Knee replacement (also called knee arthroplasty) helps patients find relief from chronic pain.
After full recovery, most adults have improved their range of motion and can return to normal activities.
But what if the pain persists? Know what type of pain is normal after total knee replacement surgery and when you should contact your physician for further care.
You can expect some pain and swelling for a few months after surgery. Improved surgical techniques and new technology, such as robotic arm-assisted technology, make knee replacement recovery quicker and less painful.
Nevertheless, pain and swelling following your procedure are expected, especially at night and with activity. Your body just went through a major surgery and needs time to heal.
Most people can resume daily activities with reduced pain approximately three to six weeks after surgery. Full recovery can take anywhere from four months to a year.
Most patients also see a gradual reduction in swelling after knee replacement as their body heals.
Some swelling is normal, especially in the first weeks. Swelling after total knee surgery can increase after activity, warm weather, or long periods of standing, and often improves with rest, elevation and cold therapy.
Reach out if the swelling suddenly increases, becomes very hot to the touch, or comes with fever, severe pain or redness.
Immediately after surgery, your physician will prescribe pain medication for short-term relief.
Possible medications include acetaminophen, nonsteroidal anti-inflammatory medications, or more potent prescription pain relievers when necessary. Take all medications as instructed.
But as the doctors and physical therapists emphasize, some pain is normal and expected during the healing process.
Physical therapy after knee replacement focuses on restoring movement and strengthening the joint while managing discomfort. Targeted exercises guided by a professional are designed to be safe for your healing knee and can also reduce pain over time.
Attending your physical therapy sessions can help with the pain. The main goals of physical therapy following joint replacement are to restore movement and strengthen your knee joint, but gentle exercise can also help lessen postoperative pain.
Your physical therapist will give you a set of exercises that are safe for your healing knee joint.During early recovery, you may be prescribed to walk for 30 minutes and exercise for 20 to 30 minutes, two to three times daily.
According to CHRISTUS Health therapists, movement should begin quickly after surgery. Getting the joint moving soon can reduce stiffness, improve circulation and begin restoring your range of motion. While this can temporarily increase swelling and cause pain, it supports long-term healing and movement. That is why care teams require you to walk quickly after surgery.
In physical therapy, you will use ice, compression, electrical stimulation, and manual therapy techniques, which are hands-on methods to mobilize the joint and ease tension. These strategies help improve comfort and movement in the first weeks after surgery.
As strength returns, functional tests, or structured movements that mimic daily activities, may be introduced to determine readiness for more advanced exercises.
During early recovery, patients may be advised to walk and perform targeted exercises regularly, with frequency and duration based on individual needs.
Building confidence is an important part of therapy. Your therapist may need to help you get over the mental block of thinking your knee is not better. Even when the knee is physically ready, fear of re-injury can limit performance.
Notify your physician immediately for possible signs of complications from surgery.
While you may not be living completely free of discomfort, you shouldn’t struggle with excessive pain, either. Learn to recognize these signs of surgery complications:
If you suspect you have a blood clot, infection, or implant failure, call your physician or orthopedic surgeon to explain the symptoms.
Your provider will give you instructions on further care. In the case of implant loosening, you may need to discuss revision surgery to repair the knee after recent wear and tear.
If you are considering knee replacement, don’t let pain scare you away.
Most people experience less pain with their new joint over time. Your health care team will also educate you about how to avoid possible complications. Ask your physician if a joint replacement is a good fit for you.
As patients recover from knee replacement surgery, they often wonder whether their pain is normal or a sign that something’s wrong. Dr. Hayden Joseph, an orthopedic surgeon with CHRISTUS Health in Longview, shares what pain patterns are expected, what’s not, and when to follow up with your doctor.
“Pain six weeks after surgery can still be normal, but if it doesn’t improve with rest and ice—or worsens—it’s time to talk to your surgeon.”
Here’s what Dr. Joseph shares about key insights about post-op pain.
Pain six weeks after surgery can still be normal. Pain with increased activity along with some swelling should be expected. However, pain that does not improve with rest, ice, and elevation of the knee can be concerning.
Soreness of the knee and swelling after a really busy day that improves with ice and elevation and allows you to go about your normal day after a night's rest is normal. If pain does not improve with ice and elevation and continues to worsen to the point where you can no longer continue with daily activities, it needs to be evaluated.
You will have good days and bad days, but pain that persistently worsens after surgery is not typical.
The biggest cause for concern with worsening pain after knee replacement is infection. Typically, early after a knee replacement—within the first six weeks to three months—this presents with significant redness, swelling, and worsening pain that does not improve with ice, elevation, and rest. It can also be associated with fevers, chills, and other systemic signs of infection.
Stiffness or lack of flexion can also be a source of pain early postoperatively. Knee flexion is best obtained within the first 6 to 8 weeks of surgery. If it is not addressed early or within the first three months, it can be more difficult to regain your knee motion.
There are several other causes of painful knee replacements; however, these typically reveal themselves further down the road.
Complete recovery after a knee replacement can take 6 to 12 months; therefore, I would not recommend revision surgery until at least 12 months after surgery.
If at one year after surgery you continue to have pain that is preventing you from doing daily activities or the activities you would like to participate in, I would recommend evaluation with a joint replacement specialist for a possible source of the pain and potential treatment options.
Nerve pain after knee replacement surgery can surprise patients — it may feel different from surgical pain and linger in unexpected ways. Dr. Christopher Meltsakos, an orthopedic surgeon with CHRISTUS Health in Longview, explains why nerve discomfort can happen after a joint replacement, how to manage it, and what to watch for as you recover.
“Some nerve pain is expected after a knee replacement, but if it persists beyond 6 to 12 months or doesn’t respond to treatment, that’s when we look closer.
Here’s what Dr. Meltsakos shares about key insights about nerve pain after knee replacement surgery.
Overall, nerve pain is caused by irritation and disturbance of the nerves — typically the sensory nerves in the skin — as a result of having to make a cut in the skin and tissues around the knee for the surgical incision.
Though there have been advances through the years in the procedure, we are still having to cut the skin and some soft tissue to get to the knee joint, which may irritate some of the nerves. Though surgeons will take care not to damage and to protect the large nerves of the leg, there are small skin nerves that do sensation, which may result in the somewhat ‘typical’ nerve pain that is expected after this type of procedure.
Occasionally, patients will be hypersensitive to touch in certain areas, which may last for two to six months. The symptoms they have may be burning-type pain, heightened sensitivity, electrical sensation, and difficulty — especially at nighttime — sleeping and being comfortable when the sheets touch their skin. This will usually resolve on its own.
Treatment options for this usually involve a combination of physical therapy with soft tissue work to improve flexibility, range of motion, cold therapy, massage, and electrical stimulation.
Medications such as gabapentin may help reduce nerve excitability and how those pain messages from the nerves are transmitted to the brain. Occasionally, medications such as duloxetine may be used for a central pain axis treatment, depending on the patient’s other medications and medical history.
In general, it is always good to discuss with your surgeon the symptoms that you are having. Although some degree of nerve pain is expected after surgical intervention such as a knee replacement, there are other symptoms we also evaluate — such as fever, chills, or wound issues — which may be more concerning or indicate a different issue.
Indirect and direct nerve pain may be commonly or fairly expected and normal after surgery. But if the pain does persist beyond the typical recovery period — or beyond approximately six months to twelve months — or if it is unresponsive entirely to interventions, it may be something that we would further evaluate.”
CHRISTUS Health has highly skilled orthopedic surgeons that will help you determine if a knee replacement is the right for you.
