first
Follow-up after a joint replacement rightly checks the repair itself: how it is healing, infection or wound problems, the position of the implant, and blood clots. Those questions come first, and your surgeon answers them.
What can keep pain going when the joint looks fine
When those checks are clear, the cause often lies in the tissue around the joint.
- Guarded muscles. Muscles protect the surgical area and can stay tight long after healing.
- Overworked neighbors. Nearby muscles take on extra work and develop trigger points.
- Scar tissue. A scar can limit movement and tether the tissue around it.
- Small nerves. Nerves near the incision can be stretched or irritated during surgery.
- Compensation. Favoring one leg can make other areas hurt.
The nervous system plays a part too. In one study of people after knee replacement, quadriceps strength dropped by 62 percent at one month. The nervous system not fully switching the muscle on contributed nearly twice as much to that loss as the muscle shrinking did. That is one reason steady strengthening with your physical therapist matters so much.
Working alongside your surgeon and physical therapist
I start once your surgeon clears you, usually six weeks or more after surgery, depending on the procedure. The first visit runs 60 to 75 minutes. I review your operative report, your surgeon's restrictions and your physical therapy progress, gently assess the scar and surrounding tissue, and check range of motion and compensation within your restrictions.
Dry needling releases guarded and overworked muscles around the surgical area, and I avoid the implant area. Alongside dry needling, I use neuro-functional acupuncture, built on neuroscience and evidence-based practice. Unlike regular electroacupuncture, the needles and gentle electrical stimulation are mapped to the specific nerves involved, such as the nerves around the new joint. It works in three ways. It neurorehabilitates, helping irritated tissues and nerve receptors recover. It neuromodulates, shifting the body's own pain-relieving chemistry. It neuroregulates, calming the nerve signals and circuits that keep post-surgical pain going. The plan follows your surgeon's restrictions and works alongside your physical therapy. If arthritis in your other hip or knee is also part of the picture, the knee and hip osteoarthritis page explains how I approach it.
Most patients are seen weekly or every other week during active care. Results vary from person to person.
See a doctor first if you have fever, chills, or redness, warmth or drainage at the incision; calf pain and swelling, chest pain or shortness of breath; a sudden increase in pain or swelling; new numbness or weakness; or inability to bear weight or use the limb as your surgeon expected. If you have any of these, contact your doctor or go to the nearest emergency department.
If you are not sure what is causing your pain, try the My Symptoms tool.
Questions people ask
Is the numb patch near my knee scar normal?
Most people feel some numbness in the skin around the incision after a knee replacement. Tell your surgeon if numbness is new, spreading or comes with weakness.
Could my pain be coming from somewhere other than the new joint?
Yes. Hip arthritis can send pain to the knee, and back problems can send pain into the buttock and hip. Muscles that worked overtime while you favored the leg can hurt too. The exam looks beyond the joint itself.
Is pain at night normal after a knee replacement?
For the first several weeks, some pain at night is common. If night pain is still strong months later, or comes with fever, redness or swelling, let your surgeon know.
References
- Beswick AD, et al. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012;2:e000435.
- Mizner RL, et al. Early quadriceps strength loss after total knee arthroplasty: the contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am. 2005;87(5):1047-1053.
- American Academy of Orthopaedic Surgeons. Total knee replacement. OrthoInfo. https://www.orthoinfo.org/treatment/total-knee-replacement
- American Academy of Orthopaedic Surgeons. Osteoarthritis of the hip. OrthoInfo. https://www.orthoinfo.org/diseases--conditions/osteoarthritis-of-the-hip
