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What causes pain after knee replacement surgery?

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Posted on Thu, 25 Sep 2014
Question: Three years after successful total knee replacement, I continue to experience a burning pain in my knee, which goes down my leg and into my foot. It feels nerve related. I have slight swelling on outside of knee, in thigh area and around the ankle bone. I have been prescribed gabapentin with minimal relief. The pain gets worse as the day progresses. Sleeping is difficult and the pressure of the other knee on the affected knee makes the pain worse as the night progresses. I am constantly having to change positions. My orthopedic surgeon has done MRI, bone scan and checked for infection. No indications of anything wrong from him. What can be causing this and what can be done to relieve the pain? No one seems interested in treating this. I walk "perfectly" now but in constant pain.
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Answered by Dr. Matt Wachsman (1 hour later)
Brief Answer:
Very good question!

Detailed Answer:
Pain gives it's etiology from location and quality.
see pretty picture... note L4-L5... the commonest location for LUMBAR DISK DISEASE.
http://www.drstevenjdolgoff.com/heel_and_arch_pain.html
Pulling the leg forward straight like yanking on a fishing rod will pull on a nerve going from the back down the leg. If this triggers the pain, then that is the cause and the operation is a coincidence.

But I doubt this is the case.

Location .. traveling in the path of a nerve... burning quality... would mean IT'S a Nerve. Occurring after a trauma AND a small distance means the pain is due to a local, small nerve that is irritated. AMITRiPTYLINE is likely the strongest nerve pain pill (and non-narcotic, generally safe and very inexpensive). It has action like lidocaine and you could instead use a lidocaine patch on the area of prev. surgery. Any other nerve pill (lyrica at > 100 mg; gabapentin, epilepsy meds) might also work.
Narcotics work on nerve pain (neuropathic) BUT they have to be given at such high doses, that this is why neuropathic pain pills were developed. ALso, local steroid+lidocaine injection into knee (cheap, safe) MIGHT work (but doubt it).
Then, there's ways of bearing it. Physical therapy, exercise, ballroom dance--all are essentially ACTIVE meditation techniques in a therapeutic context can help people increase tolerance of pain.
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Matt Wachsman

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Practicing since :1985

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What causes pain after knee replacement surgery?

Brief Answer: Very good question! Detailed Answer: Pain gives it's etiology from location and quality. see pretty picture... note L4-L5... the commonest location for LUMBAR DISK DISEASE. http://www.drstevenjdolgoff.com/heel_and_arch_pain.html Pulling the leg forward straight like yanking on a fishing rod will pull on a nerve going from the back down the leg. If this triggers the pain, then that is the cause and the operation is a coincidence. But I doubt this is the case. Location .. traveling in the path of a nerve... burning quality... would mean IT'S a Nerve. Occurring after a trauma AND a small distance means the pain is due to a local, small nerve that is irritated. AMITRiPTYLINE is likely the strongest nerve pain pill (and non-narcotic, generally safe and very inexpensive). It has action like lidocaine and you could instead use a lidocaine patch on the area of prev. surgery. Any other nerve pill (lyrica at > 100 mg; gabapentin, epilepsy meds) might also work. Narcotics work on nerve pain (neuropathic) BUT they have to be given at such high doses, that this is why neuropathic pain pills were developed. ALso, local steroid+lidocaine injection into knee (cheap, safe) MIGHT work (but doubt it). Then, there's ways of bearing it. Physical therapy, exercise, ballroom dance--all are essentially ACTIVE meditation techniques in a therapeutic context can help people increase tolerance of pain.