When does the pain end or lighten up after total knee replacement?

@cyndi2013
Everyone heals differently. Our surgeons have varying skill levels and used different methods. Recovery is not one size fits all. Even the most basic total knee replacement involves cutting open the leg and cutting off the end of both the femur and tibia and then removing the ACL and perhaps the PCL as well. A traditional method will also involve cutting the tendon and muscle to gain access and then sewing them back at the conclusion of the procedure. Traditional TKRs will also involve using a tourniquet to control blood. The traditional technique creates greater trauma and the tourniquet creates recovery pain for around a month in many cases.

I had a very successful recovery with no post surgery pain. Here is what my extraordinary surgeon did:
1) used a minimally invasive mid vastus method which involves going under the tendon and through the muscle fibers;
2) Did not use a tourniquet but instead used tranexamic acid to control blood;
3) Used a robot (CORI) for added precision;
4) Put in a bicruciate retaining implant (BCR). In a BCR the ACL and PCL are retained and protected but BCRs are done in less than 1% of all total knee replacements. It is a very rare procedure and the surgery is more complex;
5) Corrected my severe misalignment with a Functional alignment. A Functional alignment attempts to match the natural alignment of the patient, not an arbitrary straight-line;
6) Did a plastic surgery close.

Importantly, my surgeon is vastly experienced at doing all of the above and I believe that this experience is critical. There is actually a video on the internet of my surgeon doing exactly my procedure in 2020 at an orthopedic innovations conference. I wanted a BCR but would not have agreed to having it done unless my surgeon had this experience.

Finally, my surgeon has been using a recovery protocol for some time that is similar to the Hospital for Special Surgery's new Quiet Knee protocol. He had me essentially resting the first two weeks while using an ice machine regularly for cooling and compression to bring down the inflammation in the knee before starting PT. I didn't appear to lose anything by waiting as my therapist measured my ROM at 122 in that third week and my extension as flat.

@steveinarizona That's awesome you had a great recovery.
However, every person's body will heal at a different rate.
Thanks for sharing.

@cyndi2013
That was my very first sentence!

I still have interior knee pain on my right knee after total knee replacement 8.5 weeks ago. The back of my knee keeps getting tight and sore. I am in physical therapy and following what I am told to do but I feel defeated that it still hurts and I still have tightness.

What does your surgeon say? There are many muscles, ligaments and tendon back there.

Do you know if your surgeon used a tourniquet? That can cause pain behind the knee but it should be relenting around now if that is the cause.

Hi,
I’m 11 1/2 weeks out from my TKR, and still have pain off and on. Mostly on inner part of knee.
Not so unusual really, we are still fairly early in recovery.
Also, if your PT is pushing for better flexion and extension numbers, that can just irritate everything. So be careful with that. Many people with experience will tell you that there’s no need for aggressive pushing in that regard.
I am betting and hoping that by the end of the summer, you will feel more confident because you will be gradually feeling better and better.

@danettef I'm sorry you still hurt, and I have said this so often I should record it. If your doctor told you "recovery takes 6-8 weeks" they meant "the wound will heal and you can begin work on getting back to normal." Two very different things.

Your body has had a major assault! At this point the surgical damage has barely healed, the nerves, muscles and tendons are still trying to recover, the implants and bones are still in the phase of getting to know each other. On top of that the PT is pushing you to do more to regain strength and flexibility.

So, you will hurt, but it will gradually ease. Keep ahead of the pain - ice after PT, in the evening, whenever the hurt comes. Use Tylenol or ibuprofen. Elevate that leg often when you sit. If it swells, have the PT show you how to do lymphedema.

Gradually, you will notice less discomfort, and soon you will go for a time without noticing your new knee.

Be patient with yourself.

A TKR is a very traumatic event. One's skin is cut open and the tibia and femur are cut to remove arthritic elements and to allow the implant to replace the cut bones. If the surgeon used a tourniquet, that can cause pain for a number of weeks. If your surgery was traditional, the surgeon also cut the tendon and muscle and had to sew them back up at the end of the procedure. More trauma.

That is why some surgeons have changed recovery procedures to rest the first few weeks while icing to help the inflammation to subside. Then start PT. My surgeon had me resting the first two weeks before starting PT at the PT facility. Similar to the new Quiet Knee Protocol from the Hospital for Special Surgery.

I am in exactly the same place as you 8 1/2 weeks out from total knee replacement and the majority of my pain is on the inner right knee. when I wake up in the morning it’s like there is a tight band just above the knee that is preventing me from bending my knee all the way back. I am exercising at home as well as continuing with my PT. The more I move the better it feels. I’ve tried to get back to walking again on a daily basis and can go about a mile to a mile and a half now. the kind of shoes you’re wearing I find make a difference. I’ve barely worn my summer sandals just because I’ve noted when I do my knee hurts more so I’m generally in sneakers.
I’ve also been told by the end of the fourth month after surgery I should feel much better but things will continue to heal possibly for the next 18 to 24 months and that includes a decrease in swelling. It sounds like you , I and others are kind of at the same point with swelling and inner knee pain. I’m thinking it’s probably pretty typical and where we’re supposed to be at this juncture in recovery. I’ve heard some people have no pain after 2 to 3 weeks from knee replacement. I think that’s rare and I know I’m not one of those people but in the long run I think everyone ends up the same place and they’re happy that they’ve had their new replacement after the healing has been completed. Wishing you the best as you continue to recover from your total knee surgery.

@danettef Hey There! Bless you. I'm 3.5 months out from TKR. I still battle some of the things you mention.

I cannot do 3 days of something vigorous (for me!) and then go to PT or I will pay for it and it will take me another week to get back to where I was. I took this week off from PT as I had a lot on my plate. I do my exercises at home daily. I am still not sleeping through the night and still battling fatigue from the TKR.

I reached all of my goals last week with 123 on bend and 0 of straightening, stretches, exercises & riding the bike backwards and forwards. I was elated, BUT, it set me back. I am stiffer this week, more inflammation and more aching. I am also finding, the heat & humidity play a role in my knee and weather changes too. I am icing my knee and still elevating my knee. It's important to keep moving, but, not to over do. There is a balance of doing that when you have a good day!

Don't compare yourself to others. Some folks can drive at 2 weeks....I was just able to drive last week.

I have been told this is not a sprint....it's a marathon. I've been told by several who have had this that the 1 year mark is the golden moment. My advice, if you have Fibromyalgia and bilateral arthritis like I do or other pre-existing issues that cause pain, beware of a flare up when you do your PT if you go at it gung ho.

Talk to them about your symptoms and pain level when you walk in and tell them to go easy if it's a hard day. My PT respects my requests and I am most grateful.

Standing is probably the most painful thing that I do. This is not aching, it's painful to stand for a long time and prepare meals. I do it in sessions.

I am a slow healer....always have been. Am I better than I was before surgery? Yes. Post-Op surgery is a different pain and stiffness, but it gets better. You are still early into this.

Knee replacement is major surgery. Your body is healing and it takes time....I have had to learn to be patient with myself.

Praying for you right now. Be patient with yourself (I'm preaching to the choir!). We will both get there! Blessings & Prayers for you.