Why You’re Having Chronic Pain After Knee Surgery

Eric H. Williams MD
Specializing in reconstructive surgery and pain relief in the Greater Baltimore area.

Knee surgery is frequently a life-changing operation. A knee replacement is among the most successful operations performed, and surgical knee repair is also often successful. The “life-changing” part is usually positive!

Whether we are talking about knee replacement or another form of knee surgery, most patients are able to perform activities in a pain-free manner—something they have not done for many years in some cases—following the procedure. This is regardless of whether they are younger or older.

Unfortunately, “most” and “usually” successful aren’t the same as “always” successful.

Not every patient is satisfied following his or her knee replacement or knee repair surgery. For some patients, knee pain still remains afterward. In certain cases, the pain is different in nature and/or even more intense than it had been in the first place.

We have had patients report their experiences in ways such as:

  • “It’s an electric shocking pain in my knee.”
  • “It feels like someone has plugged my knee into an electric socket.”
  • “Dresses and pant legs hurt.” / “I can’t stand to put pants on.”
  • “I have to wear shorts in the winter!” (Which might not be a big detriment to many of you, but certainly can be in some of our colder climates.)
  •  “My skin feels like it’s burning.” / “It feels like the worst sunburn I have ever had.”
  • “I can’t kneel, and when I try, it feels like a giant sharp nail is being driven through my knee.”
  • “I want to tear the skin off of my knee, it hurts so bad”
  • “It feels like barbed wire is wrapped around my knee.”

All of these symptoms are terribly frustrating, and patients often ask “Why is this happening? I thought I was supposed to get better!”

Sources of Lasting Pain Following Knee Surgery

There are a couple different explanations as to why you might have lasting pain after knee surgery.

The first is simply the fact surgery hurts. It is a traumatic experience for your body, even if it’s a traumatic experience that is planned for (unlike, say, an auto accident).

Your surgeon literally had to cut through body tissue to fix or replace your knee. As such, it is reasonable to expect at least a certain degree of pain and discomfort in the period shortly following the procedure.

However, our focus today is not on the “expected” postoperative pain. That kind of pain will usually go away in time. Rather, our focus is on chronic, refractory, neuropathic pain following knee surgery or knee replacement. 

If it’s been longer than six months after your surgery and you are still having pain and difficulty, there’s clearly a problem beyond typical postoperative pain! 

Your first step in determining what is wrong—and potentially finding an answer—is to have your treating physician or surgeon reexamine the affected knee. In doing so, you will learn if everything appears to be normal from a structural standpoint. You may even want to get a second opinion, just to be sure. They can tell you whether the joint looks normal, nothing is loose, nothing is misaligned, nothing is infected, and no bones, ligament, or tendons are abnormal.

If you have severe pain outside of a typical recovery period AND the appropriate medical professionals are assuring you everything looks as it should from an orthopedic and biomechanical perspective, there’s a distinct possibility that the problem is neuropathic (nerve-related).

How Can Nerve Pain Develop Following Knee Surgery?

Nerve pain following knee surgery—whether repairing damage due to a sports injury or having total or partial joint replacement—tends to have similar root causes as nerve pain that can follow any kind of surgery.

So, what might have happened to the affected nerves? After all, this pain wasn’t always there, right?

Every case is a bit different, but it’s certainly possible you had nerves that were injured during the procedure, or perhaps had become entrapped in scar tissue as your body was recovering. If any anatomical structures were moved during the surgery, they might be pressing on nerve tissue (i.e. compression).

Nerve injury, entrapment, and compression can cause symptoms to develop, including:

  • Burning, tingling, electric and/or “pins and needles” sensations
  • Intense pain from contact with objects (hypersensitivity)
  • Pain in the scar or surrounding area
  • Pain when moving or bending the knee
  • Pain feeling like it is still coming from inside the knee joint, in some cases

With regard to nerve injuries that result from knee replacement or other surgical procedures, some specific issues include:

Transection of the infrapatellar branch of the saphenous nerve (IPBSN)

When a surgeon performs total knee arthroplasty by using a standard midline skin incision, it is possible to cut the IPBSN or its terminal branches.

A transection will usually cause an area of numbness on the outside half of the knee, but can also result in a painful neuroma in rarer cases.

It’s important to note that the progression of postsurgical pain from this root cause can be relatively slow and not terribly intense in the early stages. You might not recognize the problem until symptoms intensify later.

It is also important to note that damage to a nerve in this manner is most often not due to neglect on the part of the surgeon. Even when every precaution is taken, there always remains a risk of unintentional nerve damage during a surgery. 

Common peroneal nerve damage

Nerve damage can also occur after knee replacement surgery because the peroneal nerve resides close to the fibula bone, and can become compressed or damaged. In fact, nerve damage is one reason why some people have persistent lateral knee pain and loss of function in the foot or to the top or side of the foot after a newly replaced knee.

If this is the source of your pain and difficulty, it may be possible to decompress the peroneal nerve surgically (remove the tight tissue around the nerve), thereby allowing it more room to recover. 

General neuromas

When nerves are inadvertently cut during any procedure or injury, it can potentially lead to the growth of a neuroma.

This happens because the proximal part of the nerve (the nerve ending that is still attached to the spinal cord) is still alive, and it wants to try to regrow. When trying to regrow, it sends out many small branches searching for the downstream nerve. 

If the nerve is severed, and the downstream end is more than a few millimeters away, this can often lead to ball of nerve tissues forming. That ball can attach to various non-nerve tissues, such as muscles, bones, and scar tissue. Then whenever anything pulls on or compresses against these raw nerve endings—something that happens as the body moves—it can cause painful symptoms that can be rather intense.

Understanding and Treating Your Knee Pain

More important than just knowing what has caused chronic knee pain is to take measures to correct the problem—and that’s where we come in.

We have been able to help people just like you find relief from post-surgical pain throughout the body, including knee joints that have been repaired or replaced. If this is what you are suffering from, we may be able to do the same for you.

Our goal is to identify if you may have some of these painful neuromas around the knee joint and then determine whether they may be the cause of your chronic pain.  

We will be able to determine this for you with a straightforward examination supplemented by a few targeted injections to try to put these nerves temporarily “asleep.” The patient will be able to tell us within a matter of a few minutes if the pain that they are suffering from is gone while the medicine is working.  

If we are successful in determining which branches are your problem, then we can work with you to determine the ideal next steps in trying to get your pain under control permanently.  

So, if you’ve already gotten second opinions from appropriate medical professionals who tell you everything appears just fine from an orthopedic perspective—AND it’s been more than six months (which means the pain is chronic in nature)—contact our Baltimore office for a consultation. We would love to try to help you find the relief you need.

And please do not hesitate to call us if you have already tried other forms of treatment in an attempt to treat nerve-related pain, such as radiofrequency ablation. These methods can be effective, but their failure does not mean that your problem isn’t still nerve-related, or that we can’t potentially help you.

Call our Baltimore-area office today at (410) 709-3868 and one of our team members will be happy to help you schedule an appointment that works best for you. If you prefer to contact us electronically, you can also reach out to us via our online contact form.

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