Top 10 Reasons For Chronic Knee Pain From A Failed Knee Replacement

I’m going to give you the top ten reasons for chronic pain from a failed knee replacement. It’s estimated that 10 to 25% of knee replacements end up in failure. Now, that’s a hard number to measure because the definition of failure changes from research study to research study and there’s some obvious signs, like if the knee just doesn’t bend, doesn’t straighten out.

If you have an infection, if there’s just tremendous pain, and then there’s some less obvious signs that some doctors may not consider a failure, but some patients might because they can bend and move just fine, but they’re not 100% on their knee. And there’s issues with that moving forward, even though they can do a lot of things like walk and even exercise.

Let’s get into the top ten reasons. Number one is infection. This is the big thing that every surgeons concerned about. Whenever you go in for a knee replacement surgery, they educate you about this. They’ll talk to you about it. You may have had a friend who had a knee replacement who had an infection. And what happens is they take great care in the surgery to make sure that everything is as clean as possible, as sterile as possible.

Of course, the surgeons are all geared up. They’re masked up. Everybody in the operating room has gloves on and they sanitize everything. But it happens to where some tiny bacteria, ends up in the operating room and ends up on the prosthetics that are installed into the knee during the joint replacement. And once they close everything up, if that bacteria makes it, it has a chance to grow and duplicate itself and create an infection inside the knee joint.

If that happens, it’s potentially a very dangerous situation where you’ll get treated with antibiotics first. Hopefully that will take care of it. But if it doesn’t, then you’re going to have to go through what’s called a two stage knee replacement revision, where they’ll take out the original hardware that they put in because it was infected and they’ll put in a spacer.

Make sure that you’re treated with lots of antibiotics in order to kill the infection. And then they’ll come in and do the revision, which is doing a knee replacement again. But usually it’s going to be a more intense knee surgery than the original one, because they have to put in bigger pieces that go in deeper into the bones.

Now, the infection itself is painful. It can cause swelling. It can cause irritation, redness in the area. It can cause you to get a fever throughout your whole body. That’s going to be at the beginning of recovery stages. After having had a knee replacement. It doesn’t tend to be a problem months after the knee replacement has already happened.

Number two is a bad hardware fit. So when they do a knee replacement in your knee, they’re replacing the top end of the shin bone right here, the bottom end of the thigh bone right here. And oftentimes the back end of the kneecap gets replaced. Sometimes even the whole kneecap gets replaced. The sizing of the hardware that’s installed has to be custom to your body, the shape of your bones.

And if it’s off by just a bit, which sometimes happens, then it can overhang off the edge of this bone right here, this side, or in any one of the places that are replaced. And they will close you up and do everything. It’s not always easy to tell for the surgeon, even though they’re doing the best job they can.

And what happens is that bit of the hardware that’s sticking out one way too far can begin to rub on the tissues from the inside of the joints that can cause pain. After having had a knee replacement. Very often people recover. They get sewn up. Of course, they go to physical therapy, they get to walking. But there’s some irritation that’s not always known.

And if you go to the doctor, they’ll do an X-ray and be able to see very often that the prosthesis is overhanging on one side or or sometimes is too small or just a bad fit of the hardware size for your bones. Number three is a metal sensitivity. Now, this is hard to know, though, usually do some sort of allergy test for the metals that are used in the prosthetics before you do surgery.

But those tests aren’t always reliable. And in rare cases, after they’ve done the surgery, the replacement, you can get a sensitivity or an allergic reaction to the metal hardware that was put into your knee. If this is the case, you’re probably going to have to have a revision done because you can’t live with a metal that you’re allergic to inside your knee joints.

Number four is a misalignment of the hardware. Now, this is different from the bad fit. A misalignment means if you’re taking into consideration the foot and the hip, all the joints together, the position that the implants are in have to be made in such a way that the joint bends in a way that’s natural for the hip in the foot, if it’s aligned so that the knee wants to bend a little outwards too much or a little inwards too much, then it can create an off feeling in your knee that you can rehab just fine.

You can get to the recovery. You can start to bend your knee just fine. But when it comes to doing more advanced activities like walking for longer periods of time or exercising, being on a bike, it feels off every time you go to bend your knee because the hardware was installed in a bad angle for the hip in the foot.

Most of the time people get used to this and they’ll just have to adapt to the position that the knee moves into. But in rare circumstances, it can be bad enough that it impedes certain motions and the patient may want to go get a revision done to have that angle corrected. Number five is loose hardware inside the knee joint.

So that happens when the plates that are installed on the top part of the tibia here, the shin bone and on the end of the thigh bone become loosened. This typically doesn’t happen right after surgery because it’ll cement everything and it makes sure it’s all very secure. But if you have certain muscle imbalances, which I’ll talk about before we’re done with with this list, you can add bad pressures to the knee joint and start to gradually loosen the hardware.

And often it’s visible in an X-ray. You may have popping or clicking sounds coming from the knee joints, which are normal for anybody who’s had a knee replacement. But if it’s associated with pain, if when you feel a click, a pop or a knocking sensation inside your knee joint and it also hurts, that is more in line with having loose hardware inside the knee joint.

Surgeons will often recommend that you go do proper strengthening exercises in order to get more stability out of your knee joints, your replace knee joint. But if you’ve already been exercising, then there’s a good chance that you might have been exercising into a muscle imbalance and it could actually get worse over time. So you’ve got to make sure to fix that muscle imbalance.

If this continues and it worsens over time, then you’ll likely have to sign up for a revision of your knee replacement. The reason number five and all the rest of the reasons moving forward are more things that are in your control, not necessarily because of the surgeons. Surgeons are doing the best they can, of course, and this is a very complicated technical, high skill surgery that many surgeons are getting great at all over the country, all over the world.

But not all of it is due to the surgeon’s fault. And I want to make that point because I often see patients coming in who are telling me they have a failed knee replacement because they’re still having pain, you know, a year out, two years out, and they’re wanting to blame the surgeon. And it’s not always the surgeon’s fault.

It’s very often problems that were underlying that need to be addressed. Now, even though you already have a knee replacement, they can still be fixed. You can influence them. So that’s what these problems coming forward, these reasons are going to be more about. So number six is scar tissue. After your healing from surgery, you have to get a scar to close down everything.

And if you’re the type of person that happens to get very fibrotic scars, sometimes you call it keloid scars. Where were your scars or even raised on your skin? You just have a genetic tendency to scar too much, and that extra scar tissue takes up space inside the knee joints. And it also can push on other things in the knee, like the nerves or the tendons, the ligaments.

And that extra space can cause pain. It can also kink itself up to where it doesn’t allow full range of motion. If your skin is very scarred up, if the tendons below that and the joint capsule below that are thickened with scar like too much scar tissue, then it won’t let your knee bend all the way. And it needs to be addressed with proper exercise and proper stretching so that you can make that tissue as mobile as it can be.

It doesn’t always loosen up as people like, but if you had a knee replacement, chances are the situation is better than what you’re dealing with before knee arthritis. Hopefully, scars are not stopping you from getting your full range of motion and getting the best out of your knee. Number seven is a nerve injury. Now, a lot of people don’t know this.

Doctors rarely talk to their patients about it. But here on the knee joint, there’s a big nerve that comes in the front of the thigh. It’s called the femoral nerve. And it ends about here on the on the distal third of the thigh leg towards the end of the thigh. There’s a branch that keeps going down, though. It goes down all the way into the arch of the foot.

It’s called the softest nerve and off that big softness nerve. There’s a branch called the infra patellar branch of the softness nerve that goes right under the kneecap and over the knee joint. When they go do that surgery, they cut you open right here, sometimes right in the middle. And they have to cut that nerve. They have to sever the nerve in order to get into the joint where they’re going to replace the ends of the bones.

That’s just a necessary step to perform this surgery as a result of cutting the nerve, that nerve becomes injured. In most cases, people have numbness associated with this for a year or more, sometimes indefinitely, because that nerve was severed. That nerve is responsible for sensation to the skin sensation of the tendons. And even the joint capsule under it’s now responsible for muscle movement.

So that’s why it’s not the surgeons don’t get too concerned with cutting that nerve because they’re not losing function of any of the muscles. It’s just skin sensation. But the problem is not everybody just has numbness. There’s a few people out there that will get pain associated with this if that nerve heals a certain way or there’s too much scar tissue could be related to scar tissue as well.

That nerve can become very sensitive, very irritable, and cause pain on the front of the knee. Sometimes the inner part of the knee on the front of the knee, sometimes the outer part of the knee or the front of the knee. But it’s always somewhere in the front of the knee, right below the kneecap, or even it may feel like it’s on the kneecap.

People with this nerve injury will often go crazy because their it hurts, it throbs, it aches, it doesn’t let him sleep at night. And then the worst part is they’ll follow up with their surgeon or with a doctor and they’ll do X-rays on the knee. And the doctor says everything looks fine. The surgery did looks perfect. There’s nothing wrong with your surgery.

And then they’ll look at your motion and your ability to do things and they’ll say, Well, knee bends just fine, just as good as the other side, and it straightens out just fine. There’s nothing wrong with the surgery. Your strengths coming back. You finished physical therapy, you walked in here involving a cane or a walker. There’s nothing I can do for you.

We can talk about an injection, but there’s no point in doing a revision. Everything’s just fine. I don’t know what else to tell you, and I’ll just leave it at that. And they may not even think to tell you that it’s a nerve problem. Or they might mention that it is a nerve problem, but they don’t really know what to do about it.

And there’s a lot of things that can be done. Follow a channel, check out our playlist down below in the description for failed knee replacement Help. And we’ve got a program to that I want to mention. It’s called the Failed Knee Replacement Recovery Program. There’s a link in the description below for that as well, where we do talk in depth about how to help a nerve injury if that’s causing chronic pain after having a knee replacement.

But that is a reason for you to have chronic pain after having the replacement as that nerve just doesn’t get properly rehabilitated by physical therapists very often. And surgeons really don’t do much about it besides just say, well, eventually it’ll heal. Number eight is overdoing it. Now you may be one of the lucky ones, which most people are, where they have a really good outcome After the surgery.

They’re feeling fantastic. They’re surprised that not having as much pain as they expected to. They’re taking their pain medication, of course, but their knees bending great and straightening out fantastic. And they’re kind of speeding through recovery after the knee replacement. Those people are susceptible to overdoing it because they get back to feeling relatively normal a lot quicker and especially if their knee arthritis was really bad going into surgery.

They already feel like they had a massive improvement. So they’re excited to go walking again to get on the treadmill, to even try stairs to do more and more activities at home. Those people are susceptible to overdoing exercise and putting too much pressure through that knee joints and possibly beginning to loosen the hardware or aggravate tissues around. They’re developing things like tendinitis and bursitis because you still have those tissues around your knee joint.

So overdoing it is something that you can control. You have to be careful to make sure to gradually add more activity and listen to your knee. Follow the recovery plan, the rehabilitation plan that your surgeon gave you and that your physical therapist gave you. And if you’re already done working with them, then you still need to use moderation in how fast you go through recovery, how fast you go through adding more exercises.

If you’re exercising to adding more distance or walking to walking faster to do more around the home. And if you’re still having pain, even though it’s been months, maybe even a year or more since you’ve finished with the surgeon and finish with physical therapy, you’re pretty active doing things, but there’s issues. There’s a lot to look at. We go into great extent in helping you with that failed knee replacement recovery program.

Don’t forget to check out the link in the description below. The number nine is weakness. You would think you gained enough strength to do most things after having gone through physical therapy, rehabilitation after your surgery, and you’re probably feeling tremendously better anyway. But a lot of people try to get back to normal things and some of those normal things require a little more strength, a little more endurance, or being able to suddenly catch yourself.

Like, for instance, if you’re doing yard work outside or even in the home, if you’re doing things that require more force, like moving furniture, if you to do some deep cleaning or if you suddenly move to catch something that’s about to fall or or help somebody who’s losing their balance, that quick movement reprise their muscles to react quickly.

And that can stress the knee joint. You need enough strength to be able to tolerate those movements, to be able to push those things, lift those things, dig in the dirt, pick up heavy things. And so you may have relative weakness, meaning you have enough strength to do your everyday, daily activities. You’re not bothered with that, but you don’t have quite enough strength to do the more advanced things that you want to get to in life.

So gaining more strength gradually over time may be something that you need to think about because you may have weakness, you may not feel in the moment, you may feel strong, but when you go to lift up that heavy sack of soil, that 50 pound sack of soil, your knee doesn’t like it. And when I’m talking about strength, I’m not just talking about muscle strength, but the strength of the tissues, because the tendons have to adapt, the ligaments have to adapt.

And most importantly for you, after your knee replacement is the bone has to adapt because now you’ve got metal parts on the ends and the interface where the bone attaches to the metal part that bone has to adapt and that moves the slow as compared to tendons, ligaments and muscles. So if those bones aren’t adapted, are those tendons and ligaments and muscles aren’t adapted properly, you could get aggravation that could cause chronic knee pain and it’s due to weakness in the tissues.

You just need more time and gradual increase in your activity in order to adapt it properly without problems. Number ten, this is the biggest problem that I see, especially a year or more after having had a knee replacement. It’s muscle imbalances. Now, I alluded to this already in a previous reason, but let me get in depth on the muscle imbalance.

Here’s the knee, the thigh bone and the shinbone on the front side of the knee. There’s a kneecap. You have the quad muscles, those quad muscles attached to the kneecap. And then there’s the ligament that attaches from this bone down to the bump on the shin bone right here. Those quad muscles are usually too strong. They’re too dominant.

And I see those two words strong and dominant, because there’s there’s a difference between the two. You can think that you’re not that strong, but the muscles relatively dominant because the other side of the body, the glutes, it’s not the hamstrings. Hamstrings actually work a lot with the quads, the glutes, more so oppose the quads. And if your glutes are very weak, weaker than your weak quads, then you have a dominance problem with the quads.

Or it could be that you’re strong and you’re just a lot stronger in the quads relative to the glutes. So there’s a way to delineate it. I’m splitting hairs there. The take home message is your quads are doing too much work and because your glutes aren’t strong enough, the forces down at your knee joints are not normal, not the way that the joint is designed to take it.

So it may not hurt to move around for a day or two, but if you over days, weeks, months and years of moving with bad forces because your quads are over dominant, it’s going to start to affect the pressures in the joint. It’s going to wear down your knee replacement. It’s going to pull the tendons, pull the bursa, aggravate the nerve, all those things that happen that create chronic knee pain.

That’s what this problem bleeds into. And you probably had this muscle imbalance even before you had in your replacement. This is what sets up knee arthritis. Very often people have the same imbalance and it’s putting pressure on their normal knee and over time they start to develop osteoarthritis on the ends. The thing is, the knee replacement does not fix the muscle imbalance, and physical therapy afterwards is not focused on fixing the muscle imbalance.

It takes a different specialist like what I do. I’m a manual physical therapist. I treat people who are looking to avoid surgery or avoid a second surgery like a revision, and we treat them by addressing the muscle imbalances, to normalize pressures in joints, to keep them as healthy as possible for as long as possible. So when people come to my clinic to get treated for pain, chronic pain that they’ve had after having a failed knee replacement, we’re looking at the muscle imbalances.

And very often by addressing the right strength in the right areas, not over strengthening quads and usually focusing on the glutes, sometimes we have to look at foot muscles, then the pain in the knee starts to diminish. And even though they’ve had a knee replacement that has been hurting them for a long time, that pain can improve tremendously.

Oftentimes even go away completely and get people to the feeling where they’re like, I feel fantastic. I thought I was going to have to have a revision. I was going to just suffer and live this way. And this is as good as it was going to get. But you can make your failed knee replacement feel better without having to sign up for revision surgery or just accepting it as as painful as it can be for you right now.

Now, this muscle imbalance is not detectable in an X-ray or an MRI. And surgeons are not aware of this or not thinking about this because it isn’t their specialty and you wouldn’t want it to. You want them to focus on what they have to do surgically, because that’s quite complicated and takes a lot of skill. Fixing The muscle imbalance is its own specialty.

If that muscle imbalance is still present after you’ve had your knee surgery, then you’re susceptible to loosen the hardware, to create all kinds of problems for that knee replacement. And you need it to last you the rest of your life. She never had to have another knee surgery. If you want to learn more about the muscle balance, like what exercises to do ways to help the knee pain.

I’ve got tons of videos here on this YouTube channel about that. They’re in a playlist called Failed Knee Replacement Help. I’ve linked in the description below. And then like I mentioned earlier, I’ve got a program called the Failed Knee Replacement Recovery Program that walks you step by step through what to do to help your knee pain after you’ve had a knee replacement.

Go check out the link in the description below, please like or give us a thumbs up on this video. Subscribe to our channel. If you thought this is helpful and you don’t want to miss out on any of our videos please subscribe and turn on the notification bell so that you don’t miss out on any of the videos that we upload every single week.

Thanks so much for watching. I’ll see you in the next video. Bye bye.